Nerves and Blood supply upper airway.docx

CN I (Olfactory) Sensory Upper portion of nose CN V (Trigeminal nerve) Sensory Pain, touch, temperature to body of tongue (Lingual branch) Soft palate External nose all but upper portion of nose Paranasal sinuses Nasopharynx CN VII (Facial Nerve) Sensory Taste to body (anterior 2/3) of to...

CN I (Olfactory) Sensory Upper portion of nose CN V (Trigeminal nerve) Sensory Pain, touch, temperature to body of tongue (Lingual branch) Soft palate External nose all but upper portion of nose Paranasal sinuses Nasopharynx CN VII (Facial Nerve) Sensory Taste to body (anterior 2/3) of tongue (Chorda tympani branch) Motor Parasympathetic stimulations increases mucous gland productions in nose CN IX (Glossopharyngeal nerve) 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) CN X (Vagus) Sensory Laryngopharynx Trachea (carina and true vocal cords very sensitive) Motor Palatoglossus CN XI (Spinal accessory) Sternocleidomastoid CN XII (Hypoglossal) Motor All muscles of tongue except palatoglossus Pterygopalatine ganglion (Sphenopalatine ganglion/SPG) Sensory Connects to sphenopalatine nerve. Lies inferior to CN V and receives preganglionic parasympathetic neurons from CN VII. Regional anesthesia blocks maxillary nerve, parasympathetic block!! Cholinergic neurons innervate cerebral blood vessels that dilate with stimulation. block will prevent headaches Internal Laryngeal Nerve Sensory Anesthesia landmark for awake intubation Pharyngeal plexus Sensory Most of pharynx Motor Motor fibers in plexus derived from CN X except stylopharyngeus (CN IX) Pharynx Superior Laryngeal Nerve (SNL) Internal Branch of SNL: Sensory Upper vocal cords and larynx above vocal cords External Branch of SNL: Motor Cricothyroid muscle Recurrent Laryngeal Nerve (RLN) Motor All muscles (except cricothyroid muscle) of larynx Inferior Laryngeal Nerve (branch off RLN) Sensory Lower vocal cords and larynx below vocal cords Unspecified Parasympathetic Nerves Motor Mucous glands of larynx Mucous glands of trachea Ventral rami and Dermatomes of Anterior Thoracic Wall Nipple -T4 Xiphoid process-T6 dermatome (T9 vertebra) Umbilicus -T10 Phrenic Nerve(s) (C3, C4, C5) Sensory Entire diaphragm minus periphery Motor Entire diaphragm Lower intercostal nerves Sensory Diaphragm periphery Costal parietal pleura Peripheral portion of diaphragmatic parietal pleura Pectoral nerves Pectoralis major and minor -> Pec block Long thoracic nerve Serratus anterior ->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. primarily bronchopulmonary stretch receptors, irritant receptors of proximal airways, C fibers and juxta capillary (J) receptors Sensory Visceral afferents: nociceptive and reflexive Motor Parasympathetic (cholinergic): secretomotor (glands of airways) and broncho constrictive (smooth muscle of airways) Sympathetic (adrenergic) fibers of T1-T4 have weak effect on airway diameter. some vasoconstriction and inhibition of gland secretion. May inhibit bronchoconstriction and weakly broncho dilate. Non-adrenergic/non-cholinergic (NANC): inhibition of parasympathetic bronchoconstriction