Visceral Innervation review (except thorax)

© 2018 Midwestern University

Williams 1901 © 2018 Randall Nydam
Pre-lecture review

Functional divisions of the nervous system

Somatic Visceral

Efferent Afferent Efferent Afferent

Pain Non-pain

Sympathetic Parasympathetic

Autonomic nervous system

Pre-lecture review
Autonomic (visceral efferent)
innervation “rules”

1. Two neuron system:

 Preganglionic from CNS
 Postganglionic to target organ
2. Origins:
 Thoracolumbar (T1–L2) for
sympathetic
 Craniosacral for
parasympathetic
3. Synapse:
 Paravertebral or prevertebral
ganglia for sympathetic
 Intrinsic ganglia for
parasympathetic
Pre-lecture review

GRC

Sympathetic innervation to viscera utilizes Post. root

prevertebral ganglia
e.g., preganglionic fibers pass through
PRG
sympathetic chain without synapse
IMLCC

Ant. root
GRC WRC

Abdominopelvic splanchnic nerve

Periarterial
plexus
Pre-lecture review
Visceral afferent innervation “rules”

1. Single neuron system:

 Pseudounipolar neuron in sensory ganglion
 Posterior root ganglion of spinal nerves
 Nodose ganglion of Vagus
2. Non-pain:
 Retrogrades along parasympathetic pathways
 Vagus (CN X)
 Pelvic splanchnic nerves—new this
lecture
3. Pain:
 Retrogrades along sympathetic pathways
 We will break this rule for hindgut!
 Basis for referred pain patterns
Pre-lecture review

Embryonic basis of GI anatomy Celiac

Foregut FOREGUT trunk
esophagus
stomach Superior
proximal duodenum mesenteric
liver Artery (SMA)
gall bladder
pancreas

Midgut
distal duodenum
jejunum MIDGUT Inferior
ileum
cecum mesenteric
appendix Artery (IMA)
ascending colon
proximal 2/3 of transverse colon
Sadler 82
Hindgut
distal 1/3 of transverse colon
descending colon
sigmoid colon
rectum HINDGUT Drake 295

proximal anus
Gray’s text 4.96
Pre-lecture review

Foregut innervation
Target Organs
Distal esophagus
Stomach
Proximal duodenum
N 298
Liver
Gall bladder
Pancreas
(Spleen)
N 299

N 301
Pre-lecture review

Midgut innervation
Target Organs
Distal duodenum
Jejunum
Ileum
Cecum
Appendix
Ascending colon
Proximal 2/3 of
transverse colon

N 301
N 302
Pre-lecture review

Hindgut innervation
Target Organs
Distal 1/3 of transverse
colon
Descending colon
Sigmoid colon
Upper rectum

N 302
 Generalized comparison of abdominal sympathetic vs. parasympathetic systems

Physiologic Process SNS PSNS

GI tract
Peristalsis - +
Blood flow - +
Secretion of digestive fluids -* +
Gall bladder
Secretion of bile - +
Pancreas
Secretion of insulin - +

* effect is primarily the result

of vasoconstriction

See also MDA Table I.2

General Pattern: Sympathetic Innervation of Abdominal & Pelvic Viscera
• Preganglionic neuronal cell bodies innervating
abdominal viscera are located in T5-L2 spinal cord GRC
levels (in the IMLCC/lateral horn)
Post. root

• Preganglionic axons course towards sympathetic

PRG
chain, but do not synapse
IMLCC

• Preganglion axons exit the sympathetic chain from the Ant. root
GRC WRC
T5–S4 chain ganglia and course along abdominopelvic
splanchnic nerves

• Preganglionic axons synapse with postganglionic neuronal Abdominopelvic splanchnic nerve

cell bodies in prevertebral ganglia
•Foregut targets in Celiac ganglia
•Midgut targets in Superior mesenteric ganglia
•Hindgut targets in Inferior mesenteric ganglia

• Postganglionic axons conveyed via periarteral plexus Periarterial

plexus
Sympathetic Innervation Anatomy
Abdominopelvic splanchnic nn.

Greater splanchnic n
T5-T9 spinal cord segment

Lesser splanchnic n
T10-T11 spinal cord segment

Least splanchnic n
T12 spinal cord segment

Lumbar splanchnic n
L1-L2 spinal cord segment

Sacral splanchnic n
L1-L2 spinal cord segment

N 206, 317
Prevertebral sympathetic ganglia
Celiac ganglia
base of celiac trunk

Superior mesenteric ganglia

base of superior mesenteric a.

Inferior mesenteric ganglia

base of inferior mesenteric a.

Aorticorenal ganglia
base of renal arteries
[more in unit 5]

N 297
Abdominal / Pelvic Visceral Plexuses

Celiac plexus

Superior mesenteric plexus

Carrying postganglionic
sympathetic (+ preganglionic
Intermesenteric plexus parasympathetic) fibers

Inferior mesenteric plexus

Superior hypogastric plexus

Renal plexus (Unit 5)

N 297
Abdominal / Pelvic Visceral Plexuses

Superior hypogastric plexus

-Efferents are primarily sympathetic

Hypogastric nerves
connect superior hypogastric and
inferior hypogastric plexuses
-Efferents are primarily sympathetic

Inferior hypogastric plexus

-Efferents are mixed
sympathetic/parasympathetic

N 388…see also N303

Pelvic Splanchnic vs. Sacral Splanchnic

Sacral splanchnic nerves

Sympathetic (pelvis distribution)

Pelvic splanchnic nerves

Parasympathetic

N 390
 Sympathetic Summary
ORIGIN FROM
ABDOMINOPELVIC SPINAL CORD ORIGIN FROM TYPICAL
SPLANCHNIC N. SEGMENT (IMLCC) SYMPATHETIC CHAIN SYNAPSE TARGET

Greater Celiac
T5–T9 T5–T9 Foregut
splanchnic nerve ganglion

Superior

distribution to be expected
Lesser
T10–T11 T10–T11 mesenteric Midgut
splanchnic nerve

Some overlap of T12

ganglion

Continued Aortico-
Least T12
in Unit 5 T12 T12 renal Kidneys
splanchnic nerve
ganglion

Inferior
Lumbar Hindgut,
L1–L2 L1–L5 mesenteric
splanchnic nerve Pelvic organs
ganglion

(Inferior Hindgut
Continued Sacral
L1–L2 S1–S5 hypogastric (lower rectum),
in Unit 5 splanchnic nerve
plexus) Pelvic organs
 Referred pain: Abdomen—the take home message
• FOREGUT pain tends to refer to EPIGASTRIC REGION
• MIDGUT pain tends to refer to UMBILICAL REGION
• HINDGUT pain tends to refer to HYPOGASTRIC REGION
• Pathology of liver, gallbladder, and duodenum can refer to shoulder due to irritation of the diaphragm
• Gall bladder has additional somatic sensory innervation from branch of phrenic nerve
• Irritation of parietal peritoneum (somatic innervation) causes acute, well-localized pain
•with reflexive “splinting” or “guarding” of abdominal wall musculature.
•Manifests clinically as “rebound tenderness”

MDA B2.12
 Visceral pain pathway (retrograding along sympathetic pathway) is basis of referred pain

T1

T7

T10

L1

MDA B2.12

N162
MDA I.46
 Autonomic Regulation of the GI Tract occurs via
interaction with the Enteric Nervous System

Sympathetic
• Decrease blood flow to GI tract
through vasoconstriction
• Inhibit contraction of GI smooth
muscle
Parasympathetic
• Stimulate secretory cells of the GI
mucosa, and organ-specific cells (e.g.,
parietal cells in the stomach)
• Stimulate contraction of GI smooth
muscle
Clinical Correlation
Hirschsprung’s disease (congenital aganglionic megacolon)
• Failure of neural crest cells to migrate to distal GI tract.
• Affected (aganglionic) section of colon is paralyzed in constriction (arrows)
• Results in fecal accumulation proximal to the aganglionic portion.
• Correctable by surgical resection of affected colon.

Lukman O. Abdur-Rahman

Courtesy Prof. E. A. Ameh, ABUTH, Zaria

© 2016 Midwestern University

Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7570 RadiologyKey.com
© 2016 Randall Nydam
Autonomic Plexuses

Hypogastric nerves
Inferior hypogastric plexus
Rectal plexus -at rectum
Vesical plexus -at urinary bladder
Uterovaginal plexus (female)

Sacral splanchnic nerves

Sympathetic

Pelvic splanchnic nerves

Parasympathetic

N 390
 • Inferior aspect of parietal peritoneum is the threshold determining course of visceral pain sensation
• Visceral pain sensations of structures…
• Above or in contact with the inferior peritoneum course via sympathetic-carrying splanchnic nerves (e.g.,
lumbar, greater, lesser, least)

• Below the inferior peritoneum course via parasympathetic-carrying pelvic splanchnic nerves

The approximate midway point of

sigmoid colon is exception to pelvic pain
line specific to GI tract

MDA Table 3.3

Innervation of the Suprarenal Gland
EXCEPTION to dual supply—Receive ONLY sympathetic innervation
Preganglionic sympathetics : via greater, lesser, and least splanchnic nerves
1. Targeting suprarenal vasculature: 2. Targeting secretory cells of the suprarenal medulla:
 Preganglionic sympathetic axons synapse primarily in  Pass through the celiac ganglion without synapse to directly
celiac ganglion innervate chromaffin cells
 Postganglionic sympathetics distributed via  Sympathetic stimulation promotes secretion of epinephrine
periarterial plexuses of suprarenal arteries (adrenaline) and norepinephrine (noradrenaline)
 Function: control vascular tone  EXCEPTION* TO “2-NEURON” RULE
 ↑ = vasodilation
 ↓ = vasoconstriction

T9
T10 Celiac ganglion

T11
T12

There are no visceral afferents

from suprarenal gland
N 319
Innervation of the Kidney
Preganglionic sympathetics via least splanchnic n. (T12)

Synapse in aorticorenal ganglion

Postganglionic sympathetics to kidney via renal plexus (periarterial

plexus of renal artery)

Function: control of vascular tone

↑ = vasoconstriction
↓ = vasodilation

Preganglionix parasympathetics via vagus n.

Synapse in intrinsic ganglia
Minimal function (role is unclear)

Kidneys are superior to pelvic pain line

Visceral pain conveyed via least splanchnic nerve
(Somatic pain from irritation of surrounding tissues)
Visceral non-pain conveyed via vagus nerve

MDA 2.87
Innervation of the Ureter
Innervation via nearest neighbor autonomic plexus
(e.g., renal, intermesenteric, superior & inferior hypogastric)
Density of innervation increases inferiorly
Ureters are primarily above the pelvic pain line

Proximal ureter
Pregangionic sympathetics viaT11-L2 spinal cord segments
What are the associated splanchnic nerves?
Postganglionic sympathetics via renal and intermesenteric plexuses
Function: control of vascular tone
Parasympathetic innervation via pelvic splanchnic nerves to intrinsic ganglia
Function: Promotes peristalsis
Visceral pain—most of ureter is above pelvic pain line, signals primarily
conveyed via sympathetic pathways to T11–L2 spinal cord segments
Visceral non-pain conveyed via pelvic splanchnic nerves

MDA 3.26
Innervation of the Ureter
Innervation via nearest neighbor autonomic plexus
(e.g., renal, intermesenteric, superior & inferior hypogastric)
Density of innervation increases inferiorly
Ureters are primarily above the pelvic pain line

Abdominal ureter
Pregangionic sympathetics viaT11-L2 spinal cord segments
What are the associated splanchnic nerves?
Postganglionic sympathetics via superior hypogastric plexus
Function: control of vascular tone
Parasympathetic innervation via pelvic splanchnic nerves to intrinsic ganglia
Function: Promotes peristalsis
Visceral pain—most of ureter is above pelvic pain line, signals primarily
conveyed via sympathetic pathways to T11–L2 spinal cord segments
Visceral non-pain conveyed via pelvic splanchnic nerves

MDA 3.26
Innervation of the Ureter
Innervation via nearest neighbor autonomic plexus
(e.g., renal, intermesenteric, superior & inferior hypogastric)
Density of innervation increases inferiorly
Ureters are primarily above the pelvic pain line

Pelvic ureter
Pregangionic sympathetics viaT11-L2 spinal cord segments
What are the associated splanchnic nerves?
Postganglionic sympathetics via inferior hypogastric plexus
Function: control of vascular tone
Parasympathetic innervation via pelvic splanchnic nerves to intrinsic ganglia
Function: Promotes peristalsis
Visceral pain—most of ureter is above pelvic pain line, signals primarily
conveyed via sympathetic pathways to T11–L2 spinal cord segments
Visceral non-pain conveyed via pelvic splanchnic nerves

MDA 3.26 MDA 3.26

Referred pain patterns of the Ureter
Visceral pain sensation of ureters = “ureteric colic”
-often caused by obstructive renal calculus (kidney stone)
-typically refers to the ipsilateral T11-L2 dermatome range
-depends on the location of the calculus
-“loin-to-groin” referral as calculus moves from
renal pelvis towards bladder

MDA 3.26
MDA B2.12
Innervation of the urinary bladder
Lumbar splanchnics
Preganglionic sympathetics
-from L1-L2 spinal cord segments
L1 -course via lumbar & sacral splanchnic nerves
L2
-pass though inferior hypogastric plexus and synapse
in vesical plexus

Postganglionic sympathetics
-to urinary bladder via vesical plexus
Sacral splanchnics
Inferior
Hypogastric
Plexus

S2

S3

S4

N 395 Pelvic splanchnics Vesical Plexus

Pudendal nerve
Innervation of the urinary bladder
Lumbar splanchnics Preganglionic Parasympathetics
-from S2-S4 spinal cord segments
L1 -course via pelvic splanchnic nerves
-course through inferior hypogastric & vesical plexuses
L2 -Synapse on intrinsic ganglia

Sacral splanchnics
Inferior
Hypogastric
Plexus

S2

S3

S4

N 395 Pelvic splanchnics Vesical Plexus

Pudendal nerve
Innervation of the urinary bladder Visceral afferents
Lumbar splanchnics -mostly below the pelvic pain line
-pain and non-pain afferent fibers course via the
L1 vesical & inferior hypogastric plexuses
L2 -to posterior root ganglia
-to S2-S4 spinal cord segments

Sacral splanchnics
Inferior
Hypogastric
Plexus

S2

S3

S4

N 395 Pelvic splanchnics Vesical Plexus

Pudendal nerve
Innervation of the urinary bladder
Lumbar splanchnics
Visceral pain of superior surface of urinary bladder
L1 -At the pelvic pain line
-Conveyed via lumbar and sacral splanchnic nerves to L1-
L2
L2 posterior root ganglia
-area of sensory overlap

Sacral splanchnics
Inferior
Hypogastric
Plexus

S2

S3

S4

N 395 Pelvic splanchnics Vesical Plexus

Pudendal nerve MDA Table 3.3
Autonomic/Somatic Control of Micturition (urination)

• Contraction of the internal urethral sphincter

• Relaxation of the detrusor muscle
• Allows bladder to fill and prevents emptying T11 – L2

• Stretch receptors in bladder wall (especially in the

trigone) detect “fullness”
• Triggers “sense of urgency”

• Contraction of detrusor muscle Pelvic splanchnic

• Relaxation of internal urethral sphincter

• Via Pudendal nerve maintains tonic contraction of

external urethral sphincter until voluntarily
inhibited

YYT 19.10
Innervation of the rectum
Preganglionic sympathetics
-From L1–L2 spinal cord segments
-Course via lumbar splanchnic nerves
-Synapse in inferior mesenteric ganglion & within superior
hypogastric plexus
Postganglionic sympathetics
-Distributed to rectum via periarterial plexuses of IMA and superior
rectal artery (superior rectum) or rectal plexus (inferior rectum)

Preganglionic parasympathetics
-Via pelvic splanchnic nerves
-Pass through inferior hypogastric plexus and rectal plexus
-Synapse in intrinsic ganglia

Visceral afferents
-Rectum is below the pelvic pain line
-Both visceral pain & non-pain conveyed via pelvic splanchnic
nerves

MDA 3.33
Innervation of the anal canal
Superior to pectinate line—same as rectum
Sympathetics via lumbar/sacral splanchnics
Parasympathetics via pelvic splanchnics
Visceral pain/non-pain via pelvic splanchnics

Inferior to pectinate line

Somatic motor
&
Somatic sensory
via
Inferior rectal nerve branches
of pudendal nerve (S2-S4)

Pectinate line

N 388
N 371 MDA 3.33
Autonomic & Somatic Control of Defecation

⎻ Inhibit peristalsis of rectum

⎻ Tonic contraction of internal anal sphincter
⎻ Allow rectum to fill without incontinence

⎻ Stretch receptors detect “fullness”

⎻ Triggers “sense of urgency

⎻ Stimulate peristalsis
⎻ Stimulate secretion of colorectal glands
⎻ Relax internal anal sphincter
⎻ Stimulate peristalsis of anal canal

⎻ Voluntary relaxation of somatic muscles (e.g., external

anal sphincter, puborectalis)
MDA 3.33
Innervation of the rectum
Uterus, cervix, ~superior 4/5 of vagina receive visceral innervation

Preganglionic sympathetics
⎻ Via lumbar splanchnic nerves
⎻ Synapse in inferior hypogastric plexus
Postganglionic sympathetics
⎻ Distributed via uterovaginal plexus
Preganglionic parasympathetics
⎻ Via pelvic splanchnic nerves
⎻ Pass through inferior hypogastric & uterovaginal plexuses
⎻ Synapse on intrinsic ganglia Pelvic pain
Visceral afferent line
⎻ Above pelvic pain line: pain via lumbar splanchnics
⎻ Below pelvic pain line: pain via pelvic splanchnics
⎻ All non-pain via pelvic splanchnics

Distal ~1/5 vagina receives somatic innervation via the perineal

nerve; branch of pudendal nerve (S2-S4).

N 393
Clinical Correlation: Anesthesia for Parturition (child birth)
Spinal anesthesia via lumbar puncture into subarachnoid space
⎻ Complete anesthesia of uterus, cervix, vagina, perineum,
lower extremities, and inferior abdominal wall
⎻ Most-common form of anesthesia for cesarean section

Lumbar epidural (not shown)-similar anesthesia to caudal epidural,

but with greater anesthetic effect on uterus
⎻ Most-common form of anesthesia for vaginal delivery

Caudal epidural nerve block-injection via sacral hiatus

⎻ Bathes S2-S4 spinal nerve roots
⎻ anesthetizes cervix, vagina, and perineum
⎻ Does not affect sensation from structures above pelvic pain
pelvic pain line
line (body and fundus of uterus)

Pudendal nerve block

⎻ Local anesthesia of perineum (S2-S4 dermatomes)

MDA B3.27
Innervation of Erectile Tissues
Parasympathetic innervation to erectile tissues
via cavernous nerves from prostatic plexus
⎻ Facilitates (tumescence) penile erection
Parasympathetic innervation to crura of clitoris and
bulb of vestibule via cavernous nerves from the
uterovaginal plexus
⎻ Facilitates vaginal secretion, clitoral erection,
engorgement of bulbs of the vestibule
MDA Fig. 3.64
Autonomic Control of Sexual Function
Erection (male & female) mediated by PARASYMPATHETICS
Flaccid state:
⎻ Low/Absent parasympathetic activity
⎻ Tonic sympathetic activity
 maintains arterio-venous (AV) shunt (helicine arteries)
 most blood bypasses capillaries within erectile bodies

↓PSNS Tunica

⇟SNS albuginea

Fig. 21-22; Gartner & Hiatt, Color Textbook of Histology; 2nd edition
Autonomic Control of Sexual Function
Erection (male & female) mediated by PARASYMPATHETICS
Flaccid state:
⎻ Low/Absent parasympathetic activity
⎻ Tonic sympathetic activity
 maintains arterio-venous (AV) shunt (helicine arteries)
 most blood bypasses capillaries within erectile bodies
Tumescent state (erection):
⎻ Increased parasympatheic signal via cavernous nerves to
erectile tissues
 closes the AV shunt
 blood accumulates and engorges the erectile tissues
 Swelling of erectile tissues compresses deep draining veins
against the ~inelastic tunica albuginea and Buck’s fascia
⎻ Additional contraction of the bulbospongiosus &
ischiocavernosus (somatic via pudendal nerve)
 further impedes drainage of venous blood
Following ejaculation Tunica
 Sympathetic activity re-establishes the AV shunt albuginea ↑PSNS
 Flaccid state re-established ⇟SNS
Fig. 21-22; Gartner & Hiatt, Color Textbook of Histology; 2nd edition
Autonomic Control of Sexual Function
Emission is mediated by:
⎼ Sympathetics: Semen is delivered to the prostatic
urethra through the ejaculatory ducts

Ejaculation mediated by:

⎼ Sympathetics: causes closure of the internal urethral
sphincter to prevent retrograde ejaculation (into
bladder)

⎼ Parasympathetics: causes contraction of smooth muscle

of urethra

⎼ Somatic spinal reflex: causes contraction of the

bulbospongiosus muscle via the pudendal nerve

Post ejaculation: SNS activity re-establishes the AV shunt

N 362
 Clinical Correlation: Priapism / Clitorism
Prolonged erection of either the penis (priapism) [or the clitoris (clitorism)] prevents venous blood from
exiting the erectile bodies, and can cause ischemia of erectile tissues.
1. Low flow/ischemic priaprism—blood trapped within erectile tissues
 Etiology not clear (sickle-cell, malaria, leukemia all increase risk)
2. High-flow/non-ischemic—more rare, less painful
 Typically due to perineal injury rupturing arterial supply

Fig. 21-22; Gartner & Hiatt, Color Textbook of Histology; 2nd edition © 2016 Midwestern University
© 2016 Randall Nydam
Sympathetics to the Head
• Preganglionic cell bodies (“thoraco-lumbar”)
• lateral horn (IMLCC) from T1–L2

• Preganglionic axons
• ascend in the sympathetic chain and synapse on
postganglionic cell bodies in superior cervical ganglion

• Postganglionic axons
• carotid periarterial plexus
• travel on branches of external or internal carotid
• re-coalesce into a single nerve (e.g., deep petrosal nerve), or
may join (“hitch-hike”) on branches of CN V
• Primarily vasoconstriction
• Also superior tarsal and dilator pupillae muscle in orbit

MDA I.45

Big picture: only postganglionic sympathetic fibers are found in head 45

Parasympathetics to the Head
• Preganglionic cell bodies (“Cranio-
sacral”)
• In the brain/brainstem
III
• Preganglionic axons
• Exit CNS on CN III, VII, IX (& X)
VII

• Synapse at named parasympathetic IX

ganglia (“COPS”)

• Postganglionic axons
• Carried to target structures via “hitch-hiking”
(on branches of CN V)

Big picture: ganglia are NOT intrinsic and DO have names MDA I.48

46
 Functional Components of
Cranial Nerves
CN I: VA
CN II: SA
: SE,
CN IV: SE
CN V: SA, SE
CN VI: SE
: SA, SE, , VA
CN VIII: SA
: SA, SE, , VA
: SA, SE, , VA
CN XI: SE
CN XII: SE

Cranial nerves conveying VE N 119; MDA 9.1

(parasympathetic):
CN III, CN VII, CN IX, CN X
47
Parasympathetic Ganglia of the Head
Where do each of the parasympathetic cranial nerves synapse?

: iliary ganglion
: tic ganglion
: terygopalatine & ubmandibular ganglia

Parasympathetic fibers originating from III, VII, & IX will

branch off their original nerve and “hitchhike” on
branches of CN V to reach their targets.
48
 “Hitchhiking” on the Trigeminal Nerve

(Stylized) Example: lingual

nerve (br. of V3)

VE to submandibular
& sublingual glands
Ciliary ganglion
(CN III)

Pterygopalatine
SA from floor of oral ganglion
cavity, gingivae, & anterior (CN VII)
2/3 of tongue,
Otic
ganglion
VA from anterior (CN IX)
2/3 of tongue

Submandibular ganglion
(CN VII) 49
MDA 9.9
Autonomic Innervation of the Eye
Dilator pupillae

Sphincter pupillae

Ciliary muscle

N 89

MDA 7.51 50
Autonomic Innervation of the Eye
Ciliary ganglion
Short ciliary nn *Parasympathetic root of CG
CN III (from CN III)

Sphincter
* *Sympathetic root of CG
pupillae (from internal carotid

Dilator
* plexus)

pupillae
Internal carotid plexus
Long ciliary nn
Nasociliary n.

Superior cervical
ganglion IMLCC For additional review of these
pathways
Click here
&
Click here
&
Click here 51
N 133
 Autonomic Innervation of the Parotid Gland

CN IX CN IX

MDA 9.13

Tympanic n.
N 132
(passing through tympanic
canaliculus)

Medial Wall
Lateral Wall

Tympanic
canaliculus

52
N 12 MDA 7.114
 Autonomic Innervation of the Parotid Gland
Lesser petrosal n.

Hiatus for lesser petrosal n.

Medial Wall
Lateral Wall

Tympanic Plexus Tympanic n.

MDA 7.114
N 13
53
N 50
 Autonomic Innervation of the Parotid Gland
Lesser petrosal n.

Auriculotemporal n. (branch of N 50
Otic ganglion V3)

For additional review of these pathways

Click here & Click here & Click here
54
N 50
Autonomic Innervation of the Submandibular & Sublingual Glands

• Parasympathetic (CN VII)

• Stimulates secretion

• Sympathetic
• Inhibits secretion
(vasoconstriction)
N 46
55
Autonomic Innervation of the Submandibular & Sublingual Glands
CN V

Lingual n. (br. of V3) CN VII

Submandibular
Ganglion
Chorda tympani

Superior Cervical Ganglion

IMLCC
Lingual a.

Sublingual & Submandibular Glands

External Carotid Plexus
N 134 56
For additional review of these pathways
Click here & Click here & Click here
Autonomic Innervation of the Nasal & Palatal Mucosa
V2 brs. distributing
postganglionic Greater petrosal n.
autonomics to nasal
cavity and palate CN VII

Deep petrosal
n. Internal carotid plexus

Nerve of the pterygoid

Pterygopalatine Ganglion canal*

57
Superior cervical ganglion For additional
IMLCC review of these
pathways
Click here & Click
N 53 here
Autonomic Innervation of Lacrimal Gland
Lacrimal n. (br.
of V1)

Comm. br. Lacrimal Gland

Zygomatic n.

Maxillary n.
V2

PterygopalatineGa
58
nglion N 52
For additional review of this
pathway
Click here
Autonomic Innervation of the Eye
Midbrain-Pons junction IMLCC

Sympathetic chain

CN III
Sup. cervical ganglion
Sup. orbital fissure

Parasympathetic root of Internal carotid plexus

ciliary ganglion Carotid canal
Sup. orbital fissure

Nasociliary nerve (br. Sympathetic root of

Ciliary ganglion of V1) ciliary ganglion

Ciliary ganglion no
synapse!
Short ciliary nerves (br. Long ciliary nerves Click to return
of V1) (br. of V1)
Short ciliary nerves (br. of
V1)

Sphincter pupillae &

Dilator pupillae 59
ciliary muscle
Autonomic Innervation of the Eye

Long ciliary nn
(br. of V1) Short ciliary nn
(br. of V1)
Sympathetic root of CG Ciliary Ganglion
(from internal carotid Parasympathetic root of
plexus) CG (from CN III)

Nasociliary n. (br.
of V1) CN III
Click to return
Internal carotid plexus
V1 (Ophthalmic
Division of Trigeminal
Nerve)
60
N 88
Autonomic Innervation of the Eye
Nasociliary n. (br. N 88
of V1)

CN III Parasympathetic root of CG (from

CN III)
Sympathetic root of CG (from
internal carotid plexus)

Click to return

61
MDA 7.58
 Autonomic Innervation of the Parotid Gland
Lesser petrosal n.

Otic ganglion
62
Hiatus for lesser Click to return
Auriculotemporal n. petrosal n.
(branch of V3)
N 13
N 50
 Autonomic Innervation of the Parotid Gland

N 46

Click to return

Auriculotemporal n. (branch Parotid gland

of V3)
N 50

63
 Autonomic Innervation of the Parotid Gland
Medulla IMLCC

CN IX
Jugular foramen
Sympathetic
chain
Tympanic n.
Tympanic canaliculus

Tympanic plexus Sup. cervical ganglion

Lesser petrosal n.
Hiatus for lesser petrosal n.
Foramen ovale
External
Otic Ganglion
carotid plexus
Click to return

Auriculotemporal n. (br. of V3)

Parotid gland Parotid gland 64

Autonomic Innervation of the Submandibular & Sublingual Glands
Chorda tympani
Chorda tympani

CN VII

Medial Wall
Lateral Wall
Lingual n.

Petrotympanic
fissure

MDA 7.114
Click to return

Medial View
65
N 50
Autonomic Innervation of the Submandibular & Sublingual Glands

Lingual n.
Chorda tympani

Submandibular Ganglion Click to return

N 50 66
Sublingual & Submandibular
Glands
Autonomic Innervation of the Submandibular & Sublingual Glands
Pons – Medulla junction IMLCC

CN VII Sympathetic
Chain
Internal acoustic meatus

Chorda tympani
Petrotympanic fissure Sup. Cervical Ganglion
Lingual n. (br. of V3)

Submandibular External Carotid Plexus

Ganglion

Click to return
Lingual n. (br. of V3) Lingual a.

Submandibular & 67
Sublingual Gland Submandibular Gland
Sublingual Glands
Autonomic Innervation of the Nasal & Palatal Mucosa
Pterygopalatinega
nglion (Vidian) nerve of the
pterygoid canal

Greater petrosal n.
Posterior lateral nasal
nn. Deep petrosal n.
(branches of V2)
Pharyngeal branch
of V2

Greater & lesser palatine

nn.
Click to return
(branches of V2)

& Nasopalatine n.
(br. of V2) to nasal
N 39 Lateral wall of nasal cavity septum
68
Autonomic Innervation of the Nasal & Palatal Mucosa
Pons – Medulla junction IMLCC

CN VII
Internal acoustic meatus
Greater petrosal n.
Opening to pterygoid canal
Nerve of the pterygoid
canal (Vidian n.)
Sympathetic chain
Sup. Cervical Ganglion
Internal carotid plexus
Carotid canal
Deep petrosal n.

(Vidian) nerve of the pterygoid canal

Pterygopalatine Click to return
Ganglion
Pterygopalatine Ganglion (no synapse!)

Branches of V2
Branches of V2

Nasal Cavity & Palate Nasal Cavity & Palate

69
 Autonomic Innervation of Lacrimal Gland
Same as nasal cavity / palate up to the pterygopalatine ganglion

Pterygopalatine
Pterygopalatine Ganglion (no synapse!)
Ganglion

Maxillary n. (V2) Maxillary n. (V2)

Zygomatic n. (V2) Zygomatic n. (V2)

Communicating Communicating
branch branch Click to return

Lacrimal n. (V1) Lacrimal n. (V1)

Lacrimal Gland Lacrimal Gland

© 2018 Midwestern University 70
© 2018 Randall Nydam