15-May-09

The autonomic nervous system in the head and neck

Organization of the nervous system
Anatomically, the nervous system is organized into:

The central nervous system (CNS), consisting of the brain and spinal cord. The peripheral nervous system (PNS), consisting of the cranial and spinal nerves.

Physiologically (functionally), the PNS is divided into:

The somatic nervous system. The autonomic nervous system. This system is further divided into sympathetic nervous system and parasympathetic nervous system.

The somatic nervous system

It mainly supplies skeletal muscles through its motor nerves and it also provides general and special sensations through its sensory nerves. The somatic nervous system is totally under voluntary (conscious) control.

Motor innervation (one function): skeletal muscle contraction. Sensory innervation (two functions): general and special sensations.
1. General sensations such as pain, thermal (hot and cold), pressure

and tactile (touch)!?.

2. Special sensations (only four), which are vision, smell, taste, and

hearing. Note Medically, tactile (touch) sense is considered as a general sense, not special. Dont forget that.

The autonomic nervous system

The autonomic nervous system supplies cardiac muscle, smooth muscles, and secretory glands (sweat, salivary, lacrimaletc), through itstwo divisions the sympathetic and the parasympathetic systems.It isunder involuntary control.

Motor innervation (two functions): either inhibit or excite the effector organs through the sympathetic or the parasympathetic nervous systems, but which one? The sympathetic and parasympathetic nervous systems dually innervate most visceral organs, and in normal situations both systems are partially active; this on going activity is called sympathetic or parasympathetictone or tonic activity. Under given circumstances, activity of one system can dominate the other.In emergency or stressful situations fight or flight response, the sympathetic system will dominates to prepare the body for strenuous physical activity. While in quiet, relaxed situations rest and digest, the parasympathetic system will takeover.

Sensory innervation (one function): sensory nerves terminate on the effector organs, by binding to internal receptors. These receptors are chemical (chemoreceptors); like the carotid body, which monitors oxygen level in blood, and mechanical (mechanoreceptors); like the carotid sinus, which monitors blood pressure.

Somatic and autonomicnerves pathway

Somatic nerves pathway The cell bodies of almost all motor neurons are within the spinal cord. The only exception: the cell bodies of motor neurons supplying muscles in the head are in the brain stem. Now all the axons of motor neurons will leave from their origin in the CNS, and travel all the way to the effector organ, which is the skeletal muscle without any interruption (single neuron pathway). Usually the axons are myelinated.

Autonomic nerves pathway (preganglionic neuron, autonomic ganglion, postganglionic neuron)

Each autonomic nerve pathway extending from the CNS to an innervated organ is a two-neuron chain. The cell body is located in the CNS. Its axon, the preganglionic fiber, synapses with the second neuron, which lies within an autonomic ganglion. The axon of the second neuron, the postganglionic fiber, innervates the effector organ.

Preganglionic (also known as presynaptic or 1st order) neurons: originate from the CNS, all the way to the autonomic ganglia, where theysynapse with postganglionic neurons. They are usuallymyelinated.

Autonomic ganglion: aggregation of neuronal cell bodies and supporting cells like glial cells. Because the autonomic nervous system has two subdivisions, the ganglia could be sympathetic or parasympathetic. The sympathetic ganglia lie within the sympathetic trunk. While the parasympathetic ganglia are calledterminal ganglia (because they lie in or near the effector organs).

Postganglionic (also known as postsynaptic or 2nd order neurons: their cell bodies lie within the autonomic ganglia, all the way to the effector organ. They are usually unmyelinated.

Figure 1: motor nerves pathway of the somatic and autonomic nervous system.

Sympathetic motor nerves pathway Sympathetic nerve fibers (thoracolumbar) originate in the thoracic and lumbar regions of the spinal cord. Most sympathetic preganglionic fibers are very short; synapsing with cell bodies of postganglionic neurons within ganglia that lie in a sympathetic ganglion chain (the sympathetic trunk) located along either side of the spinal cord. Long postganglionic fibers originating in the ganglion chain end on the effector organs. Parasympathetic motor nerves pathway Parasympathetic preganglionic fibers (craniosacral) arise from the cranial (brain) and sacral areas of the CNS. These fibers are longer than sympathetic preganglionic fibersbecause they do not end until they reach terminal ganglia that lie in or near the effector organs. Very shortpostganglionic fibers end on the cells of an organ itself. The tables below will help you to sum up the main ideas for what was explained.

Table1: Comparison of the autonomic nervous system and the somatic nervous system

Feature
Site of origin Types of control Organs innervated Type of innervation

Autonomic nervous system

Brain or spinal cord Under involuntary control Cardiac muscle, smooth muscles and glands Most effector organs dually innervated by the two antagonistic branches of this system (sympathetic and parasympathetic) Dual functions: excitation and inhibition

Somatic nervous system

Spinal cord for most; those supplying muscles in head originate in the brain Under voluntary control Skeletal muscle Effector organs innervated only by motor neurons

Effects on Single function: stimulation effector of skeletal muscle organ contraction Sensory Single function: non Two functions: general and innervation conscious sensation only special Number of Two neuron chain pathway Single neuron neurons (preganglionic and from origin postganglionic) in CNS to effector organ Table 2:Distinguishing features of sympathetic nervous system and parasympathetic nervous system.

Feature
Origin of preganglionic fiber Origin of postganglionic fiber (location of ganglia) Length of fiber

Sympathetic nervous system

Thoracic and lumbar regions of spinal cord Sympathetic ganglion chain (near spinal cord) Short preganglionic fibers Long postganglionic fibers
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Parasympathetic nervous system

Brain and sacral region of spinal cord Terminal ganglia (near or in effector organs) Long preganglionic fibers Short postganglionic fibers

myelination Dominance

Preganglionic fibers only Emergency fight or flight situations

Preganglionic fibers only Quiet rest and digest situations

Table 3:effects of autonomic nervous system on various organs

Organ
Heart Blood vessels (smooth muscles) Digestive tract Glands Sweat glands Salivary glands

Effect of sympathetic stimulation

Increase rate and force of contraction Constriction Decrease motility Stimulate secretion by most sweat gland Stimulate of small volume of thick saliva rich in mucus

Effect of parasympathetic stimulation

Decrease rate and force of contraction Dilation Increase motility Stimulate secretion by some sweat glands Stimulate of large volume of watery saliva rich in enzymes

Sympathetic ganglia in the head and neck

In the neck region, there are three cervical ganglia superior, middle and inferior, they are part of the sympathetic chain.The most important one is the superior one, because it carries most of the functions Location: attached posterior to the carotid sheath, within he carotid triangle. The superior ganglion usually fuses with the 1st thoracic ganglion; they form a large ganglion called the stellate ganglion.

Parasympathetic ganglion in the haed and neck

They are 4 in number:

1. Ciliary ganglion. 2. Ptergopalatine ganglion 3. Otic ganglion 4. Submandibular ganglion

Ciliary ganglion
It is located between the optic nerve (its lateral side) and lateral rectus muscle. It suspended in its position by communicating branch from nasociliary nerve (carries general sensations from the eyeball). Nasociliary nerve is a branch from the ophthalmic nerve. It receives its preganglionic parasympathetic fibers from oculomotor nerve (III), via the inferior branch (nerve to inferior oblique). The postganglionic parasympathetic fibers leave the ganglion in the short ciliarynerves (branches from nasociliary), which pass forward to the posterior aspect of the eyeball, they supply sphincter pupillae muscle and ciliary muscle. What is the function(s) of these muscles?

Sphincterpupillae muscle constricts the pupil. Ciliary muscle controls the shape of lens, by making them more convex to accommodate near vision.

Postganglionic sympathetic fibers pass from the superior cervical ganglion in the long ciliary nerves (branches from nasociliary) into the eyeball to supply dilator pupillae muscle, which dilates the pupil.

Horners syndrome
Damage to sympathetic innervation through superior cervical ganglion.

Symptoms 1. Ptosis: dropping of upper eyelid (WHY?) Once the superior cervical ganglion is damaged, the sympathetic innervation in the head region is lost. Levatorpalpebreasuperiorismuscle is responsible of raising the upper eyelid, this muscle has two parts; the superior part is made of skeletal muscle, supplied by oculomotor nerve (III), the inferior part is made of smooth muscle, supplied by sympathetic nerves. So the inferior part will be paralyzed and the muscle will not be able to hold the upper eyelid in its proper position.
2. Constriction of pupil: because dilator pupillea muscle is paralyzed

and the constrictor pupillea will takeover.

3. Anhydrosis: lack of sweating

4. Flushing of the face (WHY?) Due to parasympathetic dominance, which will vasodilate the blood vessels within the skin.

Ptergopalatine ganglion
Located in the Ptergopalatine fossa, suspended by maxillary nerve (V2) It receives its preganglionic parasympathetic fibers from greater petrosal nerve (branch from facial nerve). Postganglionic parasympathetic fibers leave in the maxillary nerve, they then run in the zygomaticotemporal nerve and the lacrimal nerve (branch from the ophthalmic nerve) to reach the lacrimal gland. They supply the gland with secretomotorinnervation. Postganglionic sympathetic fibers from superior cervical ganglia reach the ganglia via internal carotid artery, where they form the deep petrosalnerve. The deep petrosal nerve will join the greater petrosal nerve to form the nerve of the pterygoid canal (or vidian nerve), which will

enter the ganglion.

Otic ganglion
Located below foramen ovale, medial to mandibular nerve. It suspended by nerve to medial pterygoid. It receives its preganglionic parasympathetic fibers from glossopharyngeal nerve (IX), by its tympanic branch the tympanic nerve, which will form the tympanic plexuses in the tympanic cavity within the middle ear. The lesser petrosal nerve leaves the plexuses by passing anterior in the floor of middle cranial fossa, and then leaves through foramen ovale to reach the ganglion. Postganglionic parasympathetic fibers leave by joining the auriculotemporal nerve to the parotid gland and serve as secretomotor fibers.

Postganglionic sympathetic fibers from the superior cervical ganglion pass directly to the parotid gland.

Submandibular ganglion
Located lateral to hyoglossus muscle, suspended by lingual nerve. It receives its preganglionic parasympathetic fibers from facial nerve, through chorda tympani, then it join the lingual nerve within the infratemporal fossa at the lower border of lateral ptergoidmuscle. Postganglionic parasympathetic fibers are distributed directly to sublingual and Submandibular glands, because the ganglion is very close to the glands. They supply glands by secrertomotor fibers. Postganglionic sympatheticfrom superior cervical ganglion reach the glands, and they are vasomotor to the blood vessels of the glands (reduce the water content of saliva).

The end Done by: ME

Hiatham.H.M.Mendeny
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