A 55-year-old man presents with progressive dysphagia, hoarseness, an absent gag reflex on stimulation of the left side of the oropharynx, and weakness of the left sternocleidomastoid and trapezius. There is no tongue wasting or deviation. Which skull base foramen contains the affected nerves?

• A Internal acoustic meatus
• B Hypoglossal canal
• C Foramen ovale
• D Jugular foramen ✓

Explanation

Glossopharyngeal, vagus, and accessory nerves all leave the posterior cranial fossa through the jugular foramen, together with the inferior petrosal sinus and sigmoid sinus. The findings map exactly onto these three nerves: absent gag reflex and altered pharyngeal sensation from CN IX, hoarseness and dysphagia from recurrent laryngeal and pharyngeal branches of CN X, and sternocleidomastoid and trapezius weakness from the spinal accessory nerve. Normal tongue movement rules out hypoglossal canal involvement.

Reference: Gray's Anatomy, 42nd ed.

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Written and medically reviewed by the StethoPrep medical team.