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H&N Z > 4.2 Autonomic Innervation > Flashcards

4.2 Autonomic Innervation Flashcards

1
Q

Where do sympathetic fibres originate?

A

Thoracic region T1-T6 of spinal cord

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2
Q

Describe the sympathetic chain.

A

Spans from base of the skull to the coccyx formed by nerve fibres and ganglia.

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3
Q

Sympathetic ganglia of significance of head and neck?

A

Superior, middle, inferior cervical

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4
Q

Describe the sympathetic trunk.

A

Preganglionic fibres mainly arise in first thoracic neural segment and synapse in one of the 3 cervical sympathetic ganglia.
After synapsing, posganglionic fibres travel with ICA or ECA to target tissues.

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5
Q

Describe the location of the superior cervical ganglion.

A

Posteirorly to carotid artery and anterior to C1-C4 vertebrae

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6
Q

Which nerves originate from the superior cervical ganglion?

A

Internal carotid nerve
- Structures in eye, pterygopalating A and ICA
External carotid nerve
- Smooth muscles of arteries
Nerve to pharyngeal plexus
- combines with vagus and glossopharyngeal nerves
Superior cardiac branch
- cardiac plexus in the thorax
Nerves to CN II, III, IV, VI, IX.
Gray rami communicantes
- Sympathetic fibres to anterior rami of C1-C4

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7
Q

What structures do the ICN and ECN follow?

A

ICA -ICA

ECN - Common and ECA

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8
Q

What vertebral level is the middle cervical ganglion located?

A

C6,

anterior to inferior thyroid A.

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9
Q

What postganglionic fibres come from the middle cervical ganglion?

A 
Gray rami communicantes
Thyroid branches
- Travel along inferior thyroid A
Middle cardiac branch
- cardiac plexus in thorax
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10
Q

What vertebral level is the inferior cervical ganglion located at?

A

C7, anteriorly

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11
Q

What postganglionic fibres come from the inferior cervical ganglion?

A 
Gray rami communicates
Branches to subclavian and vertebral arteries
- Smooth muscle present in the A.
Inferior cardiac nerve
-cardiac plexus
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12
Q

What is the stellate ganglion?

A

Combination of the inferior cervical ganglion and the 1st thoracic ganglion.

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13
Q

Describe the parasympathetic trunk.

A

Nerves applying head and neck are situated in 4 nuclei int he brainstem.
Each is associated with a cranial nerve that carrier the fibres out of the brain to a peripheral ganglion near target viscera.
Postganglionic fibres ocntinue to the structures they innervate.

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14
Q

What are the pairs of parasympathetic ganglia in the head? Associated nuclei?

A

Ciliary gangliion - Edinger-westphal
Pterygopalatine - superiorsalivatory
Submandibular- superior salivatory
Otic - inferior salivatory

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15
Q

Where is the ciliary ganglion located?

A

• Lies in the Orbital Cavity, anterior to the superior orbital fissure, lateral to the optic nerve

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16
Q

Describe the preganglionic fibres of the ciliary ganglion.

A

the ciliary ganglion is supplied by fibres from the Edinger-Westphal nucleus (associated with oculomotor nerve)

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17
Q

Describe the postganglionic fibres of the ciliary ganglion.

A

the parasympathetic fibres leave the ganglion via the short ciliary nerves. These fibres continue into the orbit to innervate the structures of the eye.

18
Q

What are the target organs of ciliary ganglion fibres

A

the post-ganglionic fibres from the ciliary ganglion innervate:
o Sphincter Pupillae (pupil contraction)
o Ciliary Muscles (accommodation)

19
Q

Describe sensory fibres and sympathetic fibres travelling with the postganglionic fibres from the ciliary ganglion.

A

• Sensory fibres from the eyeball, innervating the cornea, ciliary body and iris pass to the nasociliary nerve

• Sympathetic Fibres come from the Superior Cervical Ganglion
o Via the plexus on the Opthalmic Artery (First branch of the Internal Carotid Artery)
o Distributed to the eyeball, innervate the dilator pupillae muscle

20
Q

Where is the pterygopalatine ganglion located?

A

• Lies in the Pterygopalatine Fossa – space located inferiorly to the base of the skull.

21
Q

Describe the preganglionic fibres of the pterygopalatine ganglion.

A

o The pterygopalatine ganglion is supplied by fibres from the superior salivatory nucleus (associated with the facial nerve).
o These fibres travel within the greater petrosal nerve and the nerve of the pterygoid canal to reach the ganglion.

22
Q

Describe the postganglionic fibres of the pterygopalatine ganglion

A

o Parasympathetic fibres leave the ganglion by hitch-hiking on branches of the Maxillary nerve (V2)

23
Q

What are the target organs of pterygopalatine ganglion fibres

A

o The post ganglionic fibres from the pterygopalatine ganglion provide secretomotor innervation to the:
• Lacrimal gland
• Mucous glands of the posterosuperior nasal cavity
• Nasopharynx
• Palate.

24
Q

Describe sensory fibres and sympathetic fibres travelling with the postganglionic fibres from the pterygopalatine ganglion.

A

• Sympathetic fibres come from the Superior Cervical Ganglion
o Via the plexus on the Internal Carotid Artery
o Distributed to the nose, palate and nasopharynx

• Sensory fibres from the nose, palate and nasopharynx pass in the branches of the ganglion to the Maxillary Nerve (CN V2)

25
Q

Where is the submandibular ganglion located?

A

• Suspended from the Lingual Nerve by small branches on the surface of hypoglossus

26
Q

Describe the preganglionic fibres of the submandibular ganglion.

A

o The ganglion is supplied by fibres from the superior salivatory nucleus (associated with the facial nerve).
o These fibres are carried within the Chorda Tympani.
o This nerve hitch-hikes along the lingual branch of the mandibular nerve to reach the ganglion.

27
Q

Describe the postganglionic fibres of the submandibular ganglion

A

o Fibres leave the ganglion and travel directly to the submandibular and sublingual glands.

28
Q

What are the target organs of submandibular ganglion fibres

A

o Secretomotor innervation to
• Submandibular Gland
• Sublingual Gland

29
Q

Describe sensory fibres and sympathetic fibres travelling with the postganglionic fibres from the submandibular ganglion.

A

• Sympathetic fibres come from the Superior Cervical Ganglion
o Along the Facial Artery
o Pass to the glands in the floor of the oral cavity
• Taste fibres may pass through the ganglion

30
Q

Where is the otic ganglion located?

A

• Located inferiorly to the foramen ovale

31
Q

Describe the preganglionic fibres of the otic ganglion.

A

From inf. salivatory nucleus

Travel with lesser petrosal nerve of CNIX

32
Q

Describe the postganglionic fibres of the otic ganglion

A

Auriculotempral nerve of CNV3 hitchhike to parotid

33
Q

What are the target organs of otic ganglion fibres

A

Secretmotor or parotid gland

34
Q

Describe the vagus nerve parasympathetic.

A

Travel within vagus nerve, many ganglia located within target tissues. Smooth muscle of bronchi, trachea and GI tract

35
Q

Why does hornet’s syndrome occur?

A

Interruption of cervical sympathetic trunk.

Manifests as absence of sympathetically stimulated functions on ipsilateral side.

36
Q

What are the features of hornet’s syndrome?

A

Miosis

  • Constriction of pupil due to paralysis of dilator pupillae
  • sphincter pupillae of pupil is sympathetic, unopposed action

Ptosis
Dropping of superior eyelid
Paralysis of smooth muscle fibres interdigitated with the aponeurosis of legator palpebrae superiors in superior tarsal muscle.

Anhydrosis
Absence of sweating
Same side of face as lesion
Loss of innervation to the sweat glands of the face

Vasodilation
-Loss of sympatheticc tone
Increased temp and redness of skin

37
Q

What is the cervical plexus? Where is it located?

A

Network of nerve fibres that supply innervation to some of the structures in the neck and trunk.
Located in the posterior triangle of the neck, halfway up the SCM and within the prevertebral layer of cervical fascia.

38
Q

Where does the cervical pleas originate

A

C1 - C4 spinal nerves anterior fibres

39
Q

What are the muscular branches of the cervical plexus?

A

Phrenic nerve
- C3, C4, C5
Motor and sensory to diaphragm
Sensory to mediastinum

Nerve to geniohyoid and thyrohyoid
C1

Ansa cervicalis
C1, C2, C3
Infrahyoids

40
Q

What are the sensory branches of the cervical plexus?

A

Greater auricular nerve
C2 and C3
Sensation to external ear and skin over parotid

Transverse cervical nerve
C2, C3
Sensation to anteiror neck
Anterolateral skin of neck and upper sternum

Lesser occipital nerve
C2
Posteiror scalp cutaneous

Supraclavicular Nerves
C3, C4
Sensation over suprascapular fossa and upper thoracic region

41
Q

Where is entry for cervical nerve block? Who should you be carful of? Why?

A

Erb’s point - middle of posterior border of SCM
Regional anaesthesia for neck surgery
Affects phrenic nerve so should not bet performed on cardiac patients.

H&N Z (23 decks)

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