04.2 Autonomic Supply of the Head and Neck

Question 1

Where does the sympathetic chain arise from?

Answer 1

T1-L2

Question 2

Which sympathetic ganglia are associate most with the head and neck?

Answer 2

Superior, middle and inferior cervical ganglia

Superior cervical is the most associated

Question 3

What structures do the sympathetic fibres hitch hike on in the head and neck?

Answer 3

ICA

ECA

Question 4

Which structures do the sympathetic fibres that hitchhike on the ICA innervate?

Answer 4

Tarsal muscle (via opthalmic artery and CNIII)
Dilator pupilae (via branches of trigeminal V1)

Question 5

What structures do the sympathetic fibres that hitch hike on the ECA innervate?

Answer 5

Sweat glands

Vascular smooth muscle

Question 6

What is interruption of the sympathetic fibres to the head and neck called and what can cause this?

Answer 6

Horner’s syndrome

Carotid artery dissection, pancoast tumour, carotid aneurysm

Question 7

What symptoms accompany Horner’s syndrome?

Answer 7

Anhydrosis
Miosis
Ptosis

Question 8

What is the general path follow post-parasympathetic brain nuclei?

Answer 8

Hitch hikes on cranial nerves
Meets a ganglion
Hitch hikes on a branch of CNV
Effector organ/tissue

Question 9

Which nerve does the edinger westphal nucleus then hitch hike on?

Answer 9

CNIII (The parasympathetic fibres are on the outside of the nerve so more prone to damage from high intracranial pressure)

Question 10

What ganglion does the parasympathetic fibres hitchhiking on CNIII join?

Answer 10

Ciliary ganglion

Question 11

What is the effector organ post ciliary ganglion?

Answer 11

Pupil
Ciliary body
(Via CNV1)

Question 12

What are symptoms of damage to the edinger westphal nucleus or its parasympathetic fibres?

Answer 12

Pupil dilation

Question 13

What is the response to shining light into the left pupil?

Answer 13

CNII sends sensory information to the brainstem
Connection with the edinger westphal nuclei (both left and right)
Parasympathetic fibres hitchhike on the CNIII nerves
Pass via ciliary ganglion
Reach sphincter pupillae
Both pupils constrict (left = direct, right = consensual)

Question 14

What is the immediate pathway followed by parasympathetic fibres from the superior salivatory nucleus?

Answer 14

Hitchhike on CNVII

Preganglionic split into fibres that follow chorda tympani and greater petrosal at the genuculate ganglion

Question 15

What are the two ganglions that parasympathetic fibres from the superior salivatory nucleus join and what are their targets?

Answer 15

Submandibular ganglion - submandibular and sublingual salivary glands
Pterygopalatine ganglion - lacrimal gland, nasal and oral mucosal glands

Question 16

What ganglion do parasympathetic fibres associated with the Glossopharyngeal nerve join?

Answer 16

Otic ganglion

Question 17

What do parasympathetic fibres from the otic ganglion target?

Answer 17

Parotid gland