Autonomic Nervous System of the...

Autonomic Nervous System

of the Neck

Adam Koleśnik, MD

Department of Descriptive and Clinical Anatomy

Center of Biostructure Research, MUW

Autonomic nervous system

• sympathetic

• parasympathetic

• enteric


sympathetic parasympathetic


innervates

• smooth muscle cells

• secretory cells

• heart muscle


is composed of

• preganglionic neurons

– found in the central nervous system

• ganglionic neurons

– found in autonomic ganglia

Autonomic vs sensory ganglia

Sympathetic and parasympathetic NS

Sympathetic system

centers

• preganglionic neurons are located in

lateral horns of the spinal cord of C8-L2

segments

• ganglionic cells are present in

– paravertebral ganglia

– intermediate ganglia

– prevertebral ganglia

Sympathetic ganglion

Sympathetic system

ganglia

• paravertebral ganglia

– arranged to form sympathetic trunk

• intermediate ganglia

– found in a course of splanchnic nerve

between paravertebral and prevertebral

ganglia

• prevertebral ganglia

– are found in several autonomic plexuses

Sympathetic trunk

Intermediate and prevertebral ganglia

Sympathetic trunk ganglia

branches

• grey communicating branches

– convey postganglionic fibers to all spinal nerves and

some cranial nerves

• vascular branches

– convey postganglionic fibers to larger vessels

– form plexuses in the adventitia

• splanchnic branches

– postganglionic fibers directly to the viscera

– preganglionic fibers to the prevertebral ganglia

– form long, anatomically distinctive nerves


cervical ganglia

• superior cervical ganglion

– fusion of C1-C4 ganglia

– constantly present at the level of C2-C3

– posterior to the ICA

• middle cervical ganglion

– fusion of C5-C6 ganglia

– present in >75% at the level of C6

• vertebral ganglion

– present in <50%

• cervicothoracic ganglion

– present in >80% at the point of origin of the vertebral artery

– inferior cervical ganglion is present in 20%


cervical ganglia

superior cervical ganglion middle cervical ganglion

middle cervical cardiac nerve


cervical ganglia middle cervical ganglion

middle cervical cardiac nerve

stellate ganglion


superior cervical ganglion


– to C1-C4 cervical nerves

– to the hypoglossal nerve

– to the inferior ganglion of the vagus nerve

– jugular nerve

• to the superior ganglion of the vagus nerve

• to the inferior ganglion of the glossopharyngeal

nerve

• to the internal jugular vein




– internal carotid nerve

• internal carotid plexus

– caroticotympanic nerves to the tympanic plexus

– deep petrosal nerve to the pterygopalatine ganglion

– cavernous plexus

» sympathetic branch to the cilliary ganglion

– external carotid nerves (4-6)

• external carotid plexus

– branches to the common carotid plexus

– plexuses along the branches of the external carotid artery

» facial artery plexus – branch to the submandibular ganglion

» middle meningeal artery plexus – to the otic ganglion

– part of the jugular nerve




– laryngopharyngeal branches

• to laryngeal nerves

• to pharyngeal plexus

– superior cervical cardiac nerve

• to the cardiac plexus


middle cervical ganglion


– to cervical spinal nerves C5 and C6


– common carotid nerves

• common carotid plexus


– thyroid branches

– parathyroid branches

– middle cervical cardiac nerve


cervicothoracic ganglion

• fusion of C7, C8 and Th1 ganglia

• found on the level between the transverse

process of the seventh cervical vertebra and

the neck of the first rib

• found just above the apex of the lung and

may be in contact with the pleura


cervicothoracic ganglion


– to the cervical nerves C7 and C8

– to the thoracic nerve Th1


– vertebral nerves

• vertebral plexus

– branches to the subclavian artery

• subclavian plexus


– esophageal branches

– tracheal branches

– inferior cervical cardiac nerve

Cervicothoracic (stellate) ganglion

lesion

• sympathetc denervation of the upper limb

• Horner's syndrome

– miosis

– ptosis

– enophtalmos

– loss of sweating in head and neck

Parasympathetic system

• cranial part

– cranial nerves

III, VII, IX, X

• sacral part

– intermediate grey

matter of S2-S4

spinal segments

Glossopharyngeal nerve:

nuclei

• Motor nucleus: nucleus ambiguus

• Parasympathetic nucleus: inferior salivatory

nucleus

• Gustatory nucleus: nucleus of solitary tract

• Sensory nucleus: spinal nucleus of trigeminal nerve

and nucleus of solitary tract

Glossopharyngeal nerve


ganglia

• Superior ganglion

– in the jugular foramen

– part of the inferior ganglion

• Inferior ganglion

– in fossula petrosa

– sensory unipolar neurons

– connected with superior cervical ganglion

– branches to auricular branch and superior

ganglion of vagus

– branch to a facial nerve


branches

• tympanic nerve

– branch of inferior ganglion

– contributes the tympanic plexus

– gives off: • branches to the mucosa of the tympanic cavity

• branches to the auditory tube

• branches to mastoid air cells

• terminal branch: lesser petrosal nerve (to the otic

ganglion)


branches

• carotid branch

‒ often double

‒ descends on the wall of ICA

‒ to the wall of carotid sinus and carotid body

‒ may communicate with vagus and superior cervical ganglion

‒ afferents end in middle third of the nucleus of solitary tract

‒ involved in control of cardiovascular system


branches

• pharyngeal branches ‒ contribute to the pharyngeal plexus

• muscular branch

‒ to the stylopharyngeus muscle

• tonsillar branches

‒ to tonsils, soft palate and fauces

• lingual branches

‒ to vallate papillae and mucosa near the sulcus terminalis

‒ to the root of tongue

‒ general sensibility and gustation

Glossopharyngeal nerve

Petrosal nerves

Vagus nerve:

nuclei

• Motor nucleus: nucleus ambiguus

• Parasympathetic nucleus: dorsal nucleus of vagus

• Gustatory nucleus: nucleus of solitary tract

• Sensory nucleus: spinal nucleus of trigeminal nerve

and nucleus of solitary tract

Vagus nerve

Vagus nerve:

ganglia

• Superior (jugular) ganglion

– spherical (~4 mm of diameter)

– connected with

• cranial root of accessory nerve

• inferior glossopharyngeal ganglion


• Inferior (nodose) ganglion

– cylindrical (~25 × 5 mm)

– connected with

• hypoglossal nerve

• loop between 1st and 2nd cervical nerve


Vagus nerve:

branches (head and neck)

• in the jugular fossa

– meningeal branch

– auricular branch

• in the neck

– pharyngeal branches

– branches to carotid body

– superior laryngeal nerve

– recurrent laryngeal nerve (right)

– cardiac branches

Vagus nerve:

branches (jugular fossa)

• meningeal branch (branches)

– dura matter in the posterior cranial fossa

• auricular branch

– course • joined by the ramus from inferior ganglion of glossopharyngeal

nerve

• enters the mastoid canaliculus

• receives a branch from facial nerve

• traverses tympanomastoid fissure

– gives off two rami: • joining the posterior auricular nerve

• to the skin of part of the cranial auricular surface, posterior wall and floor of external acoustic meatus and adjoining part of outer surface of tympanic membrane

Vagus nerve:

branches (neck)

• pharyngeal branch

– main motor nerve of the pharynx

– contributes to the pharyngeal plexus

• branches to the carotid body

• superior laryngeal nerve

– internal laryngeal nerve • sensory fibers for mucosa to the level of vocal folds

• divides into the upper and lower branches

• unites with inferior laryngeal nerve

– external laryngeal nerve • supplies cricothyroid muscle

• supplies the pharyngeal plexus and inferior pharyngeal constrictor

Vagus nerve:

branches (neck)

• recurrent laryngeal nerve – right separates in the neck and loops on the right

subclavian artery

– left separates in the thoracic cavity and loops on the aortic arch

– ascends in the groove between trachea and esophagus

– branches: • cardiac branches to the deep cardiac plexus

• supplies all laryngeal muscles except the cricothyroid

• communicates with internal laryngeal nerve and – innervates laryngeal mucosa below vocal folds

– gives off tracheal and esophageal branches

Vagus nerve:

branches (neck)

• cardiac branches – two or three in number

– superior join sympathetic cardiac nerves and reach the deep cardiac plexus

– inferior branches • right passes in front of the brachiocephalic trunk to the

deep cardiac plexus

• left descends across the left side of aortic arch and reaches superficial cardiac plexus

– additional cardiac branches • from the right vagus nerve near the trachea

• from both recurrent laryngeal nerves

• all end in deep cardiac plexus

Vagus nerve

Gag reflex

Carotid sinus


lesions

• transient or sustained hypertension

• loss of sensation over ipsilateral

– soft palate

– fauces

– pharynx

– posterior third of the tongue (also gustation)

• reduced palatal and pharyngeal reflexes

• reduced salivary secretion of the parotid gland

• glossopharyngeal neuralgia

– severe pain, especially while swallowing

– in the throat, behind mandibular angle, in the ear

Vagus nerve:

lesions

• tachycardia

• vomiting

• feeling of suffocation

• tachypnoea

• hypertension

• paralysis of soft palate, pharynx and larynx

• deviation of uvula to the unaffected side

• movement of lateral wall of pharynx to an unaffected side

• ipsilateral loss of pharyngeal and palatal reflexes

• nasal voice

• nasal regurgitation of liquids

Thank You!

Autonomic Nervous System of the...

Documents

Transcript of Autonomic Nervous System of the...