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Head And Neck > 6.1 Autonomic Innervation Of Head And Neck Structures > Flashcards

6.1 Autonomic Innervation Of Head And Neck Structures Flashcards

1
Q

What are the 2 major components of the peripheral nervous system?

A
  1. Autonomic nervous system - unconscious control

2. Somatic nervous system - conscious control

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2
Q

What are the main target tissues for ANS in the head and neck?

A

Smooth muscle (blood vessels and eye) and glands (sweat, lacrimal and salivary)

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3
Q

Where does the sympathetic outflow arise from?

A 
Thoracocolumbar portion (T1 to L2) 
Lateral horn
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4
Q

Where do the sympathetic preganglionic nerves synapse?

A

In the Sympathetic chain. May travel superiorly or inferiorly from the level of their spinal cord origin before synapsing.

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5
Q

At what spinal level does the sympathetic outflow to the head and neck arise from?

A

T1/T2

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6
Q

Where do preganglionic sympathetic nerves to the head and neck synapse?

A

Superior cervical ganglia

sometimes middle cervical ganglia

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7
Q

How do postganglionic sympathetic fibres reach their target tissues in the head and neck?

A

Hitch hiking onto blood vessels ( internal carotid artery and the external carotid artery)

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8
Q

Where does parasympathetic outflow arise from?

A

Craniosacral outflow

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9
Q

What structures are supplied by the parasympathetic fibres from the cranial portion?

A

Structures of the head and neck.

Structures of the thorax and abdomen (via the vagal nerve)

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10
Q

Where do the nuclei of the preganglionic parasympathetic fibres lie?

A

In the brain stem.

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11
Q

What structures do the preganglionic parasympathetic fibres travel with when leaving the brain stem?

A

Cranial nerves

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12
Q

What are the 4 discrete ganglia associated with the parasympathetic outflow to the head?

A

ciliary ganglia
Pterygopalatine ganglia
Submandibular ganglia
Otic ganglia

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13
Q

Which cranial nerves are parasympathetic fibres associated with?

A

CN III
CN VI
CN IX
CNX

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14
Q

What structures are the postganglionic parasympathetic fibres associated with?

A

Trigeminal Nerve

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15
Q

Where is the central control of the ANS?

A

In the hypothalamus

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16
Q

How many neurones are in series in the autonomic nervous system?

A

2 - preganglionic and postganglionic

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17
Q

What 2 muscles of the head and neck are under sympathetic innervation?

A 
Eye lid (tarsal muscle)
Iris (dilator pupillae )
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18
Q

What are the 2 muscles of the eye that have parasympathetic innervation?

A

Iris (sphincter pupillae)

Muscle in the ciliary body (control thickness of the lens)

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19
Q

Where are the cell bodies of the sympathetic preganglionic neurones?

A

Lateral horn of the grey matter of the spinal cord

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20
Q

What sympathetic ganglion are located in the neck?

A

The top 3 ganglion in the sympathetic chain are located in the neck and are known as the cervical ganglion.
Superior cervical ganglion
Middle cervical ganglion
Inferior cervical ganglion

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21
Q

What are the target tissues in the head and neck of the sympathetic neurones?

A

Sweat glands of the forehead
Smooth muscles of the eyelid
Pupil
Sweat glands of the face

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22
Q

Pathology to what structures of the head and neck can cause autonomic dysfunction to the eye and face?

A

Apex of the lung (tumours)

Common carotid artery

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23
Q

How will a patient with disrupted sympathetic innervation to the face present?

A

Partial Ptosis
Myosis
Absence of sweating on half of face ipsolateral with lesion (anhydrosis)

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24
Q

Why in Horner’s Syndrome, is the Ptosis only partial?

A

Only partial Ptosis as the skeletal muscle of the Levator Palpebrae muscle is still working to open the eyelid.
Levator palpebrae superioris opens the eye lid and has both skeletal and smooth muscle components. The skeletal muscle component is stronger and innervated by the motor fibres of the oculimotor nerve. The small smooth muscle component of the LPS known as the superior tarsal is innervated by the sympathetic nerves and is paralysed in Horners Syndrome.

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25
Q

In an occulomotor nerve lesion, why is the Ptosis experienced not partial?

A

As the occulomotor nerve innervates the skeletal muscle of the Levator palpebrae muscle. The skeletal muscle makes up the bulk of the LPS and if paralysed the smooth muscle is not strong enough to elevate the eyelid.

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26
Q

How would the pupil differ in Horner’s Syndorme compared to an oculomotor nerve lesion?

A

Horners syndrome = miosis

CN III lesion = Mydriasis

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27
Q

What is Anhydrosis?

A

Lack of sweating

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28
Q

What are the 4 cranial nerves that carry preganglionic parasympathetics out from the brain stem?

A

Oculomotor nerve
Facial Nerve
Glossopharyngel Nerve
Vagus Nerve

29
Q

What cranial nerves carry sympathetic nerves?

A

None - associated with blood vessels

30
Q

What cranial nerve is associated with postganglionic parasympathetic neurones?

A

Trigeminal

31
Q

What are the names of the 4 nucleus’ of parasympathetic presynaptic neurones to the head and neck?

A

Edinger Westphal.

Superior salivary
Inferior salivary
Dorsal motor

32
Q

Which nucleus is associated with the oculomotor parasympathetic fibres?

A

Edinger Westphal nucleus

33
Q

What are the 4 parasympathetic ganglia of the parasympathetic system called?

A

Ciliary
Submandibular
Pterygopalatine
Otic

34
Q

What is the name of the ganglion at which the parasympathetic axon travelling with the oculomotor nerve synapses with?

A

Ciliary ganglion

35
Q

What do the postganglionic nerve fibres from the ciliary ganglion supply?

A

Ciliary muscle

Sphincter Pupillae muscle

36
Q

Why are patients with a n expanding aneurysm of the posterior communicating artery likely to experience a blown pupil?

A

Likely to cause compression of the oculomotor nerve. the parasympathetic fibres from the ciliary ganglion sit on the outside of CN III and will be initially affected in compression pathology resulting in a blown pupil.

37
Q

How do we test the function of the parasympathetics fibres of the oculomotor nerve?

A

Pupillary light reflex test.

38
Q

Why is there contraction of both pupils if light is shone into one eye?

A

Light sensed by optic nerve (CN II) and relayed back to the optic chiasm. Here the information exchanges from both eyes before being transmitted via the optic tract to the pre-textual-nucleus on wither side. Edinger Westphal cell bodies in the brain stem receive the information. As both receive the same information, the response in the parasympathetics travelling via CN III to both pupils are the same. Constrictionof sphincter pupillae muscle.

39
Q

What is anisocoria?

A

Inequality in the size of the pupils of the eye.

40
Q

A patient presents with anisocoria. You shine a light in the right eye. The right pupil does not constrict but the left pupil does. You shine a light in the left eye. The left pupil constricts but the the right pupil does not. Where is the lesion likely to be?

A

Efferent limb of the oculomotor nerve of the right eye

41
Q

How many extra cranial branches does the facial nerve give?

A 
5
Temporal
Zygomatic 
Buccal
Marginal mandibular
Cervical
42
Q

How many intercranial branches does the facial nerve have? Name them

A

3
Greater pet Rosa
Nerve to Stapedius
Chorda Tympani

43
Q

Which intracranial branches of CN VII carry parasympathetic fibres?

A

Greater petrosal nerve

Chorda Tympani nerve

44
Q

What are the 2 parasympathetic ganglia associated with the facial nerve?

A

Pterygopalatine

Submandibular

45
Q

Where is the Pterygopalatine ganglion found?

A

In the pterygopalatine fossa

46
Q

Where does the facial nerve originate?

47
Q

What bone does the facial nerve enter to give its intracranial branches?

A

The petrous bone

48
Q

What is the geniculate ganglion?

A

A sensory ganglion that lies within the petrous bone. Contains the sensory cell bodies of sensory nerves associated with CN VII

49
Q

When does CN VII give off the greater petrosal nerve?

A

Within the petrous bone, at the level of the geniculate ganglion.

50
Q

What information is carried in the greater petrosal nerve?

A

Parasympathetic

51
Q

Describe the path of the greater petrosal nerve ?

A

Petrous bone ->foramen lacerum -> pterygopalatine fossa to synapse with the Pterygopalatine ganglion

52
Q

What are the target tissues of the Saxons extending from the pterygopalatine ganglion?

A

The lacrimal glands

Mucosal gland of nasal cavity and palate

53
Q

What information is carried within the nerve to the stapedius?

A

Purely motor

54
Q

What information is carried by the chordae tympani?

A

Special sensory

Parasympathetic - hitchhikes

55
Q

Which parasympathetic neurones synapse at the submandibular ganglion?

A

Parasympathetics associated with the chordae tympani

56
Q

What are the target tissues of axons of the submandibular ganglia?

A

Salivary glands (submandibular and sublingual )

57
Q

How does the facial nerve exit the petrous bone?

A

Stylomastoid foramen

58
Q

In patients that present with facial nerve palsy, aswell as dry eyes and mouth, where is the lesion likely to be?

A

Before the facial nerve enters the petrous bone, between pons and internal acoustic meatus

59
Q

In a lesion of CN VII at the stylomastoid foramen, what functions are likely to be affected/spared?

A

Palsy of muscles of facial expression

Sparing of lacrimal, mucosal and salivary glands.

60
Q

How does the glossopharyngeal exit the intracranial cavity?

A

Via the jugular foramen

61
Q

What branch of CN IX supplies the middle ear?

A

Tympanic nerve - sensory to the middle ear

62
Q

How is the lesser petrosal nerve formed?

A

Lesser petrosal nerve is parasympathetic fibres that hitchhiked via CN IX and the tympanic nerve to exit at the middle ear.

63
Q

Which nerve synapses with the otic nerve?

A

Lesser petrosal nerve

64
Q

What structure does the lesser petrosal nerve exit through to reach the otic nerve?

A

Foramen ovale

65
Q

What do the postganglionic fibres from the otic gland supply?

A

The parotid gland.

66
Q

What are the target tissues of CN IX?

A

Special sensory and sensation from posterior 1/3 of tongue
Motor to Stylopharyngeus muscle
Sensory to carotid body

67
Q

Where does the vagus nerve start?

A

At medulla

68
Q

What do parasympathetics carried by the vagus nerve supply?

A

Mucosal glands in pharynx/larynx/respiratory tract/GI tract
Smooth muscle of oesophagus/trachea/respiratory tract/GI tract
Heart

Head And Neck (13 decks)

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