Respiratory System Nerve Innervation.docx

RESPIRATORY SYSTEM NERVE INNERVATIONS Blue= only sensory innervations given Orange= only motor innervations given Green= sensory and motor innervations given Nerve Innervations CN I Olfactory Nerve Sensory Upper portion of nose Bodies contained in olfactory epithelium of internal nose...

RESPIRATORY SYSTEM NERVE INNERVATIONS Blue= only sensory innervations given Orange= only motor innervations given Green= sensory and motor innervations given Nerve Innervations CN I Olfactory Nerve Sensory Upper portion of nose Bodies contained in olfactory epithelium of internal nose Passes through cribriform plate CN V Trigeminal nerve Sensory Lingual Branch Pain, touch, temperature to body (anterior 2/3) of tongue Soft palate External nose Paranasal sinuses Nasopharynx pharyngotympanic (eustachian/auditory) tubes, pharyngeal tonsils (adenoids) 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 Oropharynx palatopharyngeal arch, palatine tonsils between pillars, and lingual tonsils Motor Motor fibers to stylopharyngeus muscle CN X Vagus Nerve Sensory Laryngopharynx Trachea (carina and true vocal cords very sensitive) Nerve fibers lie between visceral pleura and lung surface Visceral afferents from pharyngeal plexus travel with CN X fibers Motor Palatoglossus Motor fibers to pharyngeal plexus ***Except stylopharyngeus (CN IX) CN XI Spinal Accessory Nerve Motor Sternocleidomastoid CN XII Hypoglossal Nerve Motor All muscles of tongue ***Except palatoglossus (CN X) 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 PSNS block!! Cholinergic neurons innervate cerebral blood vessels that dilate with stimulation block will prevent headaches Internal Laryngeal Nerve Sensory Blocked topically for awake intubation Anesthesia landmark is mucosa under the piriform fossa Superior Laryngeal Nerve (SLN) Internal Branch Sensory Upper vocal cords Larynx above vocal cords to laryngeal inlet Superior Laryngeal Nerve (SLN) External Branch Motor Cricothyroid muscle Recurrent Laryngeal Nerve (RLN) Motor All muscles (***except cricothyroid muscle- external SLN) of larynx Vocal cord muscles thyroarytenoid, vocalis, posterior cricoarytenoid, lateral cricoarytenoid Inferior Laryngeal Nerve (branches off RLN) Sensory Lower vocal cords Larynx below vocal cords Pharyngeal Plexus Sensory Most of pharynx Motor Motor fibers in plexus derived from CN X ***Except stylopharyngeus (CN IX) Pharynx Unspecified Parasympathetic Nerves Motor Mucous glands of larynx Mucous glands of trachea Ventral Rami and Dermatomes of Anterior Thoracic Wall Sensory Nipple = T4 Xiphoid process = T6 dermatome (T9 vertebra) Umbilicus = T10 Phrenic Nerve(s) C3, C4, C5 Sensory Central diaphragm Central portion of diaphragmatic parietal pleura Mediastinal parietal pleura Motor Entire diaphragm Intercostal nerves (lower) Sensory Peripheral diaphragm Costal parietal pleura Peripheral portion of diaphragmatic parietal pleura ***SAP block targets the lateral cutaneous branches of intercostal nerves*** If patient has respiratory issues, these blocks may allow them to take deeper breaths May decrease opioid use Takes away pain without altering respiratory drive Pectoral nerves Motor Pectoralis major and minor Long thoracic nerve Motor Serratus anterior C3-C8 Motor Anterior, middle, and posterior scalene muscles Anterior Rami of T1-T11 Spinal Nerves Motor Intercostal muscles Pulmonary Plexus Follows trachea and bronchial tree Provide sensory and motor autonomic innervation to smooth muscle and glands of lungs Parasympathetic (cholinergic) Sympathetic (adrenergic) Includes autonomic and visceral afferent fibers from CNX and thoracic nerves Visceral afferent fibers transmit nociceptive and reflexive sensations via CN X primarily bronchopulmonary stretch receptors, irritant receptors of proximal airways, C and juxtacapillary J receptors Irritant receptors= nonspecific, stimulate cough/mucus/bronchoconstriction C and J receptors= respond to mechanical and chemical stimuli Vagus nerve from posterior plexus contribute to esophageal plexus 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 weak effect on airway diameter vasoconstriction and inhibition of gland secretion Inhibit secretion from bronchial glands Vasoconstrict pulmonary vessels Inhibit smooth muscle bronchoconstriction weakly bronchodilate Non-adrenergic/non-cholinergic (NANC) Provide inhibition of parasympathetic bronchoconstriction bronchodilation