4) Autonomic innervation of the H&N Flashcards
What supplies the sympathetic innervation of the H&N?
Sympathetic trunk
Where does the sympathetic trunk lie?
Anterolateral to the vertebral column
Lying on the prevertebal fascia & muscles
Deep to the carotid sheath
Describe the general course of preganglionic sympathetic fibres
Arise mainly in 1st thoracic neural segment
Synapse in either Superior, Middle or Inferior Cervical Ganglia
Describe the general course of postganglionic sympathetic fibres
After synapsing, postganglionic fibres travel as the Internal & External Carotid Nerves along blood vessels to target tissues
Where do postganglionic fibres from the superior cervical ganglion pass?
With Internal & External Carotid arteries & branches to:
Pharyngeal plexus
Upper 4 cervical nodes
Cardiac branch to the cardiac plexus
Where do postganglionic fibres from the middle cervical ganglion pass?
With Inferior Thyroid artery to:
5th & 6th Cervical nerves
Cardiac branch to the cardiac plexus
Where do postganglionic fibres from the inferior cervical ganglion pass?
With the Vertebral artery to:
7th & 8th Cervical nerves
Cardiac branch to the cardiac plexus
What is unique about the Inferior Cervical ganglion?
Small ganglion
In 80% of people combines with 1st Thoracic ganglion to form the Stellate Ganglion
Name the 4 pairs of parasympathetic ganglia in the head
Ciliary ganglion
Pterygopalatine ganglion
Submandibular ganglion
Otic ganglion
Which 4 nerves have brainstem nuclei?
Oculomotor CN III
Facial CN VII
Glossopharyngeal CN IX
Vagus CN X
Which 3 cranial nerves have branches that reach the ganglia?
Oculomotor (III) > Ciliary ganglion
Facial (VII) > Pterygopalatine/Submandibular ganglion
Glossopharyngeal (IX) > Otic ganglion
Vagus nerve does not have an associated discrete ganglion
Where does the ciliary ganglion lie?
Orbital cavity
Lateral to optic nerve
What do parasympathetic fibres from the Ciliary ganglion go on to innervate?
Sphincter Papillae
Ciliary muscles
(derived from Oculomotor nerve)
What do sympathetic fibres from the Ciliary ganglion go on to innervate?
Eyeball
Superior cervical ganglion via plexus on ophthalmic a. (branch of ICA)
What do sensory fibres from the Ciliary ganglion go on to innervate?
Sensory fibres from eyeball pass to nasociliary nerve
What do parasympathetic fibres from the Pterygopalatine ganglion go on to innervate?
Lacrimal glands
Glands of nose, palate & nasopharynx
(derived from Facial nerve)
Where does the pterygopalatine ganglion lie?
Pterygopalatine fossa
Connected to maxillary nerve (Vii) by small branches
What do sympathetic fibres from the Pterygopalatine ganglion go on to innervate?
Nose, palate & nasopharynx
Superior cervical ganglion via plexus on ICA
Which sensory fibres pass in the branches of the Pterygopalatine ganglion to the maxillary nerve?
Sensory fibres from nose, palate & nasopharynx
Where does the submandibular ganglion lie?
Suspended from Lingual nerve by small branches
What do parasympathetic fibres from the Submandibular ganglion go on to innervate?
Submandibular gland
Sublingual gland
Other glands on floor of oral cavity
(derived from Facial nerve via Chorda Tympani then Lingual nerve)
What do sympathetic fibres from the Submandibular ganglion go on to innervate?
Glands in floor of oral cavity
Superior cervical ganglion along facial artery
What sensory fibres may pass through the Submandibular ganglion?
Taste fibres
What do parasympathetic fibres from the Otic ganglion go on to innervate?
Parotid gland
derived from Glossopharyngeal nerve via auriculotemporal nerve
What do sympathetic fibres from the Otic ganglion go on to innervate?
Parotid gland
Superior cervical ganglion along middle meningeal artery
Motor fibres from which nerve pass through the Otic ganglion?
Mandibular Nerve (Viii) branches pass through without synapsing
Outline the parasympathetic innervation derived from the Edinger-Westphal nucleus
E-W nucleus > Oculomotor N. (III) > Ciliary ganglion > hitch-hike on Ophthalmic n. > Sphincter pupillae (constriction)
Outline the parasympathetic innervation derived from the Superior salivatory nucleus
S-S nucleus > Greater Petrosal N. > Pterygopalatine ganglion > hitch-hike on Maxillary n. > Lacrimal gland & Nasal mucosa (serous secretions)
or
S-S nucleus > Chorda Tympani > Submandibular ganglion > hitch-hike on Mandibular n. > Submandibular & Sublingual gland
Outline the parasympathetic innervation derived from the Inferior salivatory nucleus
I-S nucleus > Lesser Petrosal N. > Otic ganglion > hitch-hike on Mandibular n. (auriculotemporal) > Parotid gland
Outline the parasympathetic innervation derived from the Dorsal vagal motor nucleus
D-V-M nucleus > Vagus N. > Larynx
Don’t terminate in discrete ganglia, wide dist. in body
Describe the direct supply provided by the Glossopharyngeal Nerve (IX)
(direct or via pharyngeal plexus)
Glands of oropharynx
Posterior 1/3 of tongue
Describe the direct supply provided by the Vagus Nerve (X)
Glands of the laryngopharnyx, larynx, oesophagus & trachea
Ganglion cells are on the viscus
Injury to the sympathetic trunk or ganglia will result in which syndrome?
Horner’s syndrome
What is Horner’s syndrome?
Interruption to cervical sympathetic trunk:
Miosis (constriction of pupil, unopposed sphincter pupillae)
Ptosis (drooping of eyelid, paralysis of superior tarsal muscle)
Anhydrosis (absence of sweating)
Vasodilation (redness & increased temp of skin, loss of sympathetic tone)
on the Ipsilateral side
