Autonomic Innervation Of Head And Neck Flashcards
What is the sympathetic nerve outflow?
Thoracolumbar outflow
What is the parasympathetic outflow?
Craniosacral outflow
Brainstem via III, VII, IX + X
S2-S4 pelvic splanchnics
Outline the sympathetic innervation of the head and neck
- pre ganglionic sympathetic nerves exit at T1/T2
- enter sympathetic chain + ascends up
- reach cervical ganglion + synapse to a post ganglionic sympathetic neurone
- run on outside of CCA + then outside of ICA + ECA
What type of nervous system is the autonomic nervous system part of?
Peripheral nervous system
What do sympathetic nerves to the eye + orbit run with?
Internal carotid artery > ophthalmic artery
Distal branches of Va
Where do sympathetic nerves for the head and neck exit the spinal cord?
T1/T2
What do sympathetic nerves to sweat glands on face + neck run with?
Branches of external carotid artery
Where can sympathetic innervation to the head and neck be damaged?
- 1st order neurone: within CNS e.g. spinal cord injury
- 2nd order neurone: pre-ganglionic neurone - exiting CNS + within sympathetic chain
- 3rd order neurone: post ganglionic neurone - running with blood vessels
Which cranial nerves carry parasympathetic fibres with them?
Oculomotor III
Facial VII
Glossopharyngeal IX
Vagus X
What muscles are innervated by the sympathic nervous system in the eye and orbit?
Dilator pupillae
Levator palpebrae superioris
Clinical manifestations of interruption of sympathetic innervation to face + eye
Horner’s syndrome
- partial ptosis
- miosis
- anhidrosis
- (enophthalamus)
What neurones connect the sympathetic nerves to the hypothalamus?
1st order neurone (within CNS)
What are 1st order neurones?
Within CNS
What are 2nd order neurones?
Pre ganglionic neurones
(Exiting CNS + within sympathetic chain)
What are 3rd order neurones?
Post ganglionic neurones
(Running with blood vessel)
What is the innervation of the smooth + skeletal muscle of levator palpebrae superioris?
Skeletal: Oculomotor III | majority
Smooth: sympathetics |minority
What is Horner’s syndrome?
Ptosis (partial)
Miosis - constricted pupil
Anhidrosis - lack of sweating
(Enophthalmos - apparent sinking of eye)
Doesn’t effect the muscles of the eye
What is miosis?
Constricted pupil
What is anhidrosis?
Lack of sweating
Outline the parasympathetic innervation to head and neck
- parasympathetic nuclei in brainstem
- pre ganglionic axon exit with CNs III, VII, IX or X
- parasympathetic ganglia
- post ganglionic exit ganglia + run with distal branches of CN Va,b,c (except vagus X)
What do the parasympathetic post ganglionic neurones run with?
Distal branches of trigeminal nerve Va,b,c,
(Except vagus nerve X)
Parasympathetic target tissue of Oculomotor nerve II
- Sphincter pupillae: constricts pupil
- Ciliary muscle: flattens lens
Parasympathetic target tissue of facial nerve VII
- lacrimal glands: tears
- nasal + mucosal gland: mucus
- salivary glands (not parotid): saliva
Parasympathetic target tissue of glossopharngeal nerve IX
Parotid gland: saliva
Parasympathetic target tissue of vagus nerve X
- mucosal glands + smooth muscle in resp + GI tracts
- cardiac muscle
Name the parasympathetic nuclei (pre-ganglionic) of the Oculomotor nerve III
Edinger Westphal nucleus
Name the parasympathetic nuclei (pre-ganglionic) of the facial nerve VII
Superior salivary nucleus
Name the parasympathetic nuclei (pre-ganglionic) of the glossopharyngeal nerve IX
Inferior salivary nucleus
Name the parasympathetic nuclei (pre-ganglionic) of the vagus nerve X
Dorsal motor nucleus
Name the parasympathetic ganglion (post-ganglionic) of the Oculomotor nerve III
Ciliary ganglion
Name the parasympathetic ganglion (post-ganglionic) of the facial nerve VII
Pterygopalatine ganglion
Submandibular ganglion
Name the parasympathetic ganglion (post-ganglionic) of the glossopharyngeal nerve IX
Otic ganglion
Name the parasympathetic ganglion (post-ganglionic) of the vagus nerve X
No named ganglia
Sit within target tissues
What are the types of pupillary reflexes?
Direct: same pupil constricts
Consensual: opposite pupil constricts
What are the sensory + motor innervation of the pupillary reflex?
Sensory: optic nerve II
Motor: Oculomotor nerve III PNS
Outline the pupillary light reflex
- light in left eye
- sensory afferent from left retina from optic nerve II
- some branches leave CN II + enter midbrain on left
- synapse on pre-rectal nucleus
- connection with edingar-westphal nuceli on left and right
- pre-ganglionic parasympathetic fibres from EDW leaves brainstem as part of CN III on left and right
- synapse in ciliary ganglion
- post ganglionic axon reaches sphincter pupillae muscle + ciliary body **
Parasympathetic of Oculomotor nerve
- parasympathetic nuclei/ pre ganglionic
- parasympathetic ganglion/ post ganglionic
- target tissues
- Edinger Westphal nucleus
- ciliary ganglion
- sphinchter pupillae + ciliary muscle
Parasympethic of facial nerve
- parasympathetic nuclei/ pre ganglionic
- parasympathetic ganglion/ post ganglionic
- target tissues
- superior salivary nucleus
- Pterygopalatine (greater petrosal) + submandibular (chordae tympani)
- lacrimal (GP), nasal + mucosal glands + salivary glands (not parotid) (CT)
Parasympathetic of glossopharyngeal nerve
- parasympathetic nuclei/ pre ganglionic
- parasympathetic ganglion/ post ganglionic
- target tissues
- inferior salivary nucleus
- Otic ganglion
- parotid gland
Parasympathetic of vagus nerve
- parasympathetic nuclei/ pre ganglionic
- parasympathetic ganglion/ post ganglionic
- target tissues
- dorsal motor nucleus
- no named ganglia | sit very close to target tissue
- cardiac muscle + mucosal glands + smooth muscle in respiratory + GI tract
What is the organisation of the autonomic nervous system?
- craniosacral outflow for parasymathic fibres
- thoracolumbar outflow for sympathetic fibres
What is a Pancoast tumour?
Non small cell lung cancer located at apex of lung
What could cause disruption to sympathetic nervous supply to head and neck?
Pancoast tumour
Carotid artery pathology
