GANGLIONS OF HEAD AND NECK

PRESENTED BY Dr.G.MADHAN PG STUDENT

Place of the PNS in the structural organization of the nervous system

CNS

PNS

Sensory division

Motor division

Sympathetic division
Parasympathetic division

Autonomic nervous system

Somatic nervous system

GANGLION
Where nerve-cell/neuron bodies clump together in the peripheral nervous system this constitutes a GANGLION

external gut muscle

Nerve fibers from neuron bodies group together to form a nerve, or spread out as a plexus (network)
This is a microscopic plexus contrasting with the macro plexuses seen in gross lab A completely different ganglion is the swelling (often on the hand) of a tendon sheath

Structure of a nerve
Blood vessels Perineurium Endoneurium Perineurium

Axon Myelin sheath

Epineurium Fascicle Fascicle Blood vessels (a) Endoneurium Nerve fibers

(b)

Somatic motor Effectors Skeletal muscles

Visceral motor Cardiac, smooth muscles and glands

Kind of fibers

One

Two: sympathetic and parasympathetic

Two neurons: preganglionic neuron (fiber) and postganglionic neuron (fiber) Preganglionic: thin myelinated postganglionic: unmyelinated Nerve plexuses

From lower Single center to neuron effect require Fibers Thick myelinated

Distributive form Control

Nerve trunk Voluntary

Involuntary (consciousness) (unconsciousness )

Sympathetic (Thoracolumbar) Division

Preganglionic neurons are in spinal cord segments T1 L2 Sympathetic neurons produce the lateral horns of the spinal cord Preganglionic fibers pass through the white rami communicantes and enter sympathetic trunk (paravertebral) ganglia

Sympathetic part
Lower center: located in lateral gray horn of spinal cord segments T1~L3 Sympathetic ganglia
Paravertebral ganglia Prevertebral ganglia

Sympathetic Trunks and Pathways

There are 23 paravertebral ganglia in the sympathetic trunk (chain)
3 cervical 11 thoracic 4 lumbar 4 sacral 1 coccygeal

Spinal cord Dorsal root Ventral root Rib Sympathetic trunk ganglion Sympathetic trunk Ventral ramus of spinal nerve Gray ramus communicans White ramus communicans Thoracic splanchnic nerves (a) Location of the sympathetic trunk
Figure 14.5a

Paravertebral ganglia
Arranged on either side of vertebral column Consist of 19~22 of oval-shaped ganglia Three cervical
10~12 thoracic 4 lumbar 2~3 sacral Ganglion impar: unpaired on the anterior face of coccyx

Sympathetic trunk
Formed by paravertebral ganglia and interganglionic branches Lie on either side of vertebral column from base of skull to coccyx The trunks of two side unite in front of the coccyx at a small swelling, the ganglion impar

Prevertebral ganglia
Lie anterior to vertebral column and near the arteries for which they are named Celiac ganglion Aorticorenal ganglion Superior mesenteric ganglion Inferior mesenteric ganglion

 Relay in corresponding ganglion Ascend or descend in sympathetic trunk and relay in higher or lower ganglia Pass without synapse to a prevertebral ganglion for relay

Three fates of preganglionic fibers

Lateral horn (visceral motor zone) Dorsal root Dorsal root ganglion Dorsal ramus of spinal nerve Ventral ramus of spinal nerve Gray ramus communicans White ramus communicans To effector

Skin (arrector pili muscles and sweat glands)

Ventral root Sympathetic trunk ganglion Sympathetic trunk

1 Synapse at the same level

Blood vessels (b) Three pathways of sympathetic innervation

Figure 14.5b (1 of 3)

Skin (arrector pili muscles and sweat glands) To effector

Blood vessels 2 Synapse at a higher or lower level (b) Three pathways of sympathetic innervation

Figure 14.5b (2 of 3)

Splanchnic nerve

Collateral ganglion (such as the celiac)

Target organ in abdomen (e.g., intestine) 3 Synapse in a distant collateral ganglion anterior to the vertebral column (b) Three pathways of sympathetic innervation
Figure 14.5b (3 of 3)

 Greater splanchnic nerve formed by preganglionic fibers from T5~T9 ganglia, and relay in celiac ganglion. Lesser splanchnic nerve formed by preganglionic fibers from T10~T12 ganglia, and relay in aorticorenal ganglion. The postganglionic fibers supply the liver, spleen, kidney and alimentary tract as far as the left colic flexure.

 Lumbar splanchnic nerve

Formed by preganglionic fibers from L1~L4 ganglia, and relay in prevertebral ganglia. The postganglionic fibers supplydescending and sigmoid colon, rectum, pelvic viscera and lower limbs.

Three fates of postganglionic fibers

Back to a spinal nerve along gray communicating branches ( 31 pairs ) to terminate in blood vessels, arrectores pilorum and sweat glands of head, neck, trunk and limbs The fibers from their networks around blood vessels passing to visceral end organs Terminate directly in certain organs

Preganglionic fibers T1~T5 T5~T12

Distribution of sympathetic nerve

Postganglionic fibers Head, neck, upper limb and thoracic viscera Abdominal viscera

L1~L3

Pelvic viscera and lower limb

Pathways with Synapses in Chain Ganglia

Postganglionic axons enter the ventral rami via the gray rami communicantes These fibers innervate
Sweat glands Arrector pili muscles Vascular smooth muscle

Pathways to the Head

Fibers emerge from T1 T4 and synapse in the superior cervical ganglion These fibers
Innervate skin and blood vessels of the head Stimulate dilator muscles of the iris Inhibit nasal and salivary glands

Parasympathetic part
Lower center: located in four pairs parasympathetic nuclei in brain stem and in sacral parasympathetic nucleus of spinal cord segments S2~S4 Parasympathetic ganglia: terminal ganglia are near or within the wall of a visceral organ
Para-organ ganglia Ciliary ganglion Pterygopalatine ganglion Submandibular ganglion Otic ganglion Intramural ganglia

N u c leu s

E d in g erW es tp h al n u c leu s in m id b rain

Parasympathetic nervous system of the Head and Neck

P reg an g li P reg an g lio n i o n ic fib ers c fib ers trav el c ran ial C N .III - o c u lo m o to r n erv e to in ferio r o b liq u e m . C N .V II - g reater s u p erfic ial (N e r v o u s p e t r o s a l in term ed ia n erv e te) v id ian n erv e - c h o rd a ty m p an i n erv e S y n ap s P o s tg an g lio e at n ic fib ers g an g lia T arg et o rg an s - s h o rt C iliary c iliary n erv e g an g lio n - P u p illary c o n s tric to r o f iris an d c iliary m u s c le o f c iliary b o d y - L ac rim al g lan d - O ral, p alalin e g lan d s an d N as al g lan d s - s u b m an d ib u lar an d s u b lin g u al s aliv ary g lan d s -m a x illa r y n . p tery g o p alati ne g an g lio - lin g u al n . n subm a n d ib u lar g an g lio n -O t ic g an g lio au ric u lo tem n p o ral n .

W h at h ap p en s to th at o rg an ?

S u p erio r s aliv ato ry n u c leu s relate to m ed u llo p o n tin e ju n c tio n

-p u p il c o n s t r ic t - c o n trac tio n o f c iliary m . --> in c r e a s e b u lg in g o f len s fo r c lo s e v is io n -s e c r e t io n o f t e a r - s ec retio n o f m u c o u s g lan d s in th at area - s ec retio n o f s alv a fro m s u b m an d ib u lar an d s u b lin g u al s aliv ary g lan d s

In f e r i o r s aliv ato ry n u c leu s in m ed u lla

C N .IX

- ty m p an ic n erv e les s er s u p erfic ial p etro s al n erv e

-p a r o t id s a liv a r y g lan d

-s e c r e t io n o f s a liv a fro m p aro tid g lan d

Parasympathetic of CNIII Preganglionicparasympathetic neurons located at the Edinger-Westphal nucleus. * Preganglionic fibers pass along CNIII to the inferior oblique muscle * Synapse at Ciliary ganglion. * Postganglionic parasympathetic fibers go to 1. Pupillary constrictor muscles of iris and 2.Ciliary muscles of ciliary body

The ciliary ganglion (arrow 4) is an important anatomic structure in the posterior orbit because sensory innervation to the anterior eye, parasympathetic axons for the iris to control pupil constriction, and sympathetic fibers pass that innervate the iris dilators and blood vessels. Located about 1 cm in front of the annulus of Zinn, the ciliary ganglion lies interposed between the optic nerve (shown in gray in the image) and lateral rectus (arrow 9) at the lateral aspect of the ophthalmic artery with its attendant innervation from the abducens nerve

Parasympathetic of CNVII II. * Preganglionic neurons located at the Superior salivatory nucleus * fibers pass along CNVII (Nervous intermediate) Greater superficial petrosal nerve Nerve of pterygoid canal (Vidian nerve) * Synapse at Pterygopalatine ganglion. * Postganglionic parasympathetic fibers go to 1.Lacrimal gland and 2.Mucous glands of Nose, palate and pharynx

Parasympathetic of CNVII I * Preganglionic neurons located at the Superior salivatory nucleus fibers pass along tympani CNVII (Nervous intermediate) Chorda tympani nerve * Synapse at Submandibular ganglion. * Postganglionic parasympathetic fibers go to 1. Submandibular salivary gland and 2. Sublingual salivary gland

 The submandibular ganglion is small and fusiform in shape. It is situated above the deep portion of thesubmandibular gland, on the hyoglossus muscle, near the posterior border of the mylohyoid muscle. The ganglion 'hangs' by two nerve filaments from the lower border of the lingual nerve (itself a branch of themandibular nerve, CN V3). It is suspended from the lingual nerve by two filaments, one anterior and one posterior. Through the posterior of these it receives a branch from the chorda tympani nerve which runs in the sheath of the lingual nerve.

Parasympathetic of CNIX * Preganglionic neurons located at the Inferior salivatory nucleus * fibers pass along CNIX tympanic nerve tympanic plexus lesser superficial petrosal nerve * Synapse at Otic ganglion. * Postganglionic parasympathetic fibers go to Parotid salivary gland

INFERIOR SALIVATORY NUCLEUS

GLOSSOPHARYGEAL NERVE
ITS TYMPHANIC BRANCH TYMPHANIC PLEXUS

PASSES THROUGH FORAMEN OVALE

LESSER PETROSAL NERVE OTIC GANGLION. RELAY OCCURS.

POST GANGLIONIC FIBRES PASS THRROUGH AURICULO TEMORAL NERVE

PAROTID GLAND.

Parasympathetic of CNX -Dorsal motor nucleus of vagus nerve -Preganglionic parasympathetic fibers travel along the vagus nerve. -Postganglionic parasympathetic neurons locate near or within the wall of the effector organs e.g. Myenteric ganglia of GI tract -Postganglionic parasympathetic fibers end at the smooth muscle of the GI tract

Trigeminal ganglion

 The trigeminal ganglion (or Gasserian ganglion, or semilunar ganglion, or Gasser's ganglion) is a sensoryganglion of the trigeminal nerve (CN V) which occupies a cavity (Meckel's cave) in the dura mater covering thetrigeminal impression near the apex of the petrous part of the temporal bone.Relations It is somewhat crescentic in shape, with its convexity directed forward: medially, it is in relation with the internal carotid artery and the posterior part of the cavernous sinus. The motor root runs in front of and medial to the sensory root, and passes beneath the ganglion; it leaves the skull through the foramen ovale, and, immediately below this foramen, joins the mandibular nerve. The greater superficial petrosal nerve lies also underneath the ganglion. The ganglion receives, on its medial side, filaments from the carotid plexus of the sympathetic. It give off minute branches to the tentorium cerebelli, and to the dura mater in the middle fossa of the cranium. From its convex border, which is directed forward and lateralward, three large nerves proceed, viz., theophthalmic (V1), maxillary (V2), and mandibular (V3).

 A. The trigeminal nucleus complex: The collection of cells in the brainstem that can be called the trigeminal nucleus is huge - it stretches from midbrain to medulla. If we could see it in a transparent brainstem, Most of the sensory fibers enter the trigeminal ganglion, regardless of which trigeminal division they are coming from. Their cell bodies, like those of all somatosensory neurons, lie outside the CNS in the ganglion, and their proximal processes enter the brainstem in the mid-pons. From there they fan out to their different targets. Each modality will be described separately below.

 Discriminative touch: The large diameter (Ab) fibers enter directly into the main sensory nucleus of the trigeminal (V), also called the principal nucleus. Just like the somatosensory neurons of the body, they SYNAPSE, then CROSS. The secondary afferents can then join the medial lemniscus on its way to the thalamus.

. Pain and temperature:

The small diameter fibers carrying pain and temperature enter at mid pons, and then do something unusual - they turn down the brainstem. They travel down the pons and medulla until they reach the caudal medulla, which is where they finally synapse and cross. The tract that the descending axons travel in is called the spinal tract of V, and the long tail of a nucleus that they finally synapse in is called the spinal nucleus of V. These names come from the fact that they actually reach as far down as the upper cervical spinal cord. The spinal nucleus of V can be divided into three regions along its length; the region closest to the mouth is called subnucleus oralis, the middle region is called subnucleus interpolaris, and the region closest to the tail is called subnucleus caudalis. The pain fibers actually synapse in subnucleus caudalis, so you may hear that term used instead of the spinal nucleus of V The secondary afferents from subnucleus caudalis cross to the opposite side, and join the spinothalamic tract on its way to the thalamus.

D. Proprioception: The proprioceptive axons in the trigeminal nerve are the stretch and tendon receptors from the muscles of mastication. (Recall that all of the muscles of facial expression are controlled by the facial nerve. ) These axons coming from the face have a strange characteristic unique among primary somatosensory neurons: their cell bodies are inside the CNS. They are the only exception to the rule. Although their cells look similar to cells in the dorsal root ganglion (the cell body does not come between the distal and proximal axon processes), they are located inside the brainstem in a nucleus called the mesencephalic nucleus. The mesencephalic nucleus is essentially a dorsal root ganglion that has been pushed into the CNS, so there are no synapses within it. The fibers enter the brainstem via a small branch of the trigeminal that bypasses the trigeminal ganglion, turn up towards the mesencephalic nucleus, pass by the cell body, and leave the nucleus immediately. Most then synapse in the nearby motor nucleus where they can initiate the stretch reflexes for the muscles of mastication. The stretch reflex in the face behaves exactly like that in the body, and tapping on the tendon of the masseter (for example) will produce a twitch.

 E. Motor innervation: Motor or efferent control is not considered a sensory modality, but it is the fourth component of the extensive trigeminal complex. Themotor nucleus of V lies just medial to the main sensory nucleus, and in it reside the a-motor neurons that control the muscles of mastication. The two principal muscles involved are the masseter (in your cheek) and the temporalis (over your temple), both of which tighten when you clench your teeth. The motor axons leave the mid-pons and bypass the trigeminal ganglion, and reach their targets via the mandibular division of the trigeminal nerve.