Autonomic Nervous System of the Neck. Adam Koleśnik, MD Department of Descriptive and Clinical Anatomy Center of Biostructure Research, MUW

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1 Autonomic Nervous System of the Neck Adam Koleśnik, MD Department of Descriptive and Clinical Anatomy Center of Biostructure Research, MUW

2 Autonomic nervous system sympathetic parasympathetic enteric

3 Autonomic nervous system sympathetic parasympathetic

4 Autonomic nervous system innervates smooth muscle cells secretory cells heart muscle

5 Autonomic nervous system is composed of preganglionic neurons found in the central nervous system ganglionic neurons found in autonomic ganglia

6 Autonomic vs sensory ganglia

7 Sympathetic and parasympathetic NS

8 Sympathetic and parasympathetic NS

9 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

10 Sympathetic ganglion

11 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

12 Sympathetic trunk

13 Intermediate and prevertebral ganglia

14 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

15 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%

16 Sympathetic trunk ganglia cervical ganglia superior cervical ganglion middle cervical ganglion middle cervical cardiac nerve

17 Sympathetic trunk ganglia cervical ganglia middle cervical ganglion middle cervical cardiac nerve stellate ganglion

18 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

19 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

20 Sympathetic trunk ganglia superior cervical ganglion splanchnic branches laryngopharyngeal branches to laryngeal nerves to pharyngeal plexus superior cervical cardiac nerve to the cardiac plexus

21 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

22 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

23 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

24 Cervicothoracic (stellate) ganglion lesion sympathetc denervation of the upper limb Horner's syndrome miosis ptosis enophtalmos loss of sweating in head and neck

25 Parasympathetic system cranial part cranial nerves III, VII, IX, X sacral part intermediate grey matter of S2-S4 spinal segments

26 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

27 Glossopharyngeal nerve

28 Glossopharyngeal nerve: Superior ganglion in the jugular foramen ganglia 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

29 Glossopharyngeal nerve: tympanic nerve branches 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)

30 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

31 Glossopharyngeal nerve: pharyngeal branches 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

32 Glossopharyngeal nerve

33 Petrosal nerves

34 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

35 Vagus nerve

36 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 1 st and 2 nd cervical nerve superior cervical ganglion

37 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

38 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

39 pharyngeal branch Vagus nerve: branches (neck) 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

40 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

41 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

42 Vagus nerve

43 Gag reflex

44 Carotid sinus

45 Carotid sinus

46 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

47 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

48 Thank You!

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