logobossally

El nervio accesorio espinal es uno de los 12 pares craneales que salen directamente desde el tronco encefálico hacia todo el cuerpo, y es de gran importancia debido a todas las funciones que desarrolla en el cuerpo y sobretodo en la columna vertebral

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¿Qué es el Nervio Accesorio?

El nervio accesorio corresponde al par craneal 11, también conocido como nervio craneal número 11 o XI, y es caracterizado por ser un nervio motor que está formado principalmente de la unión de la raíz de la médula espinal y otra raíz del neurocráneo.

Este nervio es llamado de distintas maneras, tales como nervio espinal o accesorio del nervio vago, nervio accesorio de Willis o nervio espinal accesorio, sin embargo, su nombre genérico es Par craneal XI (par craneal 11). (Visitar artículo: Nervio Patético )

Orígenes

El origen de este nervio o sus núcleos, se pueden encontrar situados en el núcleo ambiguo del bulbo y también en los 5 o 6 primeros segmentos de la médula espinal, por lo tanto, se intuye que tiene dos núcleos u orígenes, uno bulbar y otro medular.

La ubicación exacta del origen, dada la estructura de ambas raíces se ha visto complicada y por ello se manejan dos versiones: el origen real y origen aparente del nervio accesorio, a continuación se describen con detalle estas dos consideraciones:

Origen Real del nervio accesorio

El origen real del nervio accesorio se puede dividir en dos núcleos u orígenes, ya que tiene dos raíces por donde surge hacia el resto del cuerpo, estos son:

• Raíz o núcleo Bulbar: La raíz espinal del nervio accesorio en la zona bulbar surge desde un núcleo que se distribuye hasta debajo del núcleo motor dorsal del nervio neumogástrico o nervio vago, par craneal número X, con el que forma el núcleo vago-espinal. Esta es una parte aberrante del nervio número X ya que sus fibras y las del nervio que vienen de su núcleo dorsal provienen del mismo lugar, el núcleo vago-espinal. La raíz bulbar del nervio accesorio tiene un nombre particular en la nómina de la anatomía humana, y se le puede reconocer como vagalis.
• Raíz o núcleo Medular: La raíz espinal del nervio accesorio en la zona medular tiene partes motrices, como vegetativas y sensitivas, en donde la característica motriz nace desde una porción posterior y externa de la asta anterior de la espina, mientras que la sensitiva tiene su procedencia desde los ganglios de la médula (Visitar artículo: Nervio Motor Ocular Común)

Por último, las fibras vegetativas se originan de la región intermedia lateral de la médula. Todas estas raíces y núcleos se ubican entre los 5 o 6 primeros tramos de la médula espinal.

Origen Aparente del nervio accesorio

A simple vista, puede parecer que el nervio proviene de un lugar diferente a los anteriormente mencionados, lo que se denomina como origen aparente del nervio accesorio.

Esta ilusión originaria surge por la forma en que se compone el nervio accesorio en ambas raíces, pues tal y como se explicó anteriormente, la raíz medular está compuesta por numerosos segmentos que salen del cordón lateral de la médula espinal, un poco por delante de las raíces raquídeas.

Por otro lado, la raíz bulbar también está comprendida por 4 o 5 filetes radiculares que surgen desde el surco posterior del bulbo, debajo de las raíces del nervio vago, esto dificulta apreciar el lugar correcto del origen de este nervio y ha originado la existencia de esa alternativa aparente ya mencionada.

Trayecto

El trayecto del nervio accesorio comienza en el núcleo de la médula, donde sube por un conducto raquídeo, entrando en el cráneo por el agujero conocido como magno occipital, reuniéndose con la raíz del bulbo, situado a poco espacio del agujero rasgado posterior.

De esta manera se forma el nervio espinal accesorio, para luego salir a explorar el cuerpo, hacia fuera, adelante y hacia arriba, atravesando el agujero rasgado posterior junto con otros dos nervios, y dividiéndose en dos ramas terminales hacia la región de la cervical, justo cuando sale del cráneo.

Luego de esto, el trayecto del nervio accesorio pasa alrededor de uno de los extremos de la vena yugular en su parte interna, pasando luego hacia abajo y atrás del vientre posterior del digástrico, un músculo.

El nervio accesorio luego llega al esternocleidomastoideo y lo pasa por debajo, inervando su músculo, seguidamente, emerge cerca del borde posterior de este músculo para correr hacia abajo y atrás, atravesando el músculo esplenio y pasando por debajo del músculo trapecio al cual también inerva.

Parálisis Espinal Accesorio

Es por ello que el nervio accesorio es tan importante y delicado, por su relación con la médula espinal, sin embargo pueden surgir muchas patologías del nervio accesorio como consecuencia de complicaciones si recibiera una lesión. (Visitar artículo: Contusión cerebral)

Una de las más importantes patologías del nervio accesorio sin duda alguna sería la parálisis, esta patología es común luego de que se realizan cirugías que relacionan la parte lateral del cuello, sin embargo, también pueden ser causada por traumatismos en el mismo o lesiones en la cervical. (Visitar artículo: Enfermedad cerebrovascular)

Lo grave de esta condición es que puede causar que las funciones del músculo del trapecio se vean limitadas o nulas por completo, limitando o impidiendo la movilidad del cuello y e incluso de la cabeza en las personas afectadas. A continuación te invitamos a descubrir más sobre el Nervio Accesorio en el siguiente material audiovisual, que servirá para ilustrar y complementar toda la información contenida en el presente artículo.

Introduction

Cranial nerves, are nerves that are communication with the brain and pass through the holes of the base of the skull in order to innervate different structures, in addition to the head and neck for example if we refer to stomach or vagus nerve, Area of ​​enervation includes viscera located in the mediastinum and the abdominal cabide.
According to its point of emergence on the surface of the brain, distinguished twelve pairs of ribs.
Since physiologically seen, cranial nerves can be divided into three groups or categories.

1. Sensory or sensory nerves (olfactory, visual and auditory)
2. Motor nerves ( Common ocular motor, pathetic, abducens, spinal, hypoglossal more)
3. Mixed or sensory nerves?? Engines (trigemini, facial, glosofaríngeo, neumogástrico).

In each cranial we can consider a true origin and one apparent:
Apparent origin: It is the site of nerve emergency on the surface of the brain tissue.
Real or true origin: it is the place that gives rise to nerve fibers that constitute the nerve.
For afferent sensory nerves or, its actual origin corresponds to the peripheral nerve cells, which can be grouped forming ganglia annexes nerve trunks, or be located in the sensory organs, eg nostrils, eyes or ears. Engines or afferent nerves, They begin in neuronal groups located inside the brain, which constitute the core of origin.
The two roots mixed nerves have a motor and other sensitive, each of which have their own real origin.
Some cranial nerves have vegetative fibers belonging to S. Parasinpatico, this is the case of nerves: m. Common ocular, facial, glossopharyngeal and vagus.
These nerves, besides its origin sensitive engine, They have a central core where its vegetative fibers originate.

I. Cranial nerve: olfactory nerve

It is a sensory nerve that gives rise to the sense of smell.
Real origin: olfactory nerve fibers originate in the bipolar cells of the olfactory mucosa or yellow spot, located in the upper portion of the nostrils.
These cells have axons ascending constituting olfactory nerve fillets
Apparent origin: underside of the olfactory bulb, located on the cribriform plate, on either side of the crista galli apophysis.
Sightseeing: nerve fibers from bipolar cells. They found in various directions and then meet in 12 a 20 ramos olfatorios, that traverse the cribriform plate and reach the underside of the olfactory bulb.
En intimo contacto con los nervios olfatorios, are a pair of ribs small nerves called terminal.

II. Cranial nerve: optic nerve.

It is a sensory nerve that emerges from the eyeball; It is the nerve that allows the vision.
Real origin: It originates from the layer retinal ganglion cell. The axons of the ganglion cells, to meet and go back, They form the optic nerve.
Apparent origin: It is the angle above the optic chiasm.
Travel and relationships: this nerve measuring approximately 4 cm. Of length, and he goes up, back inside.
Fourth segment are described in it.
First segment: intraocular. The axons of the retinal ganglion cell converge at the optic disc: thence, the nerve pierces the surface layers of the eye (sclera and choroid ) in a place called cribosa area.
Second segment: intra orvitario. The nerve is comprised in a cone formed by the rectus muscles of the eye and immersed in the fat retroocular. At the apex of the orbit by providing the annulus rectus muscle insertion (Zinn ring).
In this segment the nerve above relates to the ophthalmic artery and out with the ciliary ganglion.
Third segment: intracanacular. The nerve passes through the optic foramen accompanied by the artful eye. On this site, es frecuente la lesión del nervio por fractura que comprometan la base del cráneo y vértice de la órbita.
Fourth segment: intracranial. Measures 1 cm., and that between the optical aperture and chiasm. In this segment the nerve is located on the pituitary shop and the optical channel sphenoid.

III. Cranial nerve: Common ocular motor

It is a motor nerve that also has a constricting of vegetative fibers for the intrinsic muscles of the eye.
It supplies all the extrinsic muscles of the eye, execto the oblique and lateral rectus; addition, through its connection with the ophthalmic ganglion, innervate the sphincter of the pupil and the ciliary muscle are intraocular or intrinsic muscles.

Real origin
The fibers of this pair originate in two cores:
Núcleo somatomotor: located in the brainstem, previous level colliculi and in front of the aqueduct.
Núcleo parasimpático motor: is the Edinger-Westphal nucleus or core pupil, which it is situated behind and within this. This is a core engine and fotoacomodador photo

Apparent origin
The nerve emerges in her groove oculomotor. Located on the inner face of the anterior cerebral peduncle corresponding.

Travel and relationships
The oculomotor after emerging brainstem is directed outward and upward. Through the posterior cerebral artery and the superior cerebellar artery then penetrates an outer wall of fleshy frown ranking above the pathetic nerve and ophthalmic. Out of the external wall in the anterior portion of the cavernous sinus and enters the orbit through the superior orbital fissure, dividing into two branch terminals passing through the ring Zinn.

Terminal branches

1. Rama terminal superior: Supplies the superior rectus muscle and upper eyelid lift.
2. Rama terminal inferior: supplies the hamstring, the oblique muscle and inferior rectus. It also gives a branch intended for ophthalmic ciliary ganglion, which provides parasympathetic fibers that regulate pupillary sphincter via the short ciliary nerves.

IV. Cranial nerve: pathetic nerve or trochlear nerve

It is a motor nerve innervating exclusively only to oblique eye muscle. It has two particularities with respect to other cranial nerves:

1. It is the only nerve that emerges from the back of the brainstem.
2. It is the only intersecting cranial nerve fibers within the brainstem.

Real origin
In the nucleus located in the brainstem common somatomotor below the oculomotor nerve nucleus. The fibers from this core, before appearing on the surface they intersect with those of the opposite side.

Apparent origin
Emerges in the rear face of the brainstem, bridle on each side valve Vieussens.

Travel and relationships
Surrounding the sides of the brainstem and goes forward, towards the cavernous sinus. Penetrates the outer wall of the womb, and it is located below the first oculomotor and ophthalmic above. After introduced into orbit by the orbital fissure and passes outside the ring Zinn.
Su rama terminal, it penetrates oblique eye muscle, al that innervate.

The. Cranial nerve: trigeminal nerve

Mixed nerve. Receive sensitivity of the integument of the anterior two thirds of the skull, the entire face, nostrils, orbital, oral cavity and its contents. A turn is the motor nerve of the muscles of mastication and some other.

Real origin
Sensitive origin:
The sensory nerve fibers that originate in the Gasser ganglion, located at the apex of the anterior surface of the petrous. Said node has a top side, lower, un should anteroexterno, convex, and an internal posterior edge, concave. The anterolateral edge Gasser ganglion gives rise to fibers constituting the ophthalmic nerve, maxilla and sensitive part of the mandibular nerve.
The fibers that leave the posteromedial edge of said node form the sensory root of the trigeminal, that goes backward and inward to enter and finish the boss in a long column of gray matter, call termination sensory trigeminal nucleus.
The trigeminal nucleus termination extending from the top of the dorsal horn of the cervical spine to the corresponding brain stem with a maximum thickness at the level of the pons.

This core has three levels: superior, middle and lower.
The bottom or bulbomedullary, constituye el núcleo gelatinoso y las fibras que hacen sinapsis en este núcleo están en relación predominante (although not exclusively).

Source Engine:
The motor fibers of the trigeminal, born of two cores:

1. Core or chewing: It is located in the shell of the pons
2. Accessory nucleus: It is located above the previous, in the midbrain (brainstem).

Apparent origin
Emerges from the anterior surface of the pons, level cerebellar peduncles, By the raíces: an external root, gross, It is sensitive., and other internal root, thinner, which it is the motor root.

Travel and relationships
The two roots are directed from the anterior face of the protrusion forward and out toward the top edge of the cliff.
The motor root progressively located below the sensory root.
Both roots cross the top edge of the cliff recess Gruber, and then the sensory branch forming folds in the triangular array terminating in plexus ganglion Gasser.
The motor root slips below the sensory root, passes under Glaeer ganglion and then the branch is incorporated mandible.
in this way, the trigeminal nerve gives branches that are sensitive and a third that is mixed.

Terminal branches
It is the only cranial nerve that gives its terminal branches within the skull.
1 with?? Willis ophthalmic nerve: sentient
2 – Maxillary nerve: sentient
3 with?? Mandibular nerve: motor sensitivo

Each of these branches, It presents an annex node:
1 with?? Ophthalmic nerve: It presented as node attached to ciliary ganglion or ophthalmic, located within the orbit.
2 with?? Maxillary nerve: It is attached to the sphenopalatine ganglion, which it is located in the pit peterigomaxilar.
3 with?? Mandibular nerve: It is attached to the optical node, located below the foramen ovale.

WE. Cranial nerve: Or abducens abducens nerve

It is a nerve only engine, intended hamstring muscle eye.
Real origin: the abducens has its real origin in the pontine nucleus located beneath the floor of the fourth ventricle and does prominence in the ventricular floor giving rise to the teres eminence.
This core is surrounded inside, by detraes and out by the motor root of the facial nerve.
Apparent origin: the abducens emerges from the groove bulboprotuberancial, on both sides of the blind hole.
Tours relations: from its apparent origin MOE goes forward, up and out; penetrates into the cavernous sinus and travels back to front in the company of the internal carotid artery. Then the nerve enters the orbit through the superior orbital fissure, Zinn through the ring.
The cranial nerve VI äº makes no collateral branch and ends in the deep branch in the deep surface of the lateral rectus muscle of the eye.

VII. Cranial nerve: Facial nerve.

It is a mixed nerve: motor, sensitive sensory and vegetative organ.
This consists of two roots: one se4nsitiva intermediary nerve root called Wrisberg.
The facial itself has motor fibers destined to innervate the muscles of facial expression, platysma, occipital, posterior belly of digastric, stylohyoid and stirrup muscles.
The intermediary or VII nerve Wrisverg äº pair bis, shows the sensitivity of the back of the ear canal; this is the only facial and sensitive territory is called Ramsay area- Hunt.
Real origin: núcleo somatomotor: It is located in the shell protuverencial, on the border of the medulla. The fibers arising from this core, before emerging from the brainstem, surrounding the nucleus of the VI äº couple doing prominence in the floor of the room vent1rículo.
Sensory nucleus- sensorial: this part of the nerve originates in the geniculate ganglion, located inside the petrous bone.
The fibers leave the ganglion geniculador, penetrate the medulla to finish on top of a solitary tract nucleus called (Actual core termination sensitive part- facial sensory).
Vegetative nucleus: two cores are located in the pons, by core engine detraes.

1. Lacrimomuconasal core: its fibers stimulate the secretion of the tear glands and glands of the nasal mucosa.
2. Superior salivary nuclei: It gives rise to fibers that regulate the secretion of submandibular and sublingual glands.

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Apparent origin: äº VII cranial and broker Wrisberg emerge bulb pontine groove in the area of ​​the pits supraolivar, äº VI outside the front pair and the auditory nerve.
Travel: from the groove bulb protuverancial, the two branches of facial forward reach upward and outward through the cerebellopontine angle äº company VIII couple, with which it is inserted into the internal auditory canal, accompanied by internal auditory artery.
In the bottom of the internal auditory canal, facial is located in the anterior quadrant and into the fallopian aqueduct crossing it in its entirety.

The ridge like the aqueduct has three segments:

1. First segment or labyrinthine.
2. Segundo segment or segment timpánico.
3. Third segment or mastoid segment.

The facial nerve exits the skull through the hole stylomastoid, located between the base of the mastoid process and styloid process. Then enters the parotid cell and in the thickness of the parotid gland is divided into its terminal branches: temporofacial cervical nerve and facial nerve.

Collateral branches: intrapetrosas twigs and branches are distinguished extrapetrosas.

1. Left intrapetrosas.

1. Surface greater petrosal nerve.
2. Lesser superficial petrosal nerve.
3. Muscle Nerve stirrup.
4. Chorda tympani.
5. Anastomico bouquet for X äº couple.
6. Bouquet sensitive ear canal.

1. Ramas extrapetrosas.

1. Anastomico bouquet for X äº couple.
2. Posterior auricular nerve.
3. Digastric nerve.
4. Ramo lingual.

Terminal branches.

1. Temporofacial nerve.
2. Cervicofacial nerve.

VIII. Cranial nerve: Auditory nerve.

The auditory nerve, also called statoacoustic nerve or vestibulocochlear nerve, It is a sensory nerve- Sensory which it relates to the hearing and balance. This consists of two anatomical and physiologically different branches:
1Bouquet äº vestibular or balance nerve.
2º cochlear Branch, concerning hearing.

Real origin:
a) rama labial: the bodies of neurons of origin are in the ganglion Scarpa (real origin). Their dendrites carry receptors balance organs that are the utricle, saccule and semicircular drivers(superior, external and subsequent).
Since Scarpa ganglion, start axons that form the vestibular branch, and head for the brain stem ending in the vestibular nuclear complex (cores actual termination), located in the medulla and pons.

* Núcleo dorsal interno o Schwalbe.
* Delters external or dorsal nucleus.
* Núcleo central o de Betcherew.

b) cochlear branch the real origin of this branch is the ganglion of Corti and spiral ganglion, located inside the spiral membrane.

* Ventral cochlear nucleus.
* Dorsal cochlear nucleus.

Apparent origin: It is the groove bulboprotuverancial, outside the facial nerve and broker Wrisberg.
Travel and relationships: in the bottom of the internal auditory canal, both branches are related to the facial nerve, Wrisberg intermediary and internal auditory artery. Since the internal auditory canal, the rib is directed towards the side of the groove bulboprotuverancial, going through the cerebellopontine angle, where is mainly related to the facial nerve.

IX. Cranial nerve: Glossopharyngeal.

Glossopharyngeal, It is a mixed nerve: sencitivo-sensorial, motor and vegetative.
Sensorimotor sensory function: sencibilidad leading general of the pharynx and the posterior third of the tongue mucosa, tonsillar region and part of the soft palate.
As sensory nerve picks taste stimuli of the posterior third of the tongue.
Motor function: supplies the muscles of the pharynx and soft palate.
Vegetative function: It contains parasympathetic fibers that innervate the parotid gland and lingual mucous glands-laviales.

Real Origin

1. Source Engine: top of the ambiguous nucleus located in the medulla.

The middle and lower segments of the core engine for the vagus and spinal origin respectively.
2. Sensitive sensory origin: It is located on two nodes.

1. Ganglion Andersch
2. Ganglion Ehrenritter

1. Vegetative origin: the real origin of vegetative fibers is located ell the floor of the fourth ventricle, salivary corresponds to the lower core.

Apparent origin
The glossopharyngeal nerve emerges from the posterior collateral sulcus of the medulla, above the vagus and spinal.

Tours relations
The nerve exits the skull through the hole behind the torn posterior vagus and spinal, of which it is separated by the jugular ligament. Then descends through the space maxilofaringeo retroestileo behavior to the base of the tongue where it ends.

1. Jacobson nerve gives rise to six branches:

* Bouquet for the oval window
* Bouquet round window
* Ramo tubario
* Ramo caroticotimpático
* Deep greater petrosal nerve
* Lesser superficial petrosal nerve

1. Nerve Stylopharyngeus
2. Styloglossus nerve and glosoestafilino
3. Branch tosilar the amigialino
4. Branch pharyngeal
5. Ramo carotideo
6. Anastomotic bouquet for facial (form the loop of Hallerr)

Terminal branches
Arriving at the base of the tongue glosofaríngeo is divided into numerous branches that spread in the mucosa, forming the lingual plexus.

X. Cranial nerve: pneumogastric

Mixed nerve: motor, sensitive and vegetative.
It is having a more extensive territory of innervation, and viscera neck comprising. Thorax and abdomen.

Real origin

1. Somatomayor origin: It is the average of the ambiguous nucleus, engine below the origin Glossopharyngeal.
2. Somatosentitivo origin: It is located on two nodes in the path of the nerve.

1. Jugular ganglion: It is located at the level of hole torn posterior.
2. Plexiform ganglion: It is bulkier than the previous one and is located below the base of the skull.

The neurons forming these nodes, They have dendritic extensions that reduce the territory of sensory innervation of this nerve (respiratory and digestive mucosa) and a central extension extending into the medulla and ends in the nucleus of the solitary tract, located on the floor of the fourth ventricle (core actual completion of the somatosensory fibers).

Vegetative origin: vegetative fibers you originate from two cores located under the floor of the fourth ventricle in the gray wing.

1. Núcleo visceromotor: is the dorsal nucleus of the vagus also called core cardiopneumogastroenteric.
2. Núcleo viscerosensitivo: ESN is located at the outside of the dorsal nucleus of the vagus.

Apparent origin
The vagus nerve emerges from the rear side groove bulb, glossopharyngeal below and above the spinal nerve.

Travel and relationships
Exits the skull through the rear elongated hole, glossopharyngeal standing behind and ahead of the cord. Then drops the retroestileo compartment space maxilofaringeo.
In the neck, part of high neurovascular bundle, reaching the dihedral angle between back the internal carotid artery and internal jugular vain. Below, part of the neurovascular bundle under the neck, together with the common carotid and internal jugular vein.
In her chest relationships are different for the right and left vagus. The right neumogastrico passes in front of the right subclavian artery and behind the right bronchus. While the left descends past the aortic arch and behind the left bronchus.
At the bottom of the mediastinum, neumogástrico both relate to the esophagus; the right is located to the right and behind it, while the left vagus and down to the left front of the esophagus. Thus both neumogástricos from crossing the diaphragm through the esophageal hiatus, Closely related to the esophagus.
Abdomen, the left vagus, as applied on the front face of the esophagus branches into the anterior stomach. The right vagus, follows the back of the stomach and is divided into two branches ending in respective semilunar ganglion.

Collateral branches

1. Cervical branches:

1. Ramos faringeos
2. Or superior cervical cardiac nerve
3. Superior laryngeal nerve
4. Ramos carotideos

1. Thoracic branches

1. Cardiacon nerves below
2. Ramos pulmolares
3. Esophageal branches
4. Or recurrent inferior laryngeal nerve

XI. Cranial nerve: nerve or spinal accessory nerve

Es un Merv Austria, formed by the union of other cranial and spinal root.
Real origin

1. Nucleo bulbar: cells located in the lower portion of the ambiguous nucleus.
2. Core medular: It is located on the outside of the anterior horn of the upper portion of the cervical spine.

Apparent origin
Bulbar roots emerge from the back side groove below the bulb raquide neumogástrico, while the spinal roots do rear side groove marrow.

Travel
Lower roots penetrate the skull through the foramen magnum.
The cranial nerve XI äº, once formed, exits the skull through the rear elongated hole, together with the glossopharyngeal and vagus.
Once out of the cranial cavity, diivide it into two branches:

1. An internal branch, containing fibers and bulbar origin teermina uniendoce the plexiform ganglion of the vagus.
2. External branch, descends through the space and ends maxilofaringeo innervating the sternocleidomastoid and trapezius muscles.

Remaining

1. Branch anastomotic for the cranial nerve X äº.
2. Nerves of the sternocleidomastoid: It originates from a loop formed by the anastomosis XI äº pair with the corresponding branch of the deep cervical plexus.
3. Nervior the trapezius muscle.

XII. Cranial nerve: hypoglossal nerve more

It is a motor nerve destined to innervate the muscles of the tongue, the ifrahioideos muscles and muscle suprahyoid: the geniohyoid.

Real origin
The actual origin of the hypoglossal nucleus is a somatomotor located in the medulla and inner white wing it corresponds to the floor of the fourth ventricle.

Apparent origin
It emerges halibut steaks ten or eleven preolivar groove medulla.

Travel and relationships
The hypoglossal leaves the skull through the hole and drops condileoanterior the retroestileo compartment space maxilofaringeo, describing his journey in a cave of anterior concavity, until the lateral border of the tongue.

Collateral branches

* Or recurrent meningeal branch
* Vascular Ramos
* Anstomóstico bouquet for plexiform ganglion of vagus
* Nervio del tirohioideo
* Hiogloso nerve and styloglossus
* Anastomotic branch to the lingual nerve
* Nerve geniohyoid

The descending branch, It merges with the descending branch of the deep internal cervical plexus forming the handle of the hypoglossal, innervating all muscles except infrahioudeos thyrohyoid muscle.

Terminal branches
It is divided into numerous terminal branches aimed at the muscles of the tongue.

Sent work: Javier E. Clemente Garin