Head & Neck Autonomics Lecture 5 PDF

Head & Neck Autonomics Med Neuro II: Lecture 5 January 23, 2025 Liam Zachary, PhD 1 Learning Objectives: 1. Describe the autonomic innervation of the intrinsic eye muscles & eyelid. 2. Describe the autonomic innervation of the lacrimal gland, & nasal/palatal mucosa. 3....

Head & Neck Autonomics Med Neuro II: Lecture 5 January 23, 2025 Liam Zachary, PhD 1 Learning Objectives: 1. Describe the autonomic innervation of the intrinsic eye muscles & eyelid. 2. Describe the autonomic innervation of the lacrimal gland, & nasal/palatal mucosa. 3. Compare and contrast the anatomical basis of oculosympathetic paresis (Horner's syndrome) and oculomotor nerve palsy. 4. Describe the autonomic innervation of the parotid gland & buccal mucosa. Describe the anatomical basis of Frey's syndrome. 5. Describe the autonomic innervation of the submandibular & sublingual glands. 6. Describe the autonomic innervation of the pharyngeal & laryngeal mucosa. 2  Parasympathetic Ganglia of the Head: Overview ( VI) Trochlear (IV) ns uce CN V provides passageways for Abd Ve I) (II st parasympathetic fibers (mostly or Hy ibu ot po om glo loc postganglionic) via 4 ganglia: Ciliary Ganglion ssa ul ho Otic Ganglion l Oc (XI lea I) r (V Submandibular III) 1. Ciliary (V1) Ganglion 2. Pterygopalatine (V2) Optic (II) 3. Otic (V3) 4. Submandibular (V3) CN V also carries postganglionic (V) ) l (IX Ac II) ) l (V ce (X inal sympathetic fibers from cervical (I) gea s us ory so ia act g m ry Fac r yn Olf Va Trige (X ganglia of the sympathetic trunk pha I) sso Pterygopalatine Glo Ganglion 3 Trigeminal Nerve: Summary of Autonomics 4 Autonomics of the Eye & Eyelid LO#1 5  Internal Acoustic Facial Nerve Subway Map-Style Meatus Superior Orbital Fissure Autonomics of the Eye & Eyelid: Overview Fa Lacrimal N. cia lN. Nasociliary Hiatus of the Greater Petrosal N. Zygomatic N. Facial Genu ne Greater Petrosal N. Bol ra Internal Carotid Inferio po Pterygoid Canal m Te Carotid Canal Foramen Lacerum Pterygopalati in ith Ganglion N. W Middle Ear Deep Petrosal N. l ia to: External Spheno Nerve of the c Fa Acoustic Meatus Pterygoid Canal Naso Lin Late to: Stapedius gu al N. Greater and Lesser Chorda Tympani Palatine Nerves To: N Petrotympanic Fissure Hard Palate Poster e at Stylomastoid to: Stylohyoid & l Pa Posterior Belly of Digastric ft Foramen ior So Temporal Branches Au ul Zyg ric ar oma N. tic Br anche s Ton Buccal Branches Mandibular Branches Submandib Ganglion Cervical Branches ry rte lA cia Submandibular Gland Fa Parasympathetic Ganglia Facial N. and Fibers Post Synaptic Parasympathetic Fibers of Facial Branches of Mandibular Division of Trigeminal Branches of Maxillary Division of Trigeminal Branches of Ophthalmic Division of Trigeminal Post Synaptic Sympathetic Fibers 6  Superior View Autonomics of the Eye: Ciliary Ganglion Located behind eye above Optic n. (CN II) Receives preganglionic parasympathetics from Oculomotor n. (CN III) Postganglionic parasympathetics join Short ciliary nn. to intrinsic eye muscles (Ciliary muscle & Sphincter pupillae) Postganglionic sympathetics from Coronal Carotid plexus in Cavernous sinus join Section: Ophthalmic n. (CN V1) & pass through Cavernous the Ciliary ganglion w/out synapsing Sinus Join Long ciliary nn. to intrinsic eye muscles (Dilator pupillae) 7  Pupil – central in iris; aperture for transmitting light; black Controlled by 2 muscles: Autonomics of the 1. Sphincter pupillae – parasympathetically-controlled Eye: Intrinsic Eye 2. Dilator pupillae – sympathetically-controlled Ciliary body – Anchors lens Muscles Ciliary m. – accommodation; parasympathetically-controlled Lens flat -> round; greater refraction, focus on nearby obj. Cornea Iris Pupil Anterior Chamber Sclera Ciliary Body: Iris Ciliary Muscle: Meridional Fibers Lens Circular Fibers Ciliary Process Nucleus of Lens Zonular Fibers Posterior Sphincter Muscle Chamber of Pupil Transverse Sclera Dilator Muscle & Sagittal of Pupil Anterior View section The vascular layer (uvea) transmits & refracts light, and is composed of 3 structures: § Iris § Diaphragm located on the anterior surface of the lens § Portion of the uvea with color § Pupil (aperture for transmitting light; central in iris; appears black) § Controlled by two muscles: § Sphincter pupillae mm. (contracts pupil, parasympathetically-controlled) § Dilator pupillae mm. (dilates pupil, sympathetically- controlled) § Ciliary body 8  § Anchors lens § Ciliary m. (smooth) contracts for accommodation § Secretes aqueous humour & portions of vitreous humour § Choroid § Richly vascular & pigment § Thin, middle layer of posterior eye 8  Autonomics of the Eye: Ciliary Muscle Cornea Anterior Chamber Sclera Ciliary Body: Iris Ciliary Muscle: Meridional Fibers Lens Circular Fibers Ciliary Process Nucleus of Lens Zonular Fibers Posterior Sphincter Muscle Chamber of Pupil Dilator Muscle of Pupil 9  Autonomics of the Eyelid: Superior Tarsal Muscle Superior Tarsal Muscle: Smooth muscle adjoining levator palpebrae superioris; assists in elevation of superior eyelid Sympathetically-innervated Postganglionic sympathetic fibers from internal carotid plexus join Oculomotor n. in the cavernous sinus Continue with superior division of Oculomotor n. to superior tarsal m. The superior tarsal muscle receives its innervation from the sympathetic nervous system. Postganglionic sympathetic fibers originate in the superior cervical ganglion, and travel via the internal carotid plexus, where small branches communicate with the oculomotor nerve as it passes through the cavernous sinus. The sympathetic fibres continue to the superior division of the oculomotor nerve, where they enter the superior tarsal muscle on its inferior aspect. 10 Autonomics of the Lacrimal Gland, & * * * Nasal/Palatal Mucosa * LO#2 11  Internal Acoustic Facial Nerve Subway Map-Style Meatus Superior Orbital Fissure Lacrimal Gland Fa Lacrimal N. Autonomics of the Lacrimal Gland & Nasal/Palatal Mucosa: Overview cia lN To: Nasal Mucosa. Nasociliary Hiatus of the Greater Petrosal N. Zygomatic N. Bo ne Facial Genu Greater Petrosal N. l ra Internal Carotid Inferior Orbital Fissure po Trigeminal Nerve Subway Map-Style Pterygoid Canal m Te Carotid Canal Foramen Lacerum Pterygopalatine in ith Ganglion N. W ia l Middle Ear Deep Petrosal N. to: External Sphenopalatine Foramen Nerve of the c Fa Acoustic Meatus Pterygoid Canal Nasopalatine and Lin Lateral Nasal Nerves to: Stapedius gu al N. Meckel’s Cave Chorda Tympani Greater and Lesser To: Nasal Mucosa Palatine Nerves Petrotympanic Fissure Inferior Orbital Fissure Zygomaticotemporal N. Trigeminal Ganglion Foramen Rotundum Zygomatic N. Hard Palate Zygomaticofacial N. Poster e at to: Stylohyoid & Stylomastoid Infraorbital N. l Pa Posterior Belly of Digastric ft Foramen Infraorbital Canal ior So Temporal Branches Pterygoid Canal Au ul Zyg Pterygopalatine Ganglion ric ar oma N. tic Br anche s Sphenopalatine Foramen To: Superior Alveolar Plexus Posterior Superior Alveolar N. Buccal Branches Nerve of Nasopalatine Tongue N. Pterygoid To: Nasal Mucosa Mandibular Branches Canal Lateral Nasals nn Greater and Lesser Palatine nn Submandibular Ganglion Cervical Branches Sublingual Gland ry rte lA Hard Palate cia to: Muscles of Submandibular Gland Fa e Parasympathetic Ganglia at Mastication l Pa Facial N. and Fibers ft Post Synaptic Parasympathetic Fibers of Facial So Branches of Mandibular Division of Trigeminal Branches of Maxillary Division of Trigeminal Maxillary Division Branches of Ophthalmic Division of Trigeminal Post Synaptic Sympathetic Fibers Mandibular Division 12  Internal Acoustic Facial Nerve Subway Map-Style Meatus Facial Nerve: Superior Orbital Fissure Lacrimal Gland Fa Lacrimal N. c Summary of ia N.l To: Nasal Mucosa Nasociliary Autonomics Hiatus of the Greater Petrosal N. Zygomatic N. ne Greater Petrosal N. Bo Facial Genu l ra Internal Carotid Foramen Lacerum Inferior Orbital Fissure po Pterygoid Canal m Te Carotid Canal Pterygopalatine in ith Ganglion. lN W Middle Ear Deep Petrosal N. ia to: External Cartilaginous Plug Nerve of the Sphenopalatine Foramen c Fa Acoustic Meatus Nasopalatine and Pterygoid Canal Lin Lateral Nasal Nerves to: Stapedius gu al N. Greater and Lesser Chorda Tympani Chorda Tympani Palatine Nerves To: Nasal Mucosa Petrotympanic Fissure Hard Palate Poster e at Stylomastoid to: Stylohyoid & l Pa Posterior Belly of Digastric ft Foramen ior So Temporal Branches Au ul Zyg ric ar oma N. tic Br anche s Tongue Buccal Branches Mandibular Branches Submandibular Ganglion Cervical Branches Sublingual Gland ry rte lA cia Facial N. and Fibers Submandibular Gland Fa Post Synaptic Parasympathetic Fibers of Facial Branches of Mandibular Division of Trigeminal Branches of Maxillary Division of Trigeminal Branches of Ophthalmic Division of Trigeminal Post Synaptic Sympathetic Fibers Facial’s Combined General Sensory and Taste Sensory Ganglion Parasympathetic Ganglia from Trigeminal 13  Facial Nerve Branches: Medial View Sagittal Section Greater Petrosal Nerve Facial n. enters petrosal bulla & gives off 2 nerves carrying parasympathetic fibers: 1. Greater (Superficial) Petrosal n. Parasympathetics for Nasal/Palatal mucosa & Lacrimal Gland Emerges in middle cranial fossa through the hiatus for the greater petrosal n. Courses anteriorly in a groove on the floor of the middle cranial fossa before passing through the foramen lacerum Lateral View Sagittal Section The greater petrosal nerve enters the petrous part of the temporal bone and travels anteromedially through it at a 45° angle. It emerges into the middle cranial fossa upon the anterosuperior surface of the bone: 498 through the hiatus for greater petrosal nerve alongside the petrosal branch of the middle meningeal artery.: 842 In the middle cranial fossa, the nerve is situated between the two layers of the dura mater: 450, 498 and passes obliquely anterior-ward: 450 along a groove upon the floor of the fossa: 509 - the groove for the greater petrosal nerve - that is situated upon the anterosuperior aspect of the petrous part of the temporal bone: 842 and anteromedial to the arcuate eminence, and adjacent and parallel to the lesser petrosal nerve and its own groove.: 509 The nerve passes deep to the trigeminal ganglion to reach the foramen lacerum.: 498, 509 At the foramen lacerum, it unites with the (sympathetic) deep petrosal nerve, forming the nerve of the pterygoid canal (which continues anterior-ward through the pterygoid canal to reach the pterygopalatine fossa and form the pterygopalatine ganglion).: 498 14 Autonomics of the Lateral View Lacrimal Gland & Nasal/Palatal Mucosa: Pterygopalatine Ganglion Seated in Pterygopalatine fossa At the foramen lacerum, preganglionic parasympathetics from Greater petrosal N. (CN Medial View VII) & Postganglionic sympathetics from Deep Bisected Skull petrosal N. join as Nerve of the pterygoid canal Parasympathetics synapse in the Pterygopalatine ganglion & sympathetics pass through w/o synapsing Postganglionic autonomics join branches of Maxillary n. (V2) to reach Lacrimal gland (Zygomatic n.), Palatal mucosa (Palatine nn.), Nasal mucosa (Lateral nasal nn.) 15 Oculosympathetic Paresis & Oculomotor Nerve Palsy LO#3 16  Oculosympathetic Paresis: Horner’s Syndrome A combination of symptoms that arise due to interruption of sympathetic pathways (e.g., damage to sympathetic trunks) Signs & symptoms ipsilateral to lesion Characterized by 4 main symptoms: 1. Miosis – constricted pupil 2. Partial ptosis – a weak, droopy eyelid 3. Anhidrosis – decreased sweating 4. Apparent enophthalmos – inset eyeball Horner's syndrome, also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged. The signs and symptoms occur on the same side (ipsilateral) as it is a lesion of the sympathetic trunk. It is characterized by miosis (a constricted pupil), partial ptosis (a weak, droopy eyelid), apparent anhidrosis (decreased sweating), with apparent enophthalmos (inset eyeball). Interruption of sympathetic pathways leads to several implications. It inactivates the dilator muscle and thereby produces miosis. It inactivates the superior tarsal muscle which produces ptosis. It reduces sweat secretion in the face. Patients may have apparent enophthalmos (affected eye looks to be slightly sunken in) but this is not always the case. The ptosis from inactivation of the superior tarsal muscle causes the eye to appear sunken in, but when actually measured, enophthalmos is not present. 17  Oculosympathetic Paresis: Horner’s Syndrome Symptoms are caused by the following deficits: 1. Miosis: Inactive dilator pupillae muscle 2. Partial ptosis: Inactive superior tarsal muscle 3. Anhidrosis: Damage to sympathetic trunk; reduces sweat secretion in face, but upper limb & thorax may also be affected 4. Apparent enophthalmos: ptosis from inactivation of the superior tarsal muscle causes the eye to appear sunken in, but when measured, enophthalmos is not present Horner's syndrome, also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged. The signs and symptoms occur on the same side (ipsilateral) as it is a lesion of the sympathetic trunk. It is characterized by miosis (a constricted pupil), partial ptosis (a weak, droopy eyelid), apparent anhidrosis (decreased sweating), with apparent enophthalmos (inset eyeball). Interruption of sympathetic pathways leads to several implications. It inactivates the dilator muscle and thereby produces miosis. It inactivates the superior tarsal muscle which produces ptosis. It reduces sweat secretion in the face. Patients may have apparent enophthalmos (affected eye looks to be slightly sunken in) but this is not always the case. The ptosis from inactivation of the superior tarsal muscle causes the eye to appear sunken in, but when actually measured, enophthalmos is not present. 18  Oculosympathetic Paresis: Types 3 types based on lesion site and/or location of anhidrosis: 1. Central – anhidrosis of face, arm, & trunk E.g., Brain tumor 2. Preganglionic – anhidrosis of face E.g., Bronchogenic carcinoma (Pancoast tumor) 3. Postganglionic – no anhidrosis E.g., Cavernous sinus thrombosis Horner's syndrome is usually acquired as a result of disease, but may also be congenital (inborn, associated with heterochromatic iris) or iatrogenic (caused by medical treatment). In rare cases, Horner's syndrome may be the result of repeated, minor head trauma, such as being hit with a soccer ball. Although most causes are relatively benign, Horner's syndrome may reflect serious disease in the neck or chest (such as a Pancoast tumor (tumor in the apex of the lung) or thyrocervical venous dilatation).[citation needed] Causes can be divided according to the presence and location of anhidrosis:[citation needed] Central (anhidrosis of face, arm and trunk) Syringomyelia Multiple sclerosis Encephalitis Brain tumors Lateral medullary syndrome Preganglionic (anhidrosis of face) Cervical rib traction on stellate ganglion Thyroid carcinoma Thyroidectomy Goiter 19  Bronchogenic carcinoma of the superior fissure (Pancoast tumor) on apex of lung Klumpke paralysis Trauma - base of neck, usually blunt trauma, sometimes surgery. As a complication of tube thoracostomy Thoracic aortic aneurysm Postganglionic (no anhidrosis) Cluster headache - combination termed Horton's headache An episode of Horner's syndrome may occur during a migraine attack and be relieved afterwards Cavernous sinus thrombosis Middle ear infection 19  Oculosympathetic Paresis Ptosis caused by Horner’s syndrome can be distinguished from ptosis caused by oculomotor n. lesion vs. Horner’s Syndrome: mild/partial ptosis with constricted pupil Oculomotor Nerve Palsy CNIII Palsy: Severe ptosis with dilated pupil Oculomotor Nerve Palsy Oculosympathetic Paresis It is important to distinguish the ptosis caused by Horner's syndrome from the ptosis caused by a lesion to the oculomotor nerve. In the former, the ptosis occurs with a constricted pupil (due to a loss of sympathetics to the eye), whereas in the latter, the ptosis occurs with a dilated pupil (due to a loss of innervation to the sphincter pupillae). In a clinical setting, these two ptoses are fairly easy to distinguish. In addition to the blown pupil in a CNIII (oculomotor nerve) lesion, this ptosis is much more severe, occasionally occluding the whole eye. The ptosis of Horner syndrome can be quite mild or barely noticeable (partial ptosis). 20 Autonomics of the Parotid Gland & Buccal Mucosa * LO#4 21  Glossopharyngeal Nerve Subway Map-Style Carotid Canal Middle Ear Auriculotemporal N. Typanic Mandibular Division romontory Plexus P Lesser Petrosal N. of Trigeminal Foramen Ovale Foramen to: Middle Ear Spinosum Otic Ganglion Ty to: Eustachian Tube mp anic Bu Nerve cc Parotid Middle alN Superior Gland Meningeal. Ganglion Styloid Artery Lin Inferior Alveolar N. gu Proce al N. Va Petrosal Maxillary Artery gu to ss Ganglion In s : Bu N. te Jugular Foramen r cc na a Gl lJ lM ug os uc s ul op os a r h a ar yn Hiatus between: ge Superior and Middle al to: Stylopharyngeus N. Pharyngeal Constrictors Superior Nerve to Carotid Sinus External Carotid Internal Carotid Cervical Ganglion to: Pharyngeal Plexus General Sensation (ear, throat, eustachian canal) Tongue Visceral Sensation Ganglion (Taste and Cortid Sensation) Carotid Glossopharyngeal N. Parasympathetic Ganglia of Trigeminal Body Glossopharyngeal N. and Fibers Post Synaptic Parasympathetic Fibers of Glossopharyngeal Branches of Mandibular Division of Trigeminal Carotid Carotid Sinus Sinus Vagus N. Post Synaptic Sympathetic Fibers Functional chart 22 Autonomics of the Parotid Gland: Overview Trigeminal Nerve Subway Map-Style Meckel’s Cave Trigeminal Ganglion Auriculotemporal N. Lesser Petrosal N. Foramen Foramen Ovale Parotid Spinosum Gland Otic Ganglion to: Muscles of Middle Bu Mastication cc Meningeal alN Lin Artery. gu Maxillary Division al Chorda Tympani N. Mandibular Division Inferior Alveolar N. Maxillary Artery External Carotid to: Buccal Mucosa Tongue Submandibular Sublingual Gland Ganglion Facial Artery Submandibular Gland Mandibular Canal Mental Foramen N er ve to M Mental N. Inferior Alveolar N. oh yl yo id 23 Autonomics of the Parotid Gland: Lesser Petrosal Nerve Superior View Glossopharyngeal exits via jugular foramen, while in the ‘jugular canal’ Glossopharyngeal n. (CN IX) it gives off Tympanic n. Tympanic n. interacts with Sympathetics from the Carotid plexus on the Tympanic plexus before passing out of the ear as Lesser petrosal n. 24  Medial View Autonomics of the Bisected Skull Parotid Gland: Otic Ganglion Seated in Infratemporal fossa Attached to Mandibular n. (V3) Preganglionic parasympathetics from Superior View Lesser petrosal n. (CN IX) exit Foramen ovale & synapse at the Otic ganglion Postganglionic sympathetics travel through Otic ganglion via Maxillary artery (Carotid plexus) Postganglionic autonomics join Auriculotemporal n. to the Parotid gland, & Buccal n. (V3) to Buccal/Pharyngeal mucosa 25  Clinical Correlates: Frey’s Syndrome Results from damage to Auriculotemporal n. Symptoms: 1. Erythema (redness/flushing) 2. Focal hyperhidrosis on cheek adjacent to ear (cutaneous distribution of auriculotemporal n.) Etiology: Complication of parotid gland surgery or due to injury of the auriculotemporal n. , which passes through it in the early part of its course Auriculotemporal n. (V3) carries parasympathetic fibers to parotid gland and sympathetic fibers to sweat glands of scalp As a result of severance and inappropriate regeneration, the parasympathetic fibers may switch course to a sympathetic response, resulting in "gustatory sweating" Frey's syndrome (also known as Baillarger's syndrome, Dupuy's syndrome, auriculotemporal syndrome, or Frey-Baillarger syndrome) is a rare neurological disorder resulting from damage to or near the parotid glands responsible for making saliva, and from damage to the auriculotemporal nerve often from surgery. The symptoms of Frey's syndrome are redness and sweating on the cheek area adjacent to the ear (see focal hyperhidrosis). They can appear when the affected person eats, sees, dreams, thinks about, or talks about certain kinds of food which produce strong salivation. Observing sweating in the region after eating a lemon wedge may be diagnostic. Signs and symptoms include erythema (redness or flushing) and sweating in the cutaneous distribution of the auriculotemporal nerve, usually in response to gustatory stimuli. There is sometimes pain in the same area, often burning in nature. Between attacks of pain, there may be numbness or other altered sensations (anesthesia or paresthesia). This is sometimes termed "gustatory neuralgia". Frey's syndrome often results as a complication of surgeries of or near the parotid gland or due to injury to the auriculotemporal nerve, which passes through the 26 parotid gland in the early part of its course. The auriculotemporal branch of the mandibular branch (V3) of the trigeminal nerve carries parasympathetic fibers to the parotid salivary gland and sympathetic fibers to the sweat glands of the scalp. As a result of severance and inappropriate regeneration, the parasympathetic nerve fibers may switch course to a sympathetic response, resulting in "gustatory sweating" or sweating in anticipation of eating, instead of the normal salivary response. It is often seen with patients who have undergone endoscopic thoracic sympathectomy, a surgical procedure wherein part of the sympathetic trunk is cut or clamped to treat sweating of the hands or blushing. The subsequent regeneration or nerve sprouting leads to abnormal sweating and salivation. It can also include discharge from the nose when smelling certain food. 26 Autonomics of the Submandibular & * Sublingual Glands * LO#5 * 27  Internal Acoustic Facial Nerve Subway Map-Style Meatus Superior Orbital Fissure Lacrimal Gland Facial Nerve: Fa Lacrimal N. c ia N.l To: Nasal Mucosa Chorda Tympani Nasociliary Hiatus of the Greater Petrosal N. Zygomatic N. ne Greater Petrosal N. Bo Facial Genu l ra Internal Carotid Foramen Lacerum Inferior Orbital Fissure po Pterygoid Canal m Te Carotid Canal Pterygopalatine in ith Ganglion. lN W Middle Ear Deep Petrosal N. ia to: External Cartilaginous Plug Nerve of the Sphenopalatine Foramen c Fa Acoustic Meatus Nasopalatine and Pterygoid Canal Lin Lateral Nasal Nerves to: Stapedius gu al N. Greater and Lesser Chorda Tympani Chorda Tympani Palatine Nerves To: Nasal Mucosa Petrotympanic Fissure Hard Palate Poster e at Stylomastoid to: Stylohyoid & l Pa Posterior Belly of Digastric ft Foramen ior So Temporal Branches Au ul Zyg ric ar oma N. tic Br anche s Tongue Buccal Branches Mandibular Branches Submandibular Ganglion Cervical Branches Sublingual Gland ry rte lA cia Facial N. and Fibers Submandibular Gland Fa Post Synaptic Parasympathetic Fibers of Facial Branches of Mandibular Division of Trigeminal Branches of Maxillary Division of Trigeminal Branches of Ophthalmic Division of Trigeminal Post Synaptic Sympathetic Fibers Facial’s Combined General Sensory and Taste Sensory Ganglion Parasympathetic Ganglia from Trigeminal 28 Autonomics of the Sublingual & Submandibular Glands: Overview Trigeminal Nerve Subway Map-Style Meckel’s Cave Trigeminal Ganglion Auriculotemporal N. Lesser Petrosal N. Foramen Foramen Ovale Parotid Spinosum Gland Otic Ganglion to: Muscles of Middle Bu Mastication cc Meningeal alN Lin Artery. gu Maxillary Division al Chorda Tympani N. Mandibular Division Inferior Alveolar N. Maxillary Artery External Carotid to: Buccal Mucosa Tongue Submandibular Sublingual Gland Ganglion Facial Artery Submandibular Gland Mandibular Canal Mental Foramen N er ve to M Mental N. Inferior Alveolar N. oh yl yo id 29  Facial Nerve Branches: Chorda Tympani Nerve Facial n. enters petrosal bulla & gives off 2 nerves Medial View carrying parasympathetic fibers: Sagittal Section 2. Chorda Tympani n. Parasympathetics for tongue, sublingual and submandibular glands via lingual nerve (CN V3) Passes through middle ear & exits via petrotympanic fissure 30 Autonomics of the Sublingual & Submandibular Glands: Submandibular Ganglion Submandibular ganglion suspended from Lingual n. (CN V3) above Submandibular gland Preganglionic parasympathetics from Chorda tympani (CN VII) join Lingual n. & synapse in the Submandibular ganglion Postganglionic sympathetics pass through Submandibular ganglion via Facial artery (Carotid plexus) Postganglionic autonomics reach Submandibular & Sublingual glands via Lingual n. Lateral View 31 Parasympathetic Ganglia of Head: Summary 32 Autonomics of the Pharyngeal & Laryngeal Mucosa LO#6 33 Vagus Nerve: Summary of Head & Neck ANS 34  Vagus n. gives off 3 branches in neck containing parasympathetics: Autonomics of 1. Pharyngeal br.: pharyngeal mucosa Pharyngeal/Laryngeal 2. Superior Laryngeal: Courses medial to Internal Carotid a. & splits into Internal and Mucosa: External Laryngeal nn. Internal laryngeal n.: Superior larynx Parasympathetics 3. Recurrent Laryngeal n.: Infraglotic larynx Lateral View 35  Posterior View Autonomics of Pharyngeal/Laryngeal Mucosa: Sympathetics Sympathetics to pharyngeal & laryngeal mucosa from: superior cervical ganglia via pharyngeal plexus & laryngeal nn., respectively 36