Autonomic Innervation of the Head and Neck

Question 1

What is the autonomic nervous system part of?

Answer 1

The peripheral nervous system

Question 2

Does the autonomic nervous system have any central control?

Answer 2

Yes

Question 3

Where does the central control of the autonomic nervous system come from?

Answer 3

The hypothalamus of the brain

Question 4

What does the autonomic nervous system do?

Answer 4

Controls body functions that are not under conscious control

Question 5

What tissues does the autonomic nervous system act on?

Answer 5

• Smooth muscle
• Cardiac muscle
• Glands

Question 6

Give two examples of locations of smooth muscle that the autonomic nervous system acts on

Answer 6

• Gut
• Blood vessels

Question 7

Give 3 glands that the autonomic nervous system acts on

Answer 7

• Lacrimal
• Mucosal
• Salivary

Question 8

What is the overall function of the autonomic nervous system?

Answer 8

Maintains and fine tunes the internal environment

Question 9

What does the sympathetic nervous system act as in most cases?

Answer 9

An accelerator

Question 10

What does the parasympathetic nervous system act as in most cases?

Answer 10

A brake

Question 11

How are the neurones arranged in the autonomic nervous system?

Answer 11

Has a sequential two neurone arrangement, and an associated ganglion

Question 12

Where does the pre-ganglionic nerve come from in the autonomic nervous system?

Answer 12

The spinal cord

Question 13

Where do the neurones synapse in the autonomic nervous system?

Answer 13

Synapse in the ganglion

Question 14

What is a ganglion?

Answer 14

A collection of cell bodies in the peripheral nervous system

Question 15

Where do the neurones of the sympathetic nervous system arise from?

Answer 15

The thoracolumbar spinal cord

Question 16

Where do the cell bodies of the pre-ganglionic sympathetic nerves sit?

Answer 16

In the lateral horn of the grey matter of spinal cord segments T1-L2

Question 17

What happens to the pre-ganglionic neurone of the SNS once it has arisen from the spinal cord?

Answer 17

They enter the sympathetic chain and run up the spinal cord

Question 18

Where do the pre-ganglionic neurones of the SNS synapse?

Answer 18

Don’t synapse at the first ganglion they encounter while running up the sympathetic chain, go up to the top ganglia in the neck

Question 19

What are the top 3 paravertebral ganglia in the neck called?

Answer 19

Cervical ganglia

Question 20

Where do most sympathetics to the head and neck synapse?

Answer 20

In the superior cervical ganglia (the top ganglion)

Question 21

What happens to the sympathetic neurones supplying the head and neck from the sympathetic chain?

Answer 21

They hitch hike to where they need to be on blood vessels

Question 22

What to the neurones form around the internal and external carotid arteries?

Answer 22

A carotid plexus

Question 23

What happens to the neurones hitch hiking on the internal and external carotid arteries?

Answer 23

They follow the branches to the target tissues

Question 24

What sympathetic fibres does the internal carotid arteries carry?

Answer 24

The eye

Question 25

How to the sympathetic fibres get from the internal carotid artery to the eye?

Answer 25

Via the opthalmic artery

Question 26

What sympthatic fibres does the external carotid artery carry?

Answer 26

Those going to sweat glands and smooth muscle in blood vessels of the face and neck

Question 27

What is the result of the carotid plexus following the carotid arteries?

Answer 27

Any disease affecting the carotid artery could also affect the sympathetics of the face

Question 28

What is in important anatomical relations to the sympathetic nerves innervating the head and neck?

Answer 28

The carotid arteries and lung apex

Question 29

What can pathologies involving the carotid arteries and lung apex cause?

Answer 29

Autonomic dysfunction in the eye and face

Question 30

What may apical lung tumorus cause?

Answer 30

Development of autonomic disruptio of the face and eye

Question 31

What happens once sympathetic nerve fibres get close to the target tissue?

Answer 31

Sympathetic nerve fibres have to leave vessels and hitchhike on cranial nerves

Question 32

What cranial nerve does the sympathetics of the tarsal muscle hitch-hike on?

Answer 32

The oculomotor nerve

Question 33

What cranial nerve do the sympathetics of the dilator pupillae hitch-hike on?

Answer 33

The trigeminal nerve

Question 34

What do the sympathetic nerves of the head and neck innervate?

Answer 34

* Smooth muscle of the blood vessels * Smooth muscle of the eyelid **(the tarsal muscle)** * Smooth muscle of the iris **(dialtor pupillae)** * Arrector pili muscles * *Decreases secretion from salivary and lacrimal glands*

Question 35

What does the tarsal muscle do?

Answer 35

Retracts eyelid to keep eyes wide

Question 36

What does the dilator pupillae do?

Answer 36

Causes the iris to dilate, and so cause the pupils to widen

Question 37

What does Horners syndrome result from?

Answer 37

Interruption of the sympathetic nerve supply to the head and neck

Question 38

What are the signs of Horners syndrome?

Answer 38

* Miosis * Partial ptosis * +/- anhydrosis

Question 39

What is miosis?

Answer 39

Dilation of pupil

Question 40

What do the possible diagnoses of Horners syndrome relate to?

Answer 40

Anatomical relations of sympathetic nerve supply on its route from the spinal cord to head

Question 41

What are the possible causes of Horners syndrome?

Answer 41

* Apical lung cancer * Carotid artery dissection

Question 42

Where do the parasympathetic nerve fibres innervating the head and neck arise from?

Answer 42

The cranial outflow, arising from the brainstem

Question 43

How do the parasympathetic nerves from the cranial outflow leave the brainstem?

Answer 43

From specific parasympathetic nuclei

Question 44

What are parasympathetic nuclei?

Answer 44

Collections of cell bodies

Question 45

What are the names of the parasympathetic nuclei?

Answer 45

* Edinger Westphal * Superior salivary * Inferior salivary * Dorsal motor

Question 46

What cranial nerves carry parasympathetic fibres from the brainstem?

Answer 46

* Oculomotor * Facial * Glossopharyngeal * Vagus

Question 47

Where does the oculomotor nerve arise from?

Answer 47

The brainstem

Question 48

Where do the parasympathetic nerves that hitch-hike on the oculomotor nerve arise from?

Answer 48

The Edingere Westphal parasympathetic nuclei inside it

Question 49

What course does the oculomotor nerve and associated sympathetic fibres take?

Answer 49

Runs through cavernous sinus and then through the superior orbital fissure

Question 50

When do the parasympathetics leave the oculomotor nerve?

Answer 50

After it passes through the ciliary ganglion

Question 51

What happens once the parasympathetic fibres have left the oculomotor nerve?

Answer 51

They hitch hike on small branches from V1/Va

Question 52

What do the post-ganglionic parasympathetic nerves from the oculomotor nerve innervate?

Answer 52

* Ciliary body * Sphincter pupillae

Question 53

What is the sphincter pupillae responsible for?

Answer 53

The pupillary light reflex

Question 54

What course does the facial nerve and its associated parasympathetics take?

Answer 54

Arises in brainstem, travels inside the petrous part of the temporal bone, and then branches into chora tympani and greater petrosal nerves

Question 55

Where do the parasympathetics travelling on the greater petrosal nerve synapse?

Answer 55

At the pterygopalatine ganglion

Question 56

Where do the parasympathetics travelling on the chorda tympani synapse?

Answer 56

Submandibular ganglion

Question 57

Where do the nerves from the pteryogopalatine ganglion go?

Answer 57

To the lacrimal gland and mucosal glands in nasal/oral cavity

Question 58

Where do the nerves from the submandibular ganglion go to?

Answer 58

The salivary glands; submandibular and sublingual

Question 59

What is pathology of the facial nerve complex?

Answer 59

Because three branches of the facial nerve are given off in the petrous bone

Question 60

What happens in pathology at or before the geniculate ganglion?

Answer 60

May involve all parasympathetic functions carried within CN VII

Question 61

What happens in pathology after the geniculate ganglion?

Answer 61

Lacrimal glands are spared, *as the pathology does not involve the greater petrosal nerve*

Question 62

What course does the glossopharyngeal nerve and its associated parasympathetics take?

Answer 62

Arises, goes through the jugular foramen, and then branches into the tympanic nerve, then divides into a plexus. The plexus exits from the petrous part of the temporal bone through the foramen ovale to the lesser petrosal nerve

Question 63

What does the tympanic nerve supply?

Answer 63

Sensory to the middle ear

Question 64

Where do the parasympathetics hitch-hiking on the glossopharyngeal nerve synapse?

Answer 64

Otic ganglion

Question 65

What do the parasympathetics hitch-hiking on the glossopharyngeal nerve supply?

Answer 65

Parotid

Question 66

Where does the vagus nerve arise from?

Answer 66

The medulla of the brainstem

Question 67

Where do the parasympathetics hitch hiking on the vagus nerve synapse?

Answer 67

At a ganglino at, or in, the target tissue

Question 68

What are the target tissues for parasympathetics of the vagus nerve?

Answer 68

Glands in larynx, respiratory tract, GI tract, etc

Question 69

Where is the parasympathetic sacral outflow/

Answer 69

S2-4

Question 70

What do the parasympathetics innervate in the head and neck?

Answer 70

* Smooth muscle of iris **(sphincter pupillae)** * Smooth muscle of ciliary body * Lacrimal glands * Salivary and mucosal glands

Question 71

What does the sphincter pupillae do?

Answer 71

Makes pupil smaller

Question 72

What does the smooth muscle of the ciliary body do?

Answer 72

Controls thickness of the lens