Craniofacial Autonomics

Question 1

General rules for autonomics in the head:

All sympathetic fibers are _________, arising from the _____ ____ ganglion of the sympathetic trunk.

They travel on _______ to the structures they innervate.

The ______ n. is the only named sympathetic nerve of importance

Answer 1

Postganglionic; superior cervical ganglion

Vessels

Deep petrosal

Question 2

Where do the preganglionic parasympathetic fibers in the head arise from and then synapse?

Answer 2

Arise from nuclei in the brainstem and synapse at 4 ganglia in the head: ciliary, pterygopalatine, otic, and submandibular

Question 3

Preganglionic parasympathetics are carried by what cranial nerves?

Answer 3

III
VII
IX
X

Question 4

All postganglionic fibers (and preganglionic fibers for sublingual and submandibular salivary glands) “piggy back” on a branch of the _____ n. to arrive at the structure they innervate

Answer 4

Trigeminal

Question 5

Sympathetic nn. synapse in the superior cervical ganglion, then travel on vessels to the structures they innervate.

After synapsing at the superior cervical ganglion, the ____ artery plexus and ________ artery plexus travel via those vessels to provide vasomotor innervation to the sublingual, submandibular, and parotid salivary glands

Answer 5

Facial; external carotid

Question 6

Sympathetic nn. synapse in the superior cervical ganglion, then travel on vessels to the structures they innervate.

After synapsing at the superior cervical ganglion, the internal carotid a. plexus travels superiorly, giving off the deep petrosal n. (branch of CN VII) which passes through the ______ canal as well as the _________ ganglion to innervate blood vessels and sweat glands in the nasal region

Answer 6

Pterygoid; pterygopalatine

Question 7

Sympathetic nn. synapse in the superior cervical ganglion, then travel on vessels to the structures they innervate.

After synapsing at the superior cervical ganglion, the internal carotid a. plexus travels superiorly, giving off postganglionic fibers that pass through the _____ ganglion to affect pupillary dilation and accommodation. These functions are also served by the ______ n. (a branch of CN V1), which will further branch into long ciliary nn.

Answer 7

Ciliary

Nasociliary

Question 8

Which of the following is not a major arterial plexus carrying postsynaptic sympathetic fibers to their final destination?

A. Internal carotid artery plexus
B. External carotid artery plexus
C. Facial artery plexus
D. Common carotid artery plexus

Answer 8

D. Common carotid artery plexus

Question 9

What is Horner’s syndrome and what are potential causes?

Answer 9

Horner’s syndrome = a disrupted sympathetic nerve pathway on one side from the brain to the face and eye

Possible causes:
Stroke in brainstem
Injury to carotid a.
Tumor in upper lobe of lung
Migraines
Cluster headaches
Neck trauma or surgery
Tumor in brainstem or hypothalamus

Question 10

Signs/symptoms of Horner’s syndrome

Answer 10

Persistently small pupil (miosis)
Notable difference in pupil size (anisocoria)
Little or delayed dilation of affected pupil in dim light
Drooping of upper eyelid (ptosis)
Slight elevation of lower lid
Little or no sweating (anhidrosis) on either side of face

Question 11

What cranial nerves carry parasympathetic (GVE) modality?

Answer 11

III: oculomotor
VII: Facial
IX: Glossopharyngeal
X: Vagus

[these piggy back on the trigeminal]

Question 12

What nuclei in the brain convey CN’s with general sensory afferent modalities?

Answer 12

Mesencephalic trigeminal nucleus (CN V)

Pontine trigeminal nucleus (CN V)

Spinal trigeminal nucleus (CNs V, VII, IX, and X)

Question 13

Parasympathetic fibers from CN III travel from visceral oculomotor (edinger-westphal) nucleus until they synapse in the _____ ganglion prior to completing their journey to the eye

Answer 13

Ciliary

Question 14

Parasympathetic fibers from CN VII travel from the superior salivatory nucleus prior to synapsing in either the _______ ganglion (to travel onto the eye and nose) or the _____ ganglion (to travel on to the sublingual + submandibular glands)

Answer 14

Pterygopalatine; submandibular

Question 15

Parasympathetic fibers of CN IX travel from the inferior salivatory nucleus until they synapse at the _____ ganglion, prior to completing their journey to the parotid gland

Answer 15

Otic

Question 16

Parasympathetic fibers of CN X travel from the dorsal motor nucleus until they synapse in either the _____ ganglia (prior to travelling on to the lung or heart), or the _____ ganglia prior to supplying the GI tract

Answer 16

Thoracic; abdominal

Question 17

Along with the ability of parasympathetics to originate in nuclei within the head, first order neurons can also come from the _____ and higher centers prior to synapsing at the ganglia in the head

Answer 17

Hypothalamus

Question 18

Which of the following are under sympathetic control:

Constrictor pupillae
Ciliary muscles
Dilator pupillae

Answer 18

Dilator pupillae

[constrictor pupillae and ciliary muscles are parasympathetic via CN III]

Question 19

T/F: parasympathetic fibers give rise to either short or long ciliary nn.

Answer 19

False, since parasympathetic synapse in ciliary ganglion, will only see short ciliary nn to ciliary mm

However, sympathetics travel from carotid plexus, either travelling through the ciliary ganglion to become short ciliary nn, or piggy back on trigeminal to become long ciliary nn

Question 20

What named branch of CN VII provides visceral (parasympathetic) motor to submandibular and sublingual glands?

Answer 20

Chorda tympani

Question 21

The chorda tympani branch arises from CN VII just superior to the ______ foramen. It then crosses the tympanic cavity medial to the handle of the ______.

It then passes through the petrotympanic fissure between the tympanic and petrous parts of the _____ bone to join the ______ n. (branch of CN V3) in the infratemporal fossa.

Parasympathetic fibers of the chorda tympani synapse in the ______ ganglion; postsynaptic fibers follow arteries to glands

Answer 21

Stylomastoid; malleus

Temporal; lingual

Submandibular

Question 22

Visceral (parasympathetic) motor to lacrimal gland:

The greater petrosal n. arises from CN VII at the _____ ganglion and emerges from the superior surface of petrous part of temporal bone to enter _____cranial fossa.

Greater petrosal n. joins _____ petrosal n. (sympathetic) at foramen lacerum to form the nerve of the pterygoid canal

The nerve of the pterygoid canal travels through the pterygoid canal and enters the pterygopalatine fossa. Parasympathetic fibers from the nerve of pterygoid canal in pterygopalatine fossa synapse in the _____ ganglion.

Postsynaptic parasympathetic fibers from this ganglion innervate the lacrimal gland via _____ branch of V2 and ______ n. (branch of CN V1)

Answer 22

Geniculate; middle

Deep

Pterygopalatine

Zygomatic; lacrimal

Question 23

Visceral (parasympathetic) motor function of CN IX:

The tympanic n. arises from CN IX and emerges with it from the ______ foramen; it then enters middle ear via tympanic canaliculus in petrous part of temporal bone.

The tympanic n. forms the tympanic plexus on promontory of middle ear. The ______ n. arises as a branch of tympanic plexus, penetrating the root of the tympanic cavity to enter _____ cranial fossa, eventually leaving the cranium through the foramen _____.

Parasympathetic fibers synapse in the ____ ganglion; postsynaptic fibers pass to parotid gland via branches of the _____ n. (branch of CN V3)

Answer 23

Jugular

Lesser petrosal; middle; ovale

Otic; auriculotemporal

Question 24

What is the significance of the superior and inferior ganglia found on the vagus n. in the neck?

Answer 24

These contain sensory info (visceral afferent) returning from the guts, meninges, head, and ear — nothing to do with parasympathetics to head/neck!