Autonomic Nervous System of the Neck

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
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