14 Autonomics of Head and Neck Flashcards
A patient has miosis, ptosis of the eyelid and anhydrosis of the face. Which ganglia is affected?
The superior cervical ganglion, which is the uppermost part of the sympathetic chain, supplies symp. innervation to the head and neck.
The usual symptoms for SCG injury, commonly known as Horner’s syndrome, are miosis, ptosis and anhydrosis of the head and neck.
Patient has a constricted right pupil that does not react to light. His left pupil and vision in both eyes are normal. This is due to a lesion in which right-sided structure?
The superior cervical ganglion provides symp. innervation to the face and neck regions. Symp. travel along the branches of the ICA and dilate the pupil during symp. response.
Patient has a tumor at the base of the skull which results in a decrease in tear production. Which nerve is injured?
The greater petrosal nerve, a PS branch of the facial nerve, provides innervation to the lacrimal gland in the orbit.
Patient has squamous cell carcinoma on the lower lip. Which lymph nodes will be first involved in the spread of cancer cells?
The submental lymph nodes drain the anterior 2/3 of the mouth and tongue, including the lower lips.
Where is the location of the postganglionic PS neural cell bodies that directly innervate the parotid gland?
The otic ganglion is the location of the postgang PS neural cell bodies innervating the parotid gland. The ganglion lies on the mandibular division of the trigeminal nerve (V3) near the foramen ovale.
A patient has difficulty swallowing. A radiograph reveals a skull base tumor occupying the space behind the jugular foramen. Involvement of which structure is responsible?
The vagus nerve exits the skull at the jugular foramen and is responsible for motor innervation of the smooth muscles of the trachea, bronchi and digestive tract, in addition to the muscles of the palate, pharynx, larynx and sup. 2/3 of esophagus.
During a procedure to remove a tumor, the superior thyroid artery is identified and used as a landmark in order not to damage its small companion nerve. Which nerve is accompanying the superior thyroid artery?
The external branch of the superior laryngeal nerve courses together with the sup. thyroid artery.
There is a lesion in the tympanic plexus in the middle ear cavity. Since the preganglionic PS fibers that pass through the plexus have been lost, which condition will be seen?
PS innervation of the parotid gland is provided by axons carried by the glossopharyngeal nerve that emergy from the tympanic plexus of the middle ear as the lesser petrosal nerve. These pregang. PS fibers terminate at synpases in the otic ganglion, which then innervate the parotid gland.
A patient is given a sympathetic blocking drug in high doses. What condition will be expected?
Ptosis and miosis occur when blocking sympathetics.
Ptosis occurs due to lack of innervation of the superior tarsal muscle and miosis (pupillary constriction) results from unopposed PS innervation of the pupil.
A patient is admitted to the hospital with a drooping eyelid. The diagnosis is Horner’s syndrome. What additional sign would be seen?
Horner’s syndrome involves interruption of symp. supply to the face; this results in ptosis, miosis and anhydrosis.
A tonsillectomy is performed and the patient complains of ear pain post-operation. Which nerve was injured?
The glossopharyngeal nerve mediates general somatic sensation from the pharynx, the auditory tube and from the middle ear. Painful sensations from the pharynx, including the auditory tube, can be referred to the ear by this nerve.
A patient has tenderness in the upper right thorax. The patient presents with slight ptosis of her right eyelid and right pupil constriction. What is the diagnosis?
Pancoast tumors involve the sympathetic chain ganglia and cause Horner’s syndrome.
An operation is done to remove a parotid gland tumor. Three months post-operation, the patient complains that her face sweats profusely when she tastes or smells food and a diagnosis of Frey’s syndrome is made. Which nerve was injured during the procedure?
Frey’s syndrome occurs when PS axons in the auriculotemporal nerve are cut during a parotidectomy. When these PS cholingeric axons grow peripherally after parotid surgery, they establish synapses upon the cholinergic sweat glands which are innervated normally only by symp. fibers.
A patient has a dry right eye. Doctor diagnoses a lesion at the neural cell bodies of the pregang. axons of the fibers that terminate in the pterygopalatine ganglion. Which structure contains the neural cell bodies of the pregang. axons?
The neural cell bodies whose axons synpase in the PT ganglion are located in the superior salivatory nucleus which is in the pons; this nucleus provides the general visceral efferent fibers of the facial nerve for lacrimal and salivary secretion.
A patient has lost unilateral sensation of hot, cold, pain and pressure from the front part of the tongue but taste and salivary function are preserved. What the diagnosis?
The lingual nerve was injured at its origin before it joins with the chorda tympani.
