Autonomic Nervous System Of The Face

Question 1

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

Answer 1

Superior cervical sympathetic ganglion

Question 2

Where is the superior cervical sympathetic ganglion located?

Answer 2

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

Question 3

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

Answer 3

They are 4 pairs

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

Question 4

What is the pathway of the parasympathetic fibres of CIII?

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

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.

Question 7

Where is located the pterygopalatine ganglia?

Answer 7

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.

Question 8

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

Answer 8

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

Question 9

Where is the ciliary ganglia located?

Answer 9

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

Question 10

Where is the otic ganglion located?

Answer 10

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

Question 11

Where is the submandibular ganglion located?

Answer 11

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

Question 12

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

Answer 12

• 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

Question 13

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

Answer 13

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

Question 14

What fibres travel as lingual nerve?

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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.

Question 18

What does the otic ganglion supply?

Answer 18

The parotid gland for secretion of saliva and mucus

Mucus cells of posterior tongue and pharyngeal wall

Question 19

How would you address a dysfunction of the pterygopalatine ganglion?

Answer 19

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.

Question 20

What is the pathway of the sympathetic fibres to the head

Answer 20

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

Question 21

How do the sympathetic fibres travel in the head?

Answer 21

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

Question 22

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

Answer 22

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.

Question 23

What could be the effect of overactivation of the SCSG?

Answer 23

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

Question 24

What is the pathway of sympathetic fibres in the eyes?

Answer 24

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

Question 25

What is the effect of sympathetic disturbance in the eyes?

Answer 25

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)

Question 26

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

Answer 26

Dysfunction of CIII

Question 27

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

Answer 27

Stress factors or suboccipital restrictions

Question 28

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

Answer 28

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

Question 29

What is the tympanic plexus?

Answer 29

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

Question 30

What is the effect of sympathetic overstimulation in the ears?

Answer 30

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.

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

What could be the cause of migraine and headaches?

Answer 33

Overstimulation of sympathetic supply to the head, following vascular disturbances

Question 34

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

Answer 34

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

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

What is the overall effect of sympathetic overstimulation?

Answer 37

Excessive reactivity of all tissues and nerves and consequent dysfunction