Session 4 - Autonomic innervation of the head and neck

Question 1

What supplies sympathetic innervation to the head and neck?

Answer 1

The sympathetic trunk

Question 2

Where can the sympathetic trunk be found?

Answer 2

o Anterolateral to the vertebral column
o Lying on the prevertebral fascia and muscles
o Deep to the carotid sheath.

Question 3

Where do pre-ganglionic sympathetic fibres arise

Answer 3

In the first thoracic neural segment

Question 4

Where do pre-ganglionic neural segments synapse?

Answer 4

In one of the three cervical sympathetic ganglia (Superior, middle or inferior)

Question 5

In what form do the post ganglionic sympathetic nerve fibres travel after synapsing?

Answer 5

As the internal and external carotid nerves

Question 6

What do the post-ganglionic fibres from the superior cervical ganglion travel with?

Answer 6

THe internal and external carotid arteries

Question 7

Where does the sympathetic superior cervical ganglion innervate?

Answer 7

o The Pharyngeal Plexus
o The Upper 4 Cervical Nerves
o Cardiac Branch to the Cardiac Plexus

Question 8

What do the post-ganglionic fibres of the middle cervical ganglion travel with?

Answer 8

Inferior thyroid artery

Question 9

Where does the middle cervical ganglion travel to?

Answer 9

5th and 6th cervical nerves

Cardiac branch ofthe cardiac plexus

Question 10

What does the inferior cervical ganglion travel with? What does it combine with later on?

Answer 10

Vertebral artery

1st thoracic ganglion to form the stellate ganglion

Question 11

Where does the inferior cervical ganglion innervate?

Answer 11

7th and 8th Cranial nerves

Cardiac branch to the cardiac pexus

Question 12

What are the four parts of parasympathetic ganglia in the head?

Answer 12

Ciliary ganglion
Pterygopalatine ganglion
Submandibular ganglion
Otic ganglion

Question 13

What are the four cranial nerves with brainstem nuclei?

Answer 13

 Oculomotor (CN III)
 Facial (CN VII)
 Glossopharyngeal (CN IX)
 Vagus (CN X)

Question 14

What three crainial nerves reach a parasympathetic ganglion, and give their identities

Answer 14

 Oculomotor  Ciliary Ganglion
 Facial  Pterygopalatine / Submandibular Ganglion
 Glossopharyngeal  Otic Ganglion

Question 15

Where do preganglionic parasympathetic fibres synapse?

Answer 15

Either in four ganglia or in the walls of the organs they supply in the neck, thorax and abdomen

Question 16

Where does the ciliary ganglion lie?

Answer 16

In the orbital cavity, next to the optic nerve

Question 17

What are the parasympathetic neve fibres of the ciliary ganglion derived from?

Answer 17

Oculomotor nerve
Sphincter papillae
Ciliary muscles

Question 18

Where do sympathetic nerve fibres of the ciliary ganglion come from?

Answer 18

The plexus of the opthalmic artery (first branch of the internal carotid artery) which is distributed to the eyeball
Sensory fibres from the eyeball pass to the nasociliary nerve

Question 19

Where do the pterygopalantine ganglion lie?

Answer 19

In the pterygopalantine fossa

Question 20

Where are the parasympathetic fibres of the pterygopalantine ganglion derived from?

Answer 20

Facial nerve via the greater pterosal nerve

Question 21

What does the greater pterosal nerve, derived from the ptergopalantine ganglion, innervate

Answer 21

Lacrimal glands

Glands of the nose, palate and nasopharynx

Question 22

Where do the sympathetic fibres of the pterygopalantine ganglion come from?

Answer 22

THe superior cervical ganglion via the plexus on the internal carotid artery

Question 23

Where are the sympathetic fibres from the superior cervical ganglion distributed to?

Answer 23

Nose, palate and nasopharynx

Question 24

Where is the submandibular ganglion found?

Answer 24

Suspended from the lingual nerve by small branches

Question 25

Where are parasympathetic fibres of the submandibular ganglion derived from?

Answer 25

Facial nerve via the chorda tympani and then the lingual nerve

Question 26

What do the parasympathetic branches of the submandibular ganglion innervate?

Answer 26

 Submandibular Gland
 Sublingual Gland
 Other glands on the floor of the oral cavity

Question 27

Where do sympatehetic fibres of the submandibular cervical ganglion spring from and along?

Answer 27

Along the facial artery

Taste fibres may also pass through ganglion

Question 28

Where do parasympathetic fibres of the otic ganglion come from?

Answer 28

Glossopharngeal nerve via the auriculotemporal nerve, branch into the parotid gland

Question 29

Where do the sympathetic fibres of the otic ganglion come from?

Answer 29

Sympathetic fibres come from the superior cervical ganglion

Question 30

What route do the sympathetic fibres of the otic ganglion follow

Answer 30

Along the middle meningeal artery, passing into the parotid gland

Question 31

Outline some direct autonomic supply of the head and neck

Answer 31

o	Glossopharyngeal Nerve (CN IX)
	(Direct or via Pharyngeal plexus)
	Glands of the oropharynx
	Posterior Third of the Tongue
o	Vagus Nerve (CN X)
	Glands of the laryngopharynx, larynx, oesophagus and trachea
	Ganglion cells are on the viscus

Question 32

Give nucleus, organs innervated and action for following nerves
III

Answer 32

Edinger-Westphal Eye. Pupil, Ciliary Pupillary constriction

Question 33

Give nucleus, organs innervated and action for following nerves
VII

Answer 33

Superior Salivatory Nasal, Lactrimal, Submandibular and Sublingual Glands Serous Secretions

Question 34

Give nucleus, organs innervated and action for following nerves
IX

Answer 34

Inferior Salivatory Parotid Serous Secretions

Question 35

Give nucleus, organs innervated and action for following nerves
X

Answer 35

Dorsal Vagal Motor Nucleus Wide distribution Laryngeal function
(I.e. Neck only)

Question 36

What is Horner’s syndrome?

Answer 36

Interruption of a cervical sympathetic trunk results in Horner’s Syndrome. It is manifested by the Absence of Sympathetically Stimulated functions on the Ipsilateral side of the head.

Question 37

What is miosis?

Answer 37

 Constriction of the pupil

 Parasympathetically stimulated Sphincter Papillae of the pupil is unopposed

Question 38

What is ptosis?

Answer 38

 Drooping of superior eyelid
 Paralysis of smooth muscle fibres interdigitated with the aponeurosis of the Levator Palpebrae Superioris that collectively constitute the Superior Tarsal muscle (innervated by Sympathetic fibres)

Question 39

What is vasodilation?

Answer 39

 Redness and increased temperature of the skin

 Loss of sympathetic tone

Question 40

What is anhydrosis?

Answer 40

 Absence of sweating