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H&N > Session 6: Autonomic Innervation > Flashcards

Session 6: Autonomic Innervation Flashcards

1
Q

General target tissues of the autonomic nervous system from cranial nerves from Head & neck.

A

Glands

Smooth muscle

Cardiac muscle

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2
Q

Where does the parasympathetic nerve fibres arise from?

A

Called craniosacral outflow.

4 cranial nerves

S2-S4 (pelvic splanchnic)

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3
Q

Where does the sympathetic nerve fibres arise from?

A

The thoracolumbar outflow

T1-L2

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4
Q

What cranial nerves carry sympathetic nerve fibres?

A

CN III Oculomotor nerve

CN VII Facial nerve

CN IX Glossopharyngeal nerve

CN X Vagus nerve

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5
Q

Explain the general route the parasympathetics fibres take to reach their target.

A

Arise from the brainstem

Pre-ganglionic fibres go to synapse in a ganglia

Post-ganglionic fibres travel to target tissue to innervate

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6
Q

Central control of the autonomics.

A

Hypothalamus

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7
Q

Where does the parasympathetics of the oculomotor nerve arise?

A

Edinger Westphal nucleus

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8
Q

What carries the parasympathetics that arise from Edinger Westphal nucleus?

A

Oculomotor nerve

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9
Q

What ganglion does the parasympathetics from the Edinger Westphal nucleus synapse in?

Where can this ganglion be found?

A

The ciliary ganglion in the bony orbit

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10
Q

What carries the post-ganglionic parasympathetic fibres from the ciliary ganglion?

A

A branch of the ophthalmic nerve (Va) which is the short ciliary nerve.

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11
Q

What do these post-ganglionic parasympathetic fibres from the Edinger Westphal nucleus innervate?

A

The sphincter pupillae which is a pupil constrictor

The ciliary muscles controlling the lens

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12
Q

What other nuclei do parasympathetic fibres arise from?

A

Edinger Westphal (already mentioned)

Superior salivatory nucleus

Inferior salivatory nucleus

Dorsal vagal motor nucleus

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13
Q

What carries the parasympathetic fibres arising from the superior salivatory nucleus?

A

The greater petrosal nerve which is a branch of the facial nerve.

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14
Q

What do the parasympathetic fibres that are carried by the greater petrosal nerve synapse in?

Where can this ganglion be found?

A

The pterygopalatine ganglion.

In the pterygopalatine fossa

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15
Q

What are the post-ganglionic parasympathetic fibres of from the pterygopalatine ganglion carried by?

A

Branches of the maxillary nerve (Vb)

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16
Q

What do these post-ganglionic parasympathetic fibres from the pterygopalatine ganglion innervate?

A

Lacrimal glands

Nasal cavity

Nasopharynx

Palate

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17
Q

What other parasympathetic fibres arise from the superior salivatory nucleus?

A

Pre-ganglionic parasympathetic fibres which are carried by the chorda tympani of the facial nerve.

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18
Q

Where do the pre-ganglionic parasympathetic fibres carried by the chorda tympani synapse in?

Where can this ganglion be found?

A

Submandibular ganglion found inferior to the lingual nerve

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19
Q

What carries the post-ganglionic parasympathetic fibres from the submandibular ganglion?

A

The mandibular nerve (Vc)

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20
Q

What do the post-ganglionic parasympathetic fibres from the submandibular ganglion innervate?

A

The submandibular gland

Sublingual salivary glands

21
Q

What are the pre-ganglionic parasympathetic fibres rising from the inferior salivatory nucleus carried by?

A

Firstly the tympanic nerve which to thereafter branch into the lesser petrosal nerve.

Both of which are branches of the glossopharyngeal nerve.

22
Q

What do the pre-ganglionic parasympathetic fibres carried rising from the inferior salivatory nucleus synapse in?

Where can this ganglion be found?

A

The otic ganglion found in the infratemporal fossa

23
Q

What are the post-ganglionic parasympathetic fibres from the otic ganglion carried by?

A

A branch of the mandibular nerve called the auriculotemporal nerve.

24
Q

What do the post-ganglionic parasympathetic fibres that exit from the otic ganglion innervate?

A

Parotid gland

25
Q

What nerve carries the fibres arising from the dorsal vagal motor nucleus?

A

Vagus nerve

26
Q

Brief summary of innervation of the parasympathetic fibres of the vagus nerve.

A

Smooth muscle of the trachea

Bronchi

GI

Heart

27
Q

All post-ganglionic parasympathetic fibres hitch-hike onto which cranial nerve?

Which is an exception?

A

Trigeminal nerve CN V

Except for vagus nerve’s post-ganglionic parasympathetic fibres

28
Q

Parasympathetic response.

A

Rest and digest:

Pupillary constriction

Accommodation reflex

Glandular secretions (mucous and salivary)

29
Q

What does the sympathetic nervous system innervate in the head and neck?

A

Smooth muscle of the vessels

Eye lid (tarsal muscles)

Iris (dilator pupillae)

Sweat glands

Arrector pili muscles

30
Q

Where does the sympathetic outflow originate from?

A

The thoracolumbar outflow from the T1-L2.

Originate from the cell bodies of the lateral horn of grey matter of spinal cord.

31
Q

What are the nerve roots of sympathetic fibres that mainly supply the head and neck?

A

T1-T2

32
Q

Parasympathetic fibres hitch-hike on nerves to reach their destination in the head and neck.

What do sympathetic nerve fibres hitch-hike on?

A

Blood vessels

33
Q

What are the important ganglion of the sympathetic nerve fibres supplying the head and neck?

A

Superior cervical ganglion

Middle cervical ganglion

Inferior cervical ganglion

34
Q

Where can the superior cervical ganglion be found?

A

Located posteriorly to the carotid artery and anterior to the C1-C4 vertebrae.

35
Q

What sympathetic nerves exits via the superior cervical ganglion as post-ganglionic sympathetic nerve fibres?

A

Internal carotid nerve

External carotid nerve

Nerve to pharyngeal plexus

Superior cardiac branch

Nerves to cranial nerves II, III, IV, VI and IX

Gray rami communicantes

36
Q

Explain the route of the internal carotid nerve.

A

Travels along the internal carotid artery and branches to form the internal carotid plexus.

The internal carotid artery enters the cranial cavity via the carotid canal. It then travels through the carotid canal in the petrous part of the temporal bone to enter the cavernous sinus.

37
Q

What do the sympathetic nerves that exit via the superior cervical ganglion innervate?

A

Structures of the eye

Smooth muscle part of levator palpabrae superioris

Superior tarsal muscles

Sweat glands

Dilator pupillae

Arterial smooth muscle

and many more…

38
Q

What are the clinical responses to stimulation of the sympathetic nerve fibres of the head and neck?

A

Dilation of pupil

Sweating

Eye lid retraction

Vasoconstriction

39
Q

What is the triad of symptoms in Horner’s syndrome?

A

Partial ptosis

Miosis (constriction of pupil)

Andhydrosis (Decreased sweating)

40
Q

Explain how partial ptosis come about in Horner’s syndrome.

A

Due to loss of sympathetic innervation of the smooth muscle part of the levator palpabrae superioris.

41
Q

Explain why miosis come about in Horner’s syndrome.

A

Constriction of pupil due to the paralysis of the dilator pupillae and therefore unopposed parasympathetic innervation of the pupil.

42
Q

Explain why anhydrosis comes about in Horner’s syndrome.

A

Decreased sweating due to the loss of innervation of the sweat glands of the face.

This happens ipsilateral

43
Q

Causes of Horner’s syndrome

A

Spinal cord lesions

Traumatic injury

Pancoast tumour

44
Q

Explain how a pancoast tumour can cause Horner’s syndrome.

A

A pancoast syndrome is found in the apex of the lung and can impinge on the sympathetic nerve fibres going to the head and neck.

45
Q

Explain Adie’s pupil

A

Ciliary ganglion provides innervation to the sphincter pupillae muscle to constrict the pupil.

If the ciliary ganglion is damaged, there is a loss of innervation to the sphincter pupillae.

This leads to a permanent dilated pupilthat will not constrict in the presence oflight.

46
Q

Explain the light reflex.

A

Light is shone into right eye (or left eye, doesn’t matter).

This sends a signal via afferent sensory fibres of the optic nerve.

Some branches leave the CN II to go into the midbrain and then synapse in the pre-tectal nucleus.

The pre-tectal nucleus will then communicate with the Edinger-Westphal nucleus, both left AND right.

The pre-ganglionic parasympathetic fibres from the EDW leave the brainstem with the oculomotor nerve, both left AND right.

The fibres then synapse in both the ciliary ganglia and then travel via the short ciliary nerve (Va) to reach the sphincter pupillae muscle of both eyes.

This leads to constriction of both pupils.

47
Q

What is the direct light reflex?

A

When the pupil of the eye which light is shone into constricts.

48
Q

What is the consensual light reflex?

A

When the eye that doesn’t have light shone into it constricts.

(Both are physiological responses and should occur)

49
Q
A

H&N (37 decks)

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