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The Autonomic Nervous System in The Head & Neck :Introduction The nervous tissue is divided anatomically into CNS & PNS according to its location, the CNS is simply the brain & the spinal cord , the PNS consists anatomically of the nerves that are distributed in our bodies (like radial , ulnar , sciatic nerves .. ) , the PNS is functionally divided into somatic voluntary . &autonomic Its possible to find in the same nerve autonomic fibers & somatic fibers, so the nerve consists of millions of axons that could be autonomic or somatic depending on .the function of that nerve The somatic NS is under our own control & could be sensory for general sensation ((touch, pressure, tractile & special sensations, pain, thermal sensation OR motor voluntary movement of sk .m. so producing the movement The autonomic NS under unconscious control- you cant control it it divides into 2 parts a) the sensory part for internal organs & divides into chemo receptors & mechanoreceptors ( example : chemoreceptor like the carotid body monitors levels of O2 & CO2 in bld. ,, mechanical receptors like the carotid sinus for measurements ( of the bld. Pressure .most of the autonomic NS is motor, so the sensory is rare * The more important part of the ANS is b) the motor part that controls the cardiac & smooth m. (the involuntary muscles). & the glands, its also divided into sympathetic & parasympathetic for the same muscle (smooth or cardiac) receives 2 nerves (one sympathetic & one parasympathetic so one for contraction & other for relaxation), like the bld.v. when there is sympathetic do vasoconstriction in the peripheral parts of our bodies in dangerous situations, & the sympathetic does the vasodilatation in the internal organs like brain & heart but the parasympathetic is responsible for vasoconstriction of bld.v. in brain & heart, & vasodilatation in the .peripheral parts .(The motor in ANS is either excitatory or inhibiting 2 fxns (dual fxn.the motor in skeletal m. "somatic" is 1 fxn which is contraction of the muscles .sympathetic is from the word sympathy & it works in dangerous situation .parasympathetic works under relaxation & normal situations:Examples :.cardiac m * .sympathetic increases the HR & the force of contraction .parasympathetic (from vagus n.) decreases the HR & force of contraction-

:.smooth m* they are existed in the walls of hollow tubes (intestine, arteries, ureter, vas deferens.( sympathetic in arteries (contraction in peripheral & relaxation in internal arteries smooth muscles) so the bld. Aggregates in vasodilated arteries internally in heart & .brain parasympathetic: contraction on smooth muscles of arteries in the internal organs .& relaxation in the peripheral parts so increased bld. In the skin :Again to compare between the somatic & autonomic systems

Somatic Vs. Autonomic Somatic autonomic

general & special sensation 1) unconscious sensation (mech. & chem. (1 (Receptors voluntary movement of sk.m. 2) involuntary control (smooth & cardiac (2 (& glands (salivary, lacrimal, sweat single fxn (contraction) 3) dual fxn: cuz every organ receives both (3 sympathetic & parasympathetic, they "work against each other "dual innervation single neuron: the same neuron 4) 2 neuron path way cuz their fxn is (4 Originate & goes all the way to complicated & the neurons are weak .Reach the skeletal m. "one way so they need to have a rest in ganglia ."Neurons

so where ever you see a ganglion in ur body - except the spinal cord - its * .(autonomic (sympathetic or parasympathetic the sympathetic ganglia are all arranged beside the vertebral column in the sympathetic chain or trunk, but all ganglia that are distributed in the body beside the .organs are parasympathetic :ANS is anatomically composed of preganglionic neurons (1 neuron ), originate from the CNS ( spinal cord or the (1 brain -like CNs- ) , then goes to autonomic ganglia ,, these neurons are myelinated . with myelin sheath .autonomic ganglia that can be sympathetic or parasymp (2 postganglionic neurons: (2 neurons) from ganglion to the organ & its (3 .unmylinated

see all sympathetic 1 neuron be6la3 mn el thoracic & abdominal spinal .(nerves so they are called (thoracolumber pathway

the parasympathetic be6la3o mn el cranial nerves (3, 4, 7, 10) & sacralsegments so its called the craniosacral part) based on where the neurons arise .from the sympathetic 1 neurons are very short cuz the sympathetic chain is just .beside the spinal cord then the 2 neurons are distributed from the chain the para. is the opposite the ganglia are just beside the organ so the 1 is long .& 2 are the short *.ganglia in H&N are 3 symp. & 4 para.symp* The 3 sympathetic in the sympathetic chain are (sup. Mid. & inf) cervicalganglia & they are exactly existed attached to the post. Aspect of the carotid .sheath

Parasympathetic ganglia in H&N

cilliary ganglion: inside the orbit & related to intra ocular muscles (1 (sphincter pupillae, cilliary m.), but the dilator pupillae isnt innervated by cilliary
.ganglion

: Remember Cilliary m. when contracts due to parasympathetic it relaxes the suspensory ligaments of * lens , so it becomes more convex to accommodate close vision but sympathetic does the relaxation of this muscle , so the suspensory lig. Tens & the lens gets flat so we can see far . objects The carotid sheath contains IJV , carotid a. , vagus n. , . & its attached anteriorly to ansa * .cervicalis & sympathetic chain posteriorly stellate ganglion is the fusion between inf. Cervical & 1st thoracic ganglia *

(sphincter pupillae that constrict the pupil (by parasympathetic pterygopalatine ganglion in the pterygopalatine fossa gives parasympathetic (2 .innervation to the lacrimal gland the otic ganglion: inf. To foramen ovale & innervates the parotid (3 .submandibular ganglion: sublingual & submandibular salivary glands (4

Ciliary ganglion .Located between the optic n. medially & lat. Rectus laterally.suspended by the oculomotor n every ganglion has a nerve that carry it & it is not necessarily the nerve that gives it preganglionic fibers so we have to know the nerves that carries the . ganglion & the nerves give pre- & post- ganglionic fibers

preganglionic fibers from the oculomotor n. (parasympathetic innervation) this 1 neuron enters the ciliary ganglion & makes synapse there , then the 2 neuron "unmyelinated axons " comes out of it to make the short ciliary nerves ..(that supplies sphincter pupillae m. & ciliar m .so the parasympathetic constricts the pupil & accommodate for close vision * :the postganglionic sympathetic fibers The sympathetic synapse in the sympathetic chain (cervical ganglia) then the2 neuron btemshe m3 el nasociliary n. that gives the long ciliary nerves that .supplies the dilator pupillae m. to dilate the pupil

Horner's syndrome
Its damage to the sympathetic innervations through the sup. Cervical ganglion " which is the most important one cuz it caries the sympathetic innervation to the head area , so when there is damage in it then we've damage to sympathetic innervation to the whole area of the head & that makes :the parasymp. Pathway active that's why we're going to see several things Ptosis: dropping in the upper eyelid cuz the inf. Fibers of levator palpebrae (1 superioris (which is another m. called sup. Tarsal m.) & its a smooth muscle that receives sympathetic innervation from the nasociliary from ophthalmic & this sympathetic innervation do the contraction of this muscle so we can easily open our eyes in dangerous situations when the sympathetic pathway is active .so this sup tarsal m. will elevate the upper eyelid strongly so u can see farther But when the parasymp. Is active, at rest & normal situations, it will work on levator palpebrae, inf. Part, so the muscle is relaxed cuz the symp. Isnt active so the upper eyelid benzal l7alo ,,, also when the eyelid beser yermosh la7alo this is also activation of the symp. Cuz you were thinking of sth activated the . symp. Pathway . (so when the symp. Is damaged we'll have dropped eyelid (ptosis this damage also affects dilator pupillae " the muscle that contract to dilate (2 the pupil when u come into a dark room " , so when the sympathetic that supply it is damaged it will be paralyzed & the pupil will be constricted " . "miosis anhydrosis : (an : without , hydrosis : sweating) , so there is lack of (3 sweating , cuz the sympathetic pathway isnt active anymore cuz the sweat . glands are activated by sympathetic pathway : flushing of the face (4

Remember the parasymp. Do vasodilatation in the peripheral bld. V. & vasoconstriction in the inner organs & the symp. Is the opposite , so when the sympathetic is damaged the parasymp. Is activated so there will be more bld. . In the skin & peripheral parts ptosis , miosis , anhydrosis & flushing face together called horner's . syndrome

Ptergopalatine ganglion
.(Located in the pterygopalatine fossa & suspended by the maxillary n (v2it receives preganglionic parasympathetic innervation from the facial through what we call greater petrosal n. that pass in the petrous part of temporal bone , .the greater petrosal is a large nerve compared to lesser petrosal n post.gang.parasymp. are unmyelinated & weak so it need to be carried by a nerve so they 1st go with the zygomatico temporal of v2 , bemsho m3o then . betrkoh o be6la30 m3 el lacrimal of v1 to the lacrimal gland those parasympathetic fibers that reach the lacrimal gland increases the * *secretion of this gland the post.gang.symp.: comes from sup. Cervical gang. O bemshe men 3end el internal carotid , bemshe 7awaleh o be6la3 ,, so its called the deep petrosal n. " it makes a plexus around the carotid " it leaves it & enter the skull so it enters through the carotid canal & join the greater petrosal n. ( which is from . the facial) at the ant. Border of foramen lacerum the greater petrosal is pregang. Parasymp.. & the deep petrosal is symp. & post.gang. of course ,, so when they join together they form nerve of the .. pterygoid canal ="the vidian n." .. this is v. imp. Look at the pic. Below

This nerve pass inside the bone from foramen lacerum to foramen rotundum.& gets inside the pterygopalatine gang
in these ganglia ( parasympathetic ) we've only post ganglionic fibers we dont have* preganglionic cuz these are 2 neurons that have already synapsed in the ganglia of * sympathetic chain

so now we have inside the pterygopalatine gang. Symp.nerves that'll not synapse here but the parasymp. ( from greater petrosal ) will do synapse then both symp. & parasymp. Gets out of the ganglion to the zygomatico temporal . branch to the lacrimal n. then lacrimal gland

The otic ganglion

its inf. To foramen ovale & medial to the mandibular n. & its carried by ." nerve to medial pterygoid " its just suspending the ganglion the pregang. Parasymp. Starts from the glossopharyngeal that gets out of the .( skull from the jugular foramen ( CN 9 & 10 & 11, comes from there the inf. Wall of the tympanic cavity " jugular wall in the middle ear , beneath it there is the jugular foramen so when this nerve is about to get out of the skull it gives a branch b4 getting out that gets inside the inf. Wall of middle ear esmo el tympanic nerve . & on the promontory on the medial wall of middle ear it makes tympanic plexus that gives general sensation of middle ear , then men el roof to the brain be6la3 another nerve which is the lesser petrosal n. be5tare8 el middle ear & gets inside the skull in the middle cranial fossa .. then the lesser petrosal be6la3 men foramen ovale to enter into the otic . ganglion
Lesser petrosal Chorda tympani Facial nerve

Tympanic plexus on promontary

Tympanic nerve

facial

then the post gang. Parasym. Are weak so they need the auriculotemporal n. .7atta yerkab 3leh then to be distributed in the parotid gland These nerves inside the parotid gland will go to the external carotid artery which is inside the parotid, these parasymp. Innervation will do vasodilatation to the artery so increased bld. Supply & increased fluid & secretion of the gland cuz the amount of fluid increased so the watery secretion is largely .increased cuz of vasodilatation the nerves here dont work on the alveoli of the secretion process it works on * * the artery but the symp. ( from sup. Cervical ) is activated it makes vasoconstriction in the ex.carotid , so less plasma fluid will be filtered in the parotid so less fluid within the saliva so we'll have less saliva volume but rich in enzymes ."" amylase & lipase

submandibular ganglion
.located lat. To hyoglossus m. & suspended by lingual nerve pregang. Parasymp. Is from the facial through chorda tympani that joins the .lingual n post.gang.parasymp. : its very close to sublingual & submandibular glands sothey dont need a nerve to be carried on , so when they gets out of the . ganglion they are distributed directly to the glands post.gang. symp. From sup. Cervical ganglionnnnnnnnnnnnnnnnnn-

THE END

: Done by Ayat jum'a momani