Autonomic Nervous System Of The Face Flashcards

1
Q

Which one is the ganglion responsible of the sympathetic supply of the face?

A

Superior cervical sympathetic ganglion

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2
Q

Where is the superior cervical sympathetic ganglion located?

A

In the neck between C1 - C4, just below the cranium in the suboccipital region

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3
Q

How many parasympathetic ganglia do we have in the head and face? What are their names?

A

They are 4 pairs

  1. Ciliary ganglion
  2. Otic ganglion
  3. Pterygopalatine ganglion
  4. Submandibular ganglion
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4
Q

What is the pathway of the parasympathetic fibres of CIII?

A

They travel with oculomotor nerve through the middle cranial fossa, through the cavernous sinus, enter the superior orbital fissure and branch off to the ciliary ganglion in the posterior orbit to synapse with the postganglionic neurons and continue as short ciliary nerves together with sympathetic and sensory fibres (which do not synapse in the ganglion) and travel to the intrinsic muscle of the eye for lens accommodation and pupil constriction

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5
Q

What is the effect of disturbance to the parasympathetic fibres of CIII?

A

Disturbance in lens accommodation (adjusting to far distance vision) and pupil constriction, can therefore be associated with photo sensitivity

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6
Q

What is the pathway of the first division of the parasympathetic fibres travelling with CVII?

A

Parasympathetic fibres arise from the superior salivary nucleus in the pons and travel with the facial nerve as nervus intermedius through the facial canal as far as the geniculate ganglion
The first division exit from the facial canal at the level of the geniculate ganglion and travel through their own bony canal as the greater petrosal nerve, emerging into the middle cranial fossa and passing down through the foramen lacerum where they join with sympathetic fibres from the deep petrosal nerve and travel forward as the vidian nerve passing through the pterygoid canal to emerge in the pterygopalatine fossa. After synapsids at the pterygopalatine ganglion, they are distributed to the lacrimal glands, nasal glands and mucous membranes and glands of the nasal cavity, sphenoidal, maxillary and ethmoidal sinuses, tonsils, pharynx, palate, upper lip and gums.

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7
Q

Where is located the pterygopalatine ganglia?

A

In the pterygopalatine fossa, a space beneath the apex of the orbit, bounded by the body of the sphenoid superiority, lateral pterygoid plates of the sphenoid posteriorly, palatine medially and maxillae anteriorly.

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8
Q

What is the function of the fibres emerging from the pterygopalatine ganglia?

A
Lacrimal secretion of the lacrimal gland
Mucous secretion of the nasal glands
Mucous secretion of the mucous membranes of 
nasal cavity,
Sphenoidal, maxillary and ethmoidal sinuses
Tonsils
Palate
Upper lip and gums
Upper part of the pharynx
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9
Q

Where is the ciliary ganglia located?

A

In the posterior portion of the orbit, between the lateral rectus muscle and the optic nerve

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10
Q

Where is the otic ganglion located?

A

It’s located below the foramen ovale, between the mandibular nerve laterally and the cartilaginous portion of the Eustachian tube medially

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11
Q

Where is the submandibular ganglion located?

A

On the medial side of the mandible, close to the junction of the ramus with the body of the mandible, just above the submandibular gland

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12
Q

What is the pathway of the second division traveling with CVII?

A
  • Parasympathetic fibres arise from the superior salivary nucleus in the pons and travel with the facial nerve as NERVUS INTERMEDIUS through the facial canal
  • separate from the main trunk of the facial nerve between the geniculate ganglion and the stylomastoid foramen through a small bony canal and passing through the middle ear as part of the CHORDA TYMPANI NERVE together with the sensory branch of the facial nerve to the tongue .
  • subsequently the fibres join the LINGUAL NERVE (together with sensory fibres of the Mandibular nerve) and sympathetic fibres they travel to the submandibular ganglion

And travel to the submandibular and sublingual glands for saliva and mucous secretion from both glands and mucous secretion from the mucous membranes of the mouth

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13
Q

Where is the chorda tympani nerve? What fibres give form to this nerve?

A

The chorda tympani nerve is formed by sensory fibres of the CVII receiving taste information from he anterior 2/3 of the tongue
And parasympathetic fibres traveling to the submandibular ganglion
After separating in the facial canal from the main trunk of CVII before it exits the stylomastoid foramen, passes through a bony canal and enters the middle ear and travels forward joining the lingual nerve

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14
Q

What fibres travel as lingual nerve?

A
  1. Fibres which carry general sensation of pain, temperature and touch from the anterior 2/3 of the tongue, part of the mandibular division of CV
  2. Fibres which carry special sense of taste from anterior 2/3 of the tongue, part of CVII
  3. Parasympathetic fibres to submandibular ganglion to regulate saliva and mucus secretion of the submandibular ad sublingual glands and mucus secretion of mucous membranes of the mouth
  4. Sympathetic fibres to submandibular ganglion to regulate saliva and mucus secretion of the submandibular ad sublingual glands and mucus secretion of mucous membranes of the mouth
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15
Q

Why ear infections can cause loss of taste and dry mouth?

A

Because parasympathetic fibres of CVII to the submandibular ganglia and sensory fibres to the anterior 2/3 of the tongue travel through the middle ear as chorda tympani nerve and can be affected by ear infections in the middle ear

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16
Q

What are the fibres that form the tympanic nerve? What is its pathway?

A

The tympanic nerve is formed by
1. Sensory fibres of CIX to tympanic membrane, middle ear and auditory canal
2. Parasympathetic fibres to the parotid gland
It separates from the main CIX trunk at the inferior glossopharyngeal ganglion located in the jugular foramen, travels through its own bony canal through the temporal bone to the tympanic cavity where the sensory fibres end their journey and the parasympathetic continue as lesser petrosal nerve

17
Q

Where is the lesser petrosal nerve? What fibres form it?

A

It’s the continuation of the parasympathetic fibres of CIX traveling initially as tympanic nerve to the tympanic cavity. From the tympanic cavity the fibres as lesser petrosal nerve re-enter the cranial cavity through their own bony canal , exit the cranium again through the foramen ovale and synapse with the postganglionic fibres at the otic ganglion located just below the foramen ovale.

18
Q

What does the otic ganglion supply?

A

The parotid gland for secretion of saliva and mucus

Mucus cells of posterior tongue and pharyngeal wall

19
Q

How would you address a dysfunction of the pterygopalatine ganglion?

A

Within the context of the overall integration of the face, relevant contacts for addressing disturbances of the pterygopalatine ganglion include:
Contacts for the palatines
Contacts for the maxillae
Contacts for the vomer
Contacts for the sphenoid
It is also possible to take specific contact at the pterygopalatine fossa.

20
Q

What is the pathway of the sympathetic fibres to the head

A

They emerge at T1-T2
Travel up the neck within the sympathetic chain, synapsing at the superior cervical sympathetic ganglion on each side
Postganglionic fibres continue upwards as the carotid nerve together with the internal carotid artery passing through the carotid canal and emerging at the base of the cranium through the foramen lacerum
On the surface of the carotid artery , the carotid nerve divides into a network of fibres to create the carotid plexus
After emerging from the foramen lacerum, the carotid nerve passes through the cavernous sinus giving off numerous branches, widely distributed throughout the face

21
Q

How do the sympathetic fibres travel in the head?

A

They travel with most of the cranial nerves, joining their pathways briefly or for a more substantial section of their pathway, branching off in order to travel to the eyes, ears, nose, glands, arteries and all parts of the cranium.
Sympathetic fibres also join parasympathetic pathways and pass through parasympathetic ganglia

22
Q

What is the most common site of disturbance of the sympathetic supply to the head?

A

Disturbance of the SCSG in the suboccipital region
It can be disturbed by compression, injuries, restrictions and imbalances in the suboccipital region, upper cervical spine and the muscles of the neck, and by tension in the neck and contraction in the suboccipital area.

23
Q

What could be the effect of overactivation of the SCSG?

A

It may lead to widespread sympathetic overstimulation in the eyes, ears, nose, sinuses, pineal gland, pituitary gland and throughout the head, stimulating contraction of the intracranial membranes and potentially reducing arterial supply to the brain and throughout the face and cranium

24
Q

What is the pathway of sympathetic fibres in the eyes?

A

Within the orbit sympathetic fibres pass through the ciliary ganglion joining the parasympathetic fibres to continue as short ciliary nerves to the eyeball, where they supply the muscles of the iris for pupil dilation

25
Q

What is the effect of sympathetic disturbance in the eyes?

A

Photophobia, tired eyes, dry eyes, susceptibility to infections and other symptoms may be attributable to sympathetic overstimulation:
Increased sympathetic stimulation may lead to overdilated pupils and consequent photophobia (over sensitivity to light)
Sympathetic overstimulation inhibits lacrimal secretion and causes vasoconstriction of the arteries.
Sympathetic supply to the eye also helps in rising the upper eyelid through its innervation of the superior tarsal muscle (smooth muscle of the eyelid)

26
Q

If only one pupil is dilated, particularly if it’s accompanied by drooping eyelid (ptosis) what could be the cause?

A

Dysfunction of CIII

27
Q

If both pupils are dilated and photophobic, what could be the cause?

A

Stress factors or suboccipital restrictions

28
Q

If one pupil is constricted, in combination with unilateral ptosis and unilateral increased lacrimation, what would this suggest?

A

Loss or decreased sympathetic supply on that side (Horner’s syndrome)

29
Q

What is the tympanic plexus?

A

It’s the network of sympathetic fibres that from the carotid plexus travel through the middle ear, and form, together with the parasympathetic and sensory fibres of the CIX, the tympanic plexus on the medial wall of the tympanic cavity

30
Q

What is the effect of sympathetic overstimulation in the ears?

A

In view of the increased reactivity of all tissues and nerves brought about by sympathetic overstimulation, it could increase susceptibility to ear infections, earache, tinnitus and hyperacusis.

31
Q

What is the effect of sympathetic overstimulation of the nose, mouth, sinuses and face?

A

It may inhibit secretion, leading to dryness and irritability of the mucous membranes. The increased reactivity brought about to tissues and nerves could increase hypersensitivity to irritants and allergens, contributing to dry nose, dry mouth, dry skin, hay fever, sinusitis and other disturbances

32
Q

What is the pathway of the sympathetic fibres traveling to the nose, mouth, sinuses and face?

A

They travel with the parasympathetic fibres associated with the CVII, passing through the pterygoid canal as the VIDIAN NERVE and then to the pterygopalatine ganglion before being distributed throughout the face.
Other sympathetic fibres travel along somatic sensory or motor nerve pathways

33
Q

What could be the cause of migraine and headaches?

A

Overstimulation of sympathetic supply to the head, following vascular disturbances

34
Q

How would you address overstimulation of the sympathetic supply to the head?

A
  1. Identifying if the disturbance is systemic, local or both
  2. Whether it’s stress related, trauma related, caused by structural restriction or both
  3. If the cause is stress related or trauma related, overall integration of the system may be the main requirement
  4. Within this context, it will be relevant to identify specific sites of restrictions or disturbance along the pathway, examining the nature of the symptoms and through cranio-sacral therapeutic attention
35
Q

What’s the best approach to sympathetic overstimulation in the head?

A

Sympathetic distribution is so widespread and ubiquitous that overall integration of the head and face, resolving any restrictions or imbalances and restoring full mobility and fluency, is likely to be more significant than following detailed pathways.
However, specific local restrictions also need to be identified and addressed

36
Q

What would be your strategy for sympathetic overactivation of the face and head?

A
  1. Assess the overall level of stress and trauma
  2. Overall integration including psycho-emotional factors
  3. Assess and address the SCSG, suboccipital area, neck, whole sympathetic pathway through the face and head
  4. Address specific areas if the symptoms are more local: bony restrictions, muscular and fascial tension, mucous and vascular congestion, disturbance to the free mobility of any area
37
Q

What is the overall effect of sympathetic overstimulation?

A

Excessive reactivity of all tissues and nerves and consequent dysfunction