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SA head and neck > S6) Autonomic Innervation of the Head and Neck > Flashcards

S6) Autonomic Innervation of the Head and Neck Flashcards

1
Q

What is the autonomic nervous system?

A

The autonomic nervous system is the part of the peripheral nervous system that controls smooth muscle and glands

controls non-voluntary actions

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2
Q

How is the ANS controlled?

A

Central control is from the hypothalamus

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3
Q

State 2 functions of the ANS

A
  • Controls body functions not under conscious control
  • Maintains and fine tunes internal environment (accelerator and brake)
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4
Q

State 2 target tissues of the ANS

A
  • Smooth muscle
  • Glands (lacrimal & salivary)
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5
Q

Describe the arrangement of neurones and ganglions in the ANS

A
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6
Q

What are the two types of autonomic outflow from the CNS?

A
  • Sympathetic: ‘thoracolumbar outflow’
  • Parasympathetic: ‘craniosacral outflow’
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7
Q

State the origins and location of cell bodies (nuclei) in the sympathetic nervous system

A
  • Originates from T1 ‐ L2 segments of spinal cord

‐ Cell bodies are within lateral horn of grey matter of spinal cord

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8
Q

State the origins of cell bodies in the sympathetic nervous system for the head and neck structures

A

T1 - T2

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9
Q

Identify the ganglia involved in the sympathetic innervation of head & neck structures

A

Ganglia in cervical portion of sympathetic chain:

  • Superior cervical ganglion
  • Middle cervical ganglion (neck and chest structures)
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10
Q

Which structures do the post ganglionic sympathetic ganglia hitch-hike onto to innervate their effector tissues?

A
  • Blood vessels e.g. ICA, ECA, opthalmic artery
  • Branches of CN V (very distally)
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11
Q

Identify 4 effector tissues of the SNS in the structures of the head and neck

A
  • Eye (dilator pupillae)
  • Eye lid (superior tarsal muscle) for eye lid retraction
  • Blood vessels
  • smooth muscle of respiratory and GI tract to dilate
  • Sweat glands
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12
Q

State 4 responses of the SNS in the head and neck structures

A
  • Pupillary dilation (dilator pupillae)
  • Assists eyelid retraction
  • Vaso‐constriction
  • Stimulates sweating
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13
Q

Explain why carotid arteries and the lung apex are important anatomical relations to sympathetic nerves innervating head and neck

A

Pathology involving the apex of lung and internal carotid artery can cause autonomic dysfunction in the eye and face e.g. Horner’s syndrome

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14
Q

Horner’s syndrome can result from a pancoast tumour in the apex of the lung.

Identify 3 symptoms of this clinical condition

A
  • Partial ptosis
  • Miosis (constricted pupil)
  • Anhidrosis
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15
Q

What is the most likely cause of Horner’s syndrome?

A

A pancoast tumour on the apex of the lung which impinges on the sympathetic chain

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16
Q

State the origins and location of cell bodies (nuclei) in the parasympathetic nervous system

A
  • Cranial segment originates from 4 CN’s

‐ Sacral segment originates from S2 ‐ S4 (pelvic splanchnics)

‐ Cell bodies are in brainstem / within grey matter of sacral spinal cord

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17
Q

Parasympathetic preganglionic fibres for the head and neck structures arise from 4 nuclei in the brainstem.

Identify one

A

Edinger Westphal

18
Q

State the 4 cranial nerves which are associated with the pre-ganglionic fibres of the PNS

A
  • Oculomotor nerve (CN III)
  • Facial nerve (CN VII)
  • Glossopharyngeal nerve (CN IX)
  • Vagus nerve (CN X)
19
Q

State the 4 ganglia in the PNS innervation of head and neck structures

A
  • Ciliary
  • Submandibular
  • Pterygopalatine
  • Otic
20
Q

Which cranial nerve fibre is associated with the post ganglionic parasympathetic nerve fibres in the head and neck?

A

Branches of trigeminal nerve (CN V)

21
Q

Identify 4 effector tissues of the PNS in the head and neck

A
  • Iris (sphincter pupillae) & ciliary muscles (controls lens)
  • Lacrimal gland
  • Mucosal glands (nasal/oral mucosa/ resp. tract)
  • Salivary glands
22
Q

State 3 responses of the PNS in the head and neck structures

A
  • Constrict pupil
  • Accommodation reflex (lens shape)
  • Glandular (salivary and mucosal) secretions
23
Q

Describe the anatomical course of CN III and the parasympathetic fibres from the brainstem via the ciliary ganglion

A

⇒ Preganglionic fibres emerge from EDW nuclei with CN III

⇒ Ciliary ganglion

⇒ Postganglionic fibres merge with CN Va

⇒ Acts on sphincter pupiliae & lens

  • pupil constricts and lens becomes fatter
24
Q

in 8 steps, describe the pupillary light reflex for the left eye

A

⇒ Light in left pupil

⇒ Sensory afferent (side that the light enters) from left retina (CN II)

⇒ Some branches of CN II enter midbrain

⇒ Connection with Edinger - Westphal nucleus (EDW) (left and right)

⇒ Preganglionic parasympathetic fibres leave brainstem

⇒ Fibres merge with CN III (left and right) the signals are transferred to the consensual eye (eye that didn’t receive light)

⇒ Fibres pass via ciliary ganglion

⇒ Postglangionic parasympathetic fibres reach sphincter pupillae

25
Q

For the diagram below, explain the types of light reflexes one will observe:

A
  • Left: direct light reflex
  • Right: consensual light reflex
26
Q

How does the facial nerve enter the cranial cavity from the brainstem?

A

Through the petrous temporal bone

27
Q

Identify the two main branches of the facial nerve arising inside the petrous bone

A
  • Greater petrosal nerve
  • Chorda tympani nerve
28
Q

Parasympathetics arising with CN VII have two associated parasympathetic ganglia.

Identify them

A
  • Pterygopalatine ganglion
  • Submandibular ganglion
29
Q

In 5 steps, describe the anatomical course of CN VII and the parasympathetic fibres from the brainstem via the greater petrosal nerve and pterygopalatine ganglion

A

⇒ Preganglionic fibres emerge with CN VII

⇒ Pass through petrous temporal bone

⇒ At the geniculate region, greater petrosal nerve enters pterygopalatine fossa

⇒ Fibres reach pterygopalatine ganglion

⇒ Postganglionic fibres act on lacrimal, nasal & palatine glands

30
Q

In 5 steps, describe the anatomical course of CN VII and the parasympathetic fibres from the brainstem via the chorda tympani nerve and submandibular ganglion

A

⇒ Preganglionic fibres emerge with CN VII

⇒ Pass through petrous temporal bone

⇒ Fibres join chorda tympani nerve & cross through middle ear cavity

⇒ Fibres exit via base of skull & reach submandibular ganglion

⇒ Post ganglionic fibres act on sublingual & submandibular glands

31
Q

How does the glossopharyngeal nerve enter the cranial cavity?

A

Through the jugular foramen

32
Q

In 6 steps, describe the anatomical course of CN IX and the parasympathetic fibres from the brainstem via the tympanic nerve and plexus

A

⇒ Preganglionic fibres emerge with CN IX

⇒ Pass through jugular foramen

⇒ Fibres join tympanic nerve & tympanic plexus

⇒ Fibres join lesser petrosal nerve & exit via foramen ovale

⇒ Fibres reach otic ganglion (in infratemporal fossa)

⇒ Postganglionic fibres then merge with CN Vc & act on parotid gland

33
Q

In 4 steps, describe the anatomical course of CN X and the parasympathetic fibres from the brainstem to the respective effector tissues

A

⇒ Parasympathetic fibres emerge with CN X

⇒ Preganglionic fibres meets ganglion at or in target tissue

⇒ Postganglionic fibres act on smooth muscle and glands of GI & resp tract

⇒ Postganglionic fibres act on heart

34
Q

Explain how Horner’s syndrome produces its characteristic symptom of partial ptosis

A
  • Sympathetic innervation of superior tarsal muscle muscle stops
  • Parasympathetic innervation of levator palpabrae superioris (through oculomotor nerve) still functions
  • Eyelid retraction is present but cannot be assisted = partial ptosis
35
Q

Explain how Horner’s syndrome produces its characteristic symptom of miosis

A
  • partial ptosis
  • Sympathetic innervation of dilator pupillae stops = pupils constrict
  • Parasympathetic innervation of sphincter pupillae dominates = pupils constrict
  • eyeballs become dry
  • eye appears sunken but isn’t
36
Q

describe the order of a neurone pathway

A

hypothalamus → first order neurone → synapse to a second order neurone (pre-ganglionic) → leaves spinal chord (T1 & T2) and travels into neck → 3rd order neurone

37
Q

what blood vessels does the third order neurone pass

A

post ganglionic:

  1. runs outside common carotid artery
  2. sympathetic nerves to eye and orbit
  3. runs with internal carotid artery → orbit ophthalmic artery and distal branches
  4. sweat glands on face and neck
  5. run with branches of external carotid artery
38
Q

where are points that head and neck structures can be damaged

A

1st order neurone can be damaged inside the CNS

2nd order neurone can be damaged exciting the CNS within the sympathetic chain

3rd order neurone can be damaged running with blood vessels ( pathology within the common carotid or internal carotid)

39
Q

why dies interruption if sympathetic innervation only lead to partial ptosis

A
  • levator palperen superioris
  • contacts to elevate eyelid
  • skeletal part (somatic) = majority contribution
  • smooth muscle (autonomic) = smaller contribution
40
Q

go over this table and learn it!!

A
41
Q

parasympathetic overall enervation to the head and the neck

A
  1. parasympathetic nuclei in brainstem
  2. preganglionic axons exit with ¼ cranial nerves
  3. parasympathetic ganglia
  4. post ganglionic
  5. very distal branches of CN V abc
  6. to target tissue
42
Q

go over this table with parasympathetic nuclei ands their roles

A

SA head and neck (18 decks)

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