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HNNS > HNS26, HNS27 Nerves Of Head And Neck I, II > Flashcards

HNS26, HNS27 Nerves Of Head And Neck I, II Flashcards

1
Q

Classification of nervous system

A

CNS:
Brain + Spinal cord

PNS:
Cranial nerves + Spinal nerves + Ganglia + Plexuses

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2
Q

Gross anatomical approach

A

Structures:

  1. Ganglia
  2. Nerves

Nerves to:

  1. Skin
  2. Muscles
  3. Viscera
  4. Special sensory organs
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3
Q

Special sensory organs

A
  1. Vision
  2. Smell
  3. Taste
  4. Hearing
  5. Balance
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4
Q

Nerve and Neuron

A

Nerve:

  • Visible gross anatomically —> Bundle of neurons
  • Can have mixture of neurons —> ∴ can be mixed sensory / motor

Neuron:

  • Cell with extension + cell body (Histological)
  • Either Sensory / Motor —> cannot be both at the same time
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5
Q

Functional division of CNS / 5 types of peripheral tissue

A

Motor nerves:

  1. Skeletal muscle (Somatic motor)
  2. Smooth muscle (Autonomic)
  3. Gland (Autonomic)

Modified sensory neuron —> Modified nerves:

  1. General sensory organs
  2. Special sensory organs
  3. Reflexes
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6
Q

Example: innervation of gland

A

When need to secrete:

CNS (Nucleus) —> Ganglion —> Cranial nerves —> Parasympathetic fibres —> Gland

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7
Q

Innervation of head and neck

A

Nerves:

  • Cranial nerve (12)
  • Spinal nerve (5)

Ganglia:
- Autonomic ganglia
—> Sympathetic trunk (Cervical part) (3)
—> Parasympathetic ganglia (4)

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8
Q

***Ganglia of Head and Neck

A

Rmb: Ganglia (唔係Nucleus!!!)

Motor (Autonomic) ganglia:

  • Sympathetic ganglia (within sympathetic chain)
    1. Superior cervical ganglion
    2. Middle cervical ganglion
    3. Inferior cervical ganglion
  • Parasympathetic ganglia
    1. Ciliary ganglion
    2. Pterygopalatine ganglion
    3. Submandibular ganglion
    4. Otic ganglion

Sensory ganglia:

  • General sensory
    1. Dorsal root ganglia (T2-T5)
    2. Trigeminal ganglion (CN5) —> Trigeminal nucleus
    3. Superior glossopharyngeal ganglion (CN9) —> Trigeminal nucleus
    4. Superior vagal ganglion (Jugular ganglion) (CN10) —> Trigeminal nucleus
    (5. Geniculate ganglion (CN7))
  • Special sensory
    1. Vestibular ganglia + Spiral ganglion (CN8) —> Vestibular + Cochlear nucleus
    2. Geniculate ganglion (CN7) —> Gustatory nucleus
    3. Inferior glossopharyngeal ganglion (half general sensory, half special sensory (posterior 1/3 tongue taste)) (CN9) —> Trigeminal / Gustatory nucleus
    (4. Bipolar cells in olfactory epithelium (CN1))
    (5. Retinal ganglion cells (CN2))
    (6. Inferior vagal ganglion (Nodose ganglion) (CN10) epiglottis taste buds)
  • Visceral sensory
    1. Inferior glossopharyngeal ganglion (CN9) —> Solitary nucleus
    2. Inferior vagal ganglion (Nodose ganglion) (CN10) —> Solitary nucleus
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9
Q

Organisation of spinal nerves

A

Spinal cord
—> Spinal nerve roots (Dorsal + Ventral root)
—> Spinal nerve
—> Branch (Dorsal + Ventral rami + Rami communicantes (gray / white rami —> leads to sympathetic ganglion))

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10
Q

Somatic motor

A

Anterior horn cells
—> Ventral root
—> Ventral / Dorsal ramus
—> Skeletal muscles

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11
Q

Sympathetic motor

A

Lateral horn (Cell bodies of Preganglionic neuron)
—> Ventral root
—> White ramus
—> Sympathetic ganglion (Sympathetic chain, Secondary neuron)
—> Gray ramus
—> Spinal nerves at the same level —> Ventral / Dorsal ramus (skin of body)
OR
—> Sympathetic nerve at other levels —> Ventral / Dorsal ramus (head and neck)

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12
Q

Cervical spinal nerves

A
  • 8 segments

- 1st pair between foramen magnum and C1 vertebra

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13
Q

***Spinal nerves dermatomes

A

Spinal nerve ONLY supply
- posterior scalp
- neck
—> C2-C5

Anterior neck: Anterior rami of spinal nerves (C2-4 of Cervical plexus + C5)
Posterior scalp + neck: Posterior rami of spinal nerves (C2-5)

(Face supplied by Cranial nerve)

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14
Q

***Cutaneous distribution of spinal nerves

A

Posterior rami of spinal nerve

  • Greater occipital nerve (C2) (posterior scalp)
  • Third occipital nerve (C3) (posterior neck)
  • C4 (posterior neck)
  • C5 (posterior neck)

Anterior rami of spinal nerve

  • Lesser occipital nerve (C2, C3 —> cervical plexus) (lateral scalp)
  • Greater auricular nerve (C2, C3 —> cervical plexus) (anterior neck, angle of mandible, ear)
  • Transverse cervical nerve (C2, C3) (anterior neck)
  • Supraclavicular nerve (C3, C4) (Lateral + Intermediate + Medial) (clavicular region)
  • Superior / Inferior root of Ansa cervicalis

Cervical plexus: formed from C1-C4
Ansa cervicalis: part of Cervical plexus that ***also carries Cranial nerves e.g. CN12

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15
Q

Cranial nerves

A

CN3-12 emerges from Brainstem

12 pairs of CN related to 12 structures in head and neck
—> NOT all similar anatomically (NOT have similar structures e.g. root, rami)

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16
Q

***Functional classifications of Cranial nerves

A

Sensory (Special sensory):

  • Olfactory (CN1)
  • Optic (CN2)
  • Vestibulocochlear (CN8)

Motor (only Somatic motor except CN3):

  • Oculomotor (CN3) —> Visceral + Somatic
  • Trochlear (CN4)
  • Abducent (CN6)
  • Accessory (CN11)
  • Hypoglossal (CN12)

Mixed (General sensory + Visceral sensory + Special sensory + Somatic motor + Visceral motor):

  • Trigeminal (CN5)
  • Facial (CN7)
  • Glossopharyngeal (CN9)
  • Vagus (CN10)
17
Q

Cranial “Purely” somatic motor nerves

A
  1. Movement of eyeball (somatic)
    - CN3
    - CN4
    - CN6
  2. Intraocular muscles (autonomic)
    - CN3 (with ***Ciliary ganglion: Parasympathetic —> Pupillary light reflex)
  3. Neck, back muscles (SCM, Trapezius)
    - CN11
  4. Tongue muscles (except palatoglossus)
    - CN12
18
Q

Cranial “Purely” special sensory nerves

A
  1. Smell
    - CN1
  2. Vision
    - CN2
  3. Hearing
    - CN8 (Spiral ganglion)
  4. Balance
    - CN8 (Vestibular ganglion)
19
Q

***Cranial mixed nerve

A

CN5:

  1. General sensation of face (somatic sensory)
    - CN5 (Trigeminal ganglion)
  2. ***Muscles of mastication, Tensor tympani, Tensor veli palatini, Mylohyoid, Anterior belly of digastric (somatic motor)
    - CN5 (CNV3)

CN7:

  1. **Muscles of facial expression, **Stapedius, **Stylohyoid, **Posterior belly of digastric etc. (somatic motor)
    - CN7
  2. Taste (anterior 2/3 tongue) (special sensory)
    - CN7 (***Geniculate ganglion)
  3. Submandibular, Sublingual gland (visceral motor)
    - CN7 (***Submandibular ganglion: Parasympathetic) (From Superior salivatory nucleus)
  4. Lacrimal gland + Nasal gland + Palatine gland (visceral motor)
    - CN7 (***Pterygopalatine ganglion: Parasympathetic) (From Superior salivatory nucleus)

CN9:

  1. ***Stylopharyngeal muscle (somatic motor)
    - CN9
  2. Pharynx, Palate, Carotid sinus, Carotid body, Posterior 1/3 tongue (somatic + visceral sensory)
    - CN9 (Superior + Inferior glossopharyngeal ganglion)
  3. Posterior 1/3 tongue (special sensory)
    - CN9 (***Inferior glossopharyngeal ganglion)
  4. Parotid gland (visceral motor)
    - CN9 (***Otic ganglion: Parasympathetic)

CN10:

  1. Pharynx, Larynx (somatic motor)
    - CN10
  2. External ear and meatus (somatic sensory)
    - CN10 (Superior vagal ganglion)
  3. Pharynx, larynx (visceral sensory)
    - CN10 (Inferior vagal ganglion)
  4. Taste bud in epiglottis (special sensory)
    - CN10 (***Inferior vagal ganglion)
20
Q

***Innervation of tongue

A

Somatic motor:
ALL glossus except Palatoglossus: CN12
Palatoglossus: CN10

Visceral motor (saliva):
Submandibular, Sublingual gland (Submandibular ganglion): CN7
Parotid gland (Otic ganglion): CN9

Somatic sensory:
Anterior 2/3 tongue (Trigeminal ganglion): CNV3
Posterior 1/3 tongue (Superior glossopharyngeal ganglion): CN9

Special sensory:
Anterior 2/3 tongue (Geniculate ganglion): CN7
Posterior 1/3 tongue (Inferior glossopharyngeal ganglion): CN9

21
Q

***Summary of skeletal muscle innervation of head and neck

A

Pharynx:

  • Pharyngeal plexus: CN9, 10, Sympathetic
  • except Stylopharyngeus (CN9)

Palate:

  • Pharyngeal plexus: CN9, 10, Sympathetic
  • except Tensor veli palatini (CNV3 Nerve to medial pterygoid)

Tongue:

  • CN12
  • except Palatoglossus (Pharyngeal plexus: CN9, 10, Sympathetic)

Facial expression + Buccinator:

  • CN7
  • except Levator palpebrae superioris (CN3)

Mastication:

  • CNV3
  • except Buccinator (CN7)

Larynx:

  • CN10 Recurrent laryngeal nerve
  • except Cricothyroid (CN10 external branch of Superior laryngeal nerve)
22
Q

Activation of sympathetic nervous system in head and neck

A
  • Triggered by physical / psychological stress: Flight / Fight reaction
  1. Pupillary dilation (+ opening of Palpebral fissure)
  2. Perspiration
  3. Vasoconstriction (blood redistribution to muscle)
  4. Piloerection (contraction of arrector pili muscle —> at the same time release sebum to surface of skin)
23
Q

Effectors of sympathetic systems in head and neck

A

Smooth muscle

  1. ***Dilator papillae
  2. ***Superior tarsal muscle (upper lid)
  3. Blood vessel wall muscles
  4. Arrector pili

Gland
1. Sweat glands

24
Q

Cervical part of Sympathetic chain

A
  • Extends from base of skull to 1st rib
  • Continuous with thoracic part
  • 3 ganglia
  1. Superior cervical ganglion
    - largest
    - C2/3 vertebra
  2. Middle cervical ganglion
    - smallest
    - C5/6 vertebra
  3. Inferior cervical ganglion
    - may be fused with first thoracic ganglion —> Cervicothoracic ganglion (aka Stellate ganglion)
25
Q

***Branches of Cervical ganglia (Superior + Middle + Inferior)

A

Superior cervical ganglion:
1. **Internal carotid plexus (Ocular structures) (perivascular branches —> follow blood vessels to organs they supply)
—> Deep structures (e.g. Superior Tarsal Muscle, Dilator pupillae)
2. **External carotid plexus (Nasal + Salivary gland)
(Internal + External carotid plexus: perivascular branches —> follow blood vessels to organs they supply)
—> Mid + Lower face (e.g. Facial muscles, Sweat glands)
3. Gray rami (C1-C4) —> Spinal nerves
4. ***Superior cardiac nerve (Cardiac splanchnic nerve to supply visceral organs in thoracic cavity)

Arteries involved:
1. Common, External, Internal carotid arteries

Effectors:

  1. Dilator pupillae
  2. Superior tarsal muscle
  3. Pineal gland
  4. Sweat gland
    (5. Salivary gland
  5. Lacrimal gland)

Middle cervical ganglion:
1. Gray rami (C5-C6) —> Spinal nerves

Artery involved:
1. Inferior thyroid artery

Effectors:

  1. Larynx
  2. Trachea
  3. Pharynx
  4. Upper esophagus

Inferior cervical ganglion:
1. Gray rami (C7-C8) —> Spinal nerves

Artery involved:
1. Vertebral + Subclavian artery

ALL ganglion’s effector:

  1. Heart
  2. Smooth muscle (in deep arteries)
  3. Skin over head and neck
    - Smooth muscle of cutaneous arteries
    - Arrector pili
    - Sweat gland
26
Q

***Sympathetic innervation pathway overview (Superior cervical ganglion)

A 
Spinal segments (T1-T3)
—> Preganglionic neuron
—> White rami
—> ***Superior cervical ganglion (X Middle / Inferior)
—> Postganglionic neuron
—>
  1. ***Internal carotid plexus (簡單來說: Ocular structures)
    —> Superior tarsal muscle (CN3)
    —> Pupillary dilator (CNV1)
    —> Ciliary body (CNV1)
    —> Choroidal and conjunctival vessels (CNV1), Cerebral vessels
    —> Lacrimal gland (Deep petrosal nerve: vasoconstriction)
    (—> Nasal gland)
  2. ***External carotid plexus
    —> ALL 3 Salivary glands
    (sympathetic activation do NOT produce secretion (有保留), ONLY change blood supply to glands via vasoconstriction)
    (—> Nasal glands)
  3. Gray rami
    —> Skin (Vessels, Sweat gland, Arrector pili)
  4. Cardiac splanchnic nerves
    —> Visceral organs in thoracic cavity

***Before postganglionic neuron reaches its target site, it passes through different nerves e.g. Deep petrosal nerve, CN5, CN3 etc.

27
Q

Superior cervical ganglion: Sympathetic innervation of ***ocular structures

A

Superior cervical ganglion
—> ***Internal carotid plexus
—>

  1. CNV1
    —> Pupillary dilator (Mydriasis) / Ciliary muscle (Accommodation)
  2. CNV1
    —> Ciliary ganglion
    —> Choroidal and conjunctival vessels (Vasoconstriction)
  3. CN3
    —> Superior tarsal muscle
    —> Widening of Palpebral fissure
  4. Deep petrosal nerve
    —> Pterygopalatine ganglion
    —> Maxillary nerve (CNV2)
    —> Zygomaticotemporal nerve (branch of CNV2)
    —> Communicating branch
    —> Lacrimal nerve (branch of CNV1)
    —> Lacrimal gland blood vessels (Vasoconstriction)
28
Q

Superior cervical ganglion: Sympathetic innervation of ***salivary gland

A

Superior cervical ganglion
—> ***External carotid plexus
—> (follow Lingual / Facial artery)
—> ALL 3 Salivary glands + Nasal glands

(sympathetic activation do NOT produce secretion (有保留), ONLY change blood supply to glands via vasoconstriction)

29
Q

Superior cervical ganglion: Sympathetic innervation of ***skin

A

Superior cervical ganglion (+ Middle + Inferior)
—> Gray rami
—> Spinal nerve
—> Peripheral nerve (Ventral / Posterior rami)
—> Vessels, Sweat gland, Arrector pili

30
Q

Activation of parasympathetic nervous system in head and neck

A

Homeostatic / Anabolic (energy-conserving system)
—> promote quiet + orderly processes of body
—> allow body to feed + assimilate
—> “Rest and digest”

31
Q

***Parasympathetic innervation pathway overview

A

Brainstem nuclei
—> Preganglionic neuron (within CN3, 7, 9, 10)
—> 4 Ganglia (Ciliary, Pterygopalatine, Submandibular, Otic)
—> Postganglionic neuron (within ***CN5)
—>
1. Smooth muscle (Ciliary muscle / Pupillary sphincter)
2. Gland (Salivary gland / Lacrimal gland / Nasal and Palatine mucosa)

32
Q

Parasympathetic innervation of ***ocular structures

A
  1. Edinger-Westphal nucleus (midbrain)
    —> Preganglionic neuron (CN3)
    —> ***Ciliary ganglion
    —> Iris sphincter (Miosis) / Ciliary muscle (Accommodation)
2. Lacrimal nucleus (pons)
—> Preganglionic neuron (CN7)
—> ***Greater petrosal nerve
—> ***Pterygopalatine ganglion
—> ***Maxillary nerve (CNV2)
—> ***Zygomaticotemporal nerve (branch of CNV2)
—> Communicating branch
—> ***Lacrimal nerve (branch of CNV1)
—> Lacrimal gland (Lacrimation)
33
Q

Parasympathetic innervation of ***salivary gland

A
  1. Superior salivatory nucleus (medulla) (記: CLS)
    —> Preganglionic neuron (CN7)
    —> Intermediate nerve
    —> **Chorda tympani
    —> **    Lingual nerve (branch of CNV3)
    —> ***Submandibular ganglion
    —> Submandibular, Sublingual gland, Minor salivary glands of mouth, pharynx, nasopharynx
2. Inferior salivatory nucleus (記: LOA)
—> Preganglionic neuron (CN9)
—> Tympanic nerve plexus
—> ***Lesser petrosal nerve
—> ***Otic ganglion
—> ***Auriculotemporal nerve (Postganglionic cell) (branch of CNV3)
—> Parotid gland
34
Q

Cervical plexus vs Cervical ganglion

A

Cervical plexus:
Anatomical definition
- C1-4
- Cutaneous branches: Lesser occipital, Greater auricular etc.
- Muscular branches: Phrenic nerve, Ansa cervicalis (Strap muscles: Omohyoid, Sternohyoid, Thyrohyoid, Sternothyroid)

Cervical ganglion:
Functional definition (Sympathetic)
- Superior
- Middle
- Inferior

HNNS (58 decks)

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