Uvula deviation and gag reflex

Dear Ask The Doctor:  I noticed tonight that my uvula deviates to the left. I don't spend much time looking at it, so I'd never noticed it before. There are no oropharyngeal masses or tonsilar inflammation. I know uvular deviation can indicate a vagus motor lesion, but I am not experiencing any associated symptoms. I am wondering if this is something I should be concerned about or if there are cases of nonpathological uvular deviation?
 

Dear Patient:  The is innervated by the vagus nerve (Cranial Nerve X). Deviation of the uvula to one side implies a lower motor lesion of the vagus nerve opposite to the side the uvula is deviating to. An upper motor neuron vagus nerve lesion will present with the uvula deviating toward the side of the lesion. I would advise attending your family physician for history of any associated symptoms (difficulty swallowing, speech problems, nasal regurgitation, hoarseness) and physical examination including cranial nerve examination and testing the gag reflex, which is innervated by the vagus nerve, to identify any cranial nerve pathology and investigation as appropriate.

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