Vagus nerve palsy is a clinical syndrome resulting from damage to the vagus nerve caused by various factors, leading to dysfunction or disorders of vocal cord movement, swallowing, heart rhythm, and other functions.
The vagus nerve is the longest and most widely distributed mixed nerve in the human body, containing four types of nerve fibers: visceral afferent, visceral efferent, somatic afferent, and somatic efferent.
1. Classification of Etiologies
(I) Intracranial Diseases
Meningioma, chondroma, neurofibroma, metastatic tumor, platybasia, etc.
(2) Extracranial Diseases
Cervical trauma, parotid gland tumors and inflammation, sublingual gland tumors and inflammation, jugular phlebitis, carotid aneurysm, otitis media, etc., are all major predisposing factors for this condition.
II. Diagnostic Essentials
**Unilateral Vagus Nerve Paralysis:** Presents with ipsilateral vocal cord paralysis, hoarseness, and drooping of the soft palate on the affected side. Due to paralysis of the superior pharyngeal constrictor, the posterior pharyngeal wall deviates toward the healthy side when the mouth opens. Because the pharyngeal muscle fibers on both sides interlace at the midline, dysphagia is often not marked in unilateral lesions. It is frequently accompanied by cardiac arrhythmia and tachycardia.
Bilateral complete vagus nerve paralysis: critical condition, patient often dies within a short time.
III. Treatment Plan
(I) Acupoint Selection and Needling Technique
- **GV15 (Yamen)** **Location:** On the posterior midline of the neck, 0.5 cun directly above the midpoint of the posterior hairline, in the depression. **Manipulation:** Using a 30-gauge filiform needle of 1.5 cun length, perform routine local disinfection. Insert obliquely toward the interspace below the second cervical vertebra to a depth of 1.3 cun. **Needling Sensation:** Distension and pain in the neck.
- **ST9 (Renying, bilateral)** **Location:** On the neck, level with the laryngeal prominence, at the anterior border of the common carotid artery. **Operation:** A 30-gauge, 1.5 cun filiform needle is used. After routine local disinfection, the carotid artery is avoided, and the needle is inserted obliquely toward the spine to a depth of approximately 1.3 cun. **Needle Sensation:** Distension and pain in the neck.
- **CV23 (Lianquan)** **Location:** On the anterior midline of the neck, in the depression above the hyoid bone and superior to the laryngeal prominence, located with the head tilted back. **Manipulation:** Using a 30-gauge, 1.5 cun filiform needle, perform routine local disinfection, then insert obliquely toward the root of the tongue to a depth of approximately 1.3 cun. **Needling Sensation:** Distension and pain in the throat.
- **PC6 (Neiguan) (bilateral)** **Location:** On the palmar aspect of the forearm, 2 cun proximal to the wrist crease, between the tendons of the palmaris longus and the flexor carpi radialis. **Technique:** After local routine sterilization, insert a 30-gauge, 1.5 cun filiform needle perpendicularly approximately 1.3 cun toward the direction of TE5 (Waiguan). **Sensation:** Local distension and pain, or a sensation radiating to the dorsum of the hand and the middle finger.
(2) Treatment Methods
The patient was seated. Acupuncture was performed at each acupoint according to the standard protocol described above. For the acupoints on the neck, electroacupuncture was applied. The needles were retained for 40 minutes before removal. Treatment was given once daily, with 7 sessions constituting one course. A 3-day rest was taken between courses, after which treatment resumed.
IV. Commentary
Vagus nerve paralysis involves a wide range of affected areas and presents with complex clinical manifestations. Acupuncture treatment has demonstrated a certain therapeutic effect on this condition. If the patient has concurrent intracranial or peripheral secondary lesions, it is essential to first remove the primary lesion before initiating acupuncture treatment to ensure efficacy. Patients with isolated vagus nerve paralysis generally have a favorable prognosis, with relatively rapid recovery of neck muscle function and heart rate.