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Autonomic Nervous System of the Neck

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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 Autonomic nervous system sympathetic parasympathetic Autonomic nervous system innervates • smooth muscle cells • secretory cells • heart muscle Autonomic nervous system 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 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 Sympathetic trunk ganglia 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% Sympathetic trunk ganglia cervical ganglia superior cervical ganglion middle cervical ganglion middle cervical cardiac nerve Sympathetic trunk ganglia cervical ganglia middle cervical ganglion middle cervical cardiac nerve stellate ganglion Sympathetic trunk ganglia superior cervical ganglion • grey communicating branches – 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 Sympathetic trunk ganglia superior cervical ganglion • vascular branches – 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 Sympathetic trunk ganglia superior cervical ganglion • splanchnic branches – laryngopharyngeal branches • to laryngeal nerves • to pharyngeal plexus – superior cervical cardiac nerve • to the cardiac plexus Sympathetic trunk ganglia middle cervical ganglion • grey communicating branches – to cervical spinal nerves C5 and C6 • vascular branches – common carotid nerves • common carotid plexus • splanchnic branches – thyroid branches – parathyroid branches – middle cervical cardiac nerve Sympathetic trunk ganglia 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 Sympathetic trunk ganglia cervicothoracic ganglion • grey communicating branches – to the cervical nerves C7 and C8 – to the thoracic nerve Th1 • vascular branches – vertebral nerves • vertebral plexus – branches to the subclavian artery • subclavian plexus • splanchnic branches – 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 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 Glossopharyngeal 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) Glossopharyngeal nerve: 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 Glossopharyngeal nerve: 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 • superior cervical ganglion • Inferior (nodose) ganglion – cylindrical (~25 × 5 mm) – connected with • hypoglossal nerve • loop between 1st and 2nd cervical nerve • superior cervical ganglion 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 Carotid sinus Glossopharyngeal nerve: 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! .
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