4) Autonomic innervation of the H&N Flashcards

1
Q

What supplies the sympathetic innervation of the H&N?

A

Sympathetic trunk

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2
Q

Where does the sympathetic trunk lie?

A

Anterolateral to the vertebral column
Lying on the prevertebal fascia & muscles
Deep to the carotid sheath

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3
Q

Describe the general course of preganglionic sympathetic fibres

A

Arise mainly in 1st thoracic neural segment

Synapse in either Superior, Middle or Inferior Cervical Ganglia

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4
Q

Describe the general course of postganglionic sympathetic fibres

A

After synapsing, postganglionic fibres travel as the Internal & External Carotid Nerves along blood vessels to target tissues

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5
Q

Where do postganglionic fibres from the superior cervical ganglion pass?

A

With Internal & External Carotid arteries & branches to:
Pharyngeal plexus
Upper 4 cervical nodes
Cardiac branch to the cardiac plexus

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6
Q

Where do postganglionic fibres from the middle cervical ganglion pass?

A

With Inferior Thyroid artery to:
5th & 6th Cervical nerves
Cardiac branch to the cardiac plexus

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7
Q

Where do postganglionic fibres from the inferior cervical ganglion pass?

A

With the Vertebral artery to:
7th & 8th Cervical nerves
Cardiac branch to the cardiac plexus

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8
Q

What is unique about the Inferior Cervical ganglion?

A

Small ganglion

In 80% of people combines with 1st Thoracic ganglion to form the Stellate Ganglion

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9
Q

Name the 4 pairs of parasympathetic ganglia in the head

A

Ciliary ganglion
Pterygopalatine ganglion
Submandibular ganglion
Otic ganglion

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10
Q

Which 4 nerves have brainstem nuclei?

A

Oculomotor CN III
Facial CN VII
Glossopharyngeal CN IX
Vagus CN X

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11
Q

Which 3 cranial nerves have branches that reach the ganglia?

A

Oculomotor (III) > Ciliary ganglion
Facial (VII) > Pterygopalatine/Submandibular ganglion
Glossopharyngeal (IX) > Otic ganglion

Vagus nerve does not have an associated discrete ganglion

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12
Q

Where does the ciliary ganglion lie?

A

Orbital cavity

Lateral to optic nerve

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13
Q

What do parasympathetic fibres from the Ciliary ganglion go on to innervate?

A

Sphincter Papillae
Ciliary muscles
(derived from Oculomotor nerve)

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14
Q

What do sympathetic fibres from the Ciliary ganglion go on to innervate?

A

Eyeball

Superior cervical ganglion via plexus on ophthalmic a. (branch of ICA)

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15
Q

What do sensory fibres from the Ciliary ganglion go on to innervate?

A

Sensory fibres from eyeball pass to nasociliary nerve

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16
Q

What do parasympathetic fibres from the Pterygopalatine ganglion go on to innervate?

A

Lacrimal glands
Glands of nose, palate & nasopharynx
(derived from Facial nerve)

17
Q

Where does the pterygopalatine ganglion lie?

A

Pterygopalatine fossa

Connected to maxillary nerve (Vii) by small branches

18
Q

What do sympathetic fibres from the Pterygopalatine ganglion go on to innervate?

A

Nose, palate & nasopharynx

Superior cervical ganglion via plexus on ICA

19
Q

Which sensory fibres pass in the branches of the Pterygopalatine ganglion to the maxillary nerve?

A

Sensory fibres from nose, palate & nasopharynx

20
Q

Where does the submandibular ganglion lie?

A

Suspended from Lingual nerve by small branches

21
Q

What do parasympathetic fibres from the Submandibular ganglion go on to innervate?

A

Submandibular gland
Sublingual gland
Other glands on floor of oral cavity
(derived from Facial nerve via Chorda Tympani then Lingual nerve)

22
Q

What do sympathetic fibres from the Submandibular ganglion go on to innervate?

A

Glands in floor of oral cavity

Superior cervical ganglion along facial artery

23
Q

What sensory fibres may pass through the Submandibular ganglion?

A

Taste fibres

24
Q

What do parasympathetic fibres from the Otic ganglion go on to innervate?

A

Parotid gland

derived from Glossopharyngeal nerve via auriculotemporal nerve

25
What do sympathetic fibres from the Otic ganglion go on to innervate?
Parotid gland | Superior cervical ganglion along middle meningeal artery
26
Motor fibres from which nerve pass through the Otic ganglion?
Mandibular Nerve (Viii) branches pass through without synapsing
27
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)
28
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
29
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
30
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
31
Describe the direct supply provided by the Glossopharyngeal Nerve (IX)
(direct or via pharyngeal plexus) Glands of oropharynx Posterior 1/3 of tongue
32
Describe the direct supply provided by the Vagus Nerve (X)
Glands of the laryngopharnyx, larynx, oesophagus & trachea Ganglion cells are on the viscus
33
Injury to the sympathetic trunk or ganglia will result in which syndrome?
Horner's syndrome
34
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