Innervations and Blood Supply Exam 1 PDF

INNERVATIONS Nerve CN I (Olfactory) CN V (Trigeminal nerve) CN VII (Facial Nerve) CN IX (Glossopharyngeal nerve) CN X (Vagus) Innervations Sensory • Upper portion of nose Sensory • Pain, touch, temperature to body of tongue (Lingual branch) • Soft palate • External nose à all but upper portion o...

INNERVATIONS Nerve CN I (Olfactory) CN V (Trigeminal nerve) CN VII (Facial Nerve) CN IX (Glossopharyngeal nerve) CN X (Vagus) Innervations Sensory • Upper portion of nose Sensory • Pain, touch, temperature to body of tongue (Lingual branch) • Soft palate • External nose à all but upper portion of nose • Paranasal sinuses • Nasopharynx Sensory • Taste to body (anterior 2/3) of tongue (Chorda tympani branch) Motor • Parasympathetic stimulations à increases mucous gland productions in nose Sensory • Taste, pain, touch temperature to root (posterior 1/3) of tongue • Afferent limb of gag reflex • Palatopharyngeal arch, Palatine tonsils between pillars, and Lingual tonsils (oropharynx) Sensory • Laryngopharynx • Trachea (carina and true vocal cords very sensitive) Motor • Palatoglossus CN XI (Spinal accessory) CN XII (Hypoglossal) Pterygopalatine ganglion (Sphenopalatine ganglion/SPG) Internal Laryngeal Nerve Pharyngeal plexus Superior Laryngeal Nerve (SNL) Recurrent Laryngeal Nerve (RLN) Inferior Laryngeal Nerve (branch off RLN) • Sternocleidomastoid Motor • All muscles of tongue except palatoglossus Sensory • Connects to sphenopalatine nerve. • Lies inferior to CN V and receives preganglionic parasympathetic neurons from CN VII. • Regional anesthesia blocks maxillary nerve à parasympathetic block!! • Cholinergic neurons innervate cerebral blood vessels that dilate with stimulation à block will prevent headaches Sensory • Anesthesia landmark for awake intubation Sensory • Most of pharynx Motor • Motor fibers in plexus derived from CN X except stylopharyngeus (CN IX) • Pharynx Internal Branch: Sensory • Upper vocal cords and larynx above vocal cords External Branch: Motor • Cricothyroid muscle Motor • All muscles (except cricothyroid muscle) of larynx Sensory • Lower vocal cords and larynx below vocal cords Unspecified Parasympathetic Nerves Ventral rami and Dermatomes of Anterior Thoracic Wall Phrenic Nerve(s) (C3, C4, C5) Lower intercostal nerves Pectoral nerves Motor • Mucous glands of larynx • Mucous glands of trachea • Nipple à T4 • Xiphoid process à T6 dermatome (T9 vertebra) • Umbilicus à T10 Sensory • Entire diaphragm minus periphery Motor • Entire diaphragm Sensory • Diaphragm periphery • Costal parietal pleura • Peripheral portion of diaphragmatic parietal pleura • Pectoralis major and minor à Pecs block Long thoracic nerve • Serratus anterior à SAP block C3-C8 • Anterior, middle, and posterior scalene muscles Anterior Rami of T1-T11 spinal nerves • Intercostal muscles Pulmonary plexus • • Follows trachea and bronchial tree Autonomic innervation to smooth muscle and glands of lungs Visceral afferent fibers transmit nociceptive and reflexive sensations via CN X à primarily bronchopulmonary stretch receptors, irritant receptors of proximal airways, C fibers and juxtacapillary (J) receptors • Sensory • Visceral afferents: nociceptive and reflexive Motor • Parasympathetic (cholinergic): secretomotor (glands of airways) and bronchoconstrictive (smooth muscle of airways) • Sympathetic (adrenergic) fibers of T1-T4 à weak effect on airway diameter à some vasoconstriction and inhibition of gland secretion. May inhibit bronchoconstriction and weakly bronchodilate • Non-adrenergic/non-cholinergic (NANC) à inhibition of parasympathetic bronchoconstriction Color Key: - Blue à only sensory innervations given - Green à sensory and motor innervations given - Orange à only motor innervations given - Yellow à unspecified motor/sensory innervation BLOOD SUPPLY Location Tongue Nasal cavity Larynx Trachea Lungs: Pulmonary vessels à parenchymal tissue à bronchioles to alveoli Lungs: Blood flow Supply • Lingual artery (branch off external carotid) Supply • Sphenopalatine artery • Ethmoidal arteries • Greater palatine artery • Facial artery (labial artery is a branch of the facial) Kiesselbach’s area (plexus) • Region of anteroinferior nasal septum where branches of each of the above arteries • Common site of chronic EPISTAXIS Supply • Branches of superior/inferior thyroid arteries Drainage • Internal jugular Supply • Inferior thyroid arteries (bronchial arteries and intercostal arteries) Drainage • Corresponding veins?? Supply • Pulmonary arteries Drainage • Pulmonary veins (4) Supply • Bronchial arteries from descending aorta Bronchial vessels à vascular supply to stroma à conducting airways and visceral pleura Parietal pleura of lungs Visceral pleura of lungs Bronchopulmonary segments Drainage • R bronchial vein à Azygos vein à SVC • L bronchial vein à Accessory hemi-azygos vein àAzygos vein à SVC Supply • Internal thoracic artery (internal mammary) • Intercostal artery • Musculophrenic arteries Drainage • Intercostal veins • Interthoracic veins Supply • Bronchial arteries branching off aorta Drainage • Pulmonary veins Supply • Tertiary branch of pulmonary artery Drainage • Intersegmental parts of pulmonary veins that lie in the connective tissue between segments Tracheobronchial tree from main bronchi to terminal bronchioles Supply and structures of root of lung and viscera pleura • Bronchial arteries