Eric Cheng
Secret Study Sheet (shh…don’t tell Rod)
Autonomic Innervation to Head and Neck
General info on SYMPATHETICS:
Preganglionic cell bodies in lateral horns of T1 to T4

ventral roots of T1 to T4
 via white rami communicantes (WIN = white in, GOUT = gray out)
sympathetic trunk
 (run upwards: thoracic  cervical)
3 sympathetic cervical ganglia: ~synapse~
1) inferior: level of 1st rib, often fused with T1 ganglion to form stellate ganglion
postganglionic to gray rami of (C6), C7, and C8
2a) intermediate: lies close to vertebral a. (often called vertebral ganglion)
2b) middle: frequently absent, level of C6
postganglionic to gray rami of C5 and C6
to thyroid gland and larynx (hitchhikes along branches of thyroid aa)
3) superior: largest, anterior to transverse processes of C2 & C3, behind int. carotid a.
postganglionic to gray rami of C1 to C4
supply blood vessels, pharynx (via pharyngeal plexus)
 postganglionics like to hitchhike with int/ext carotid aa, vertebral aa
 all three ganglia supply heart through cardiac plexus
 two cervical sympathetic trunks may be asymmetrical
Distribution of Postganglionic Sympathetics:
Cervical ganglia (esp. the superior)
 riding int. carotid a
 riding ext. carotid a.
internal carotid nerve
external carotid nerve
 thru carotid canal
ride facial a.
 ride middle
lateral branch

medial branch
submandibular
 meningeal a

 to cav sinus
ganglion

internal carotid plexus
cavernous plexus


otic ganglion



submandibular sublingual

tympanic plexus 
ciliary ganglion
gland
gland
b.v. of parotid gland

long ciliary n 

deep petrosal nerve
dilator of pupil  short ciliary n.


n. of pterygoid canal
vasomotor tone of

ciliary blood vessels
pterygopalatine ganglion
Clinical Correlate:
 Horner’s Syndrome – lesion in cervical sympathetic pathways (pre or post-ganglionic)
Symptoms: meiosis (constricted pupil), ptosis (droopy eyelid), anhydrosis (unilateral loss of
sweating), & enophthalmos (recession of eyeball in socket)
General info on PARASYMPATHETICS:
Preganglionic cell bodies from nuclei of neurons in brain stem
Postganglionic cell bodies from ganglia in the head
Nucleus:
Edinger Westphal (midbrain)
Lacrimal
Superior Salivatory (brain stem)
Inferior Salivatory (medulla)
Dorsal Motor Nucleus of the
Vagus Nerve
Nucleus Ambiguus
Ganglion:
Ciliary
Pterygopalatine
Submandibular
Otic
ganglia in cervical,
thoracic, & abdominal
Viscera
Cardiac Plexus
Cranial Nerve:
Oculomotor (III)
Facial (VII)
Glossopharyngeal (IX)
Vagus (X)
Oculomotor Parasympathetics (III)
Edinger-Westphal Nucleus (pregang cell bodies: midbrain)
 hitchhike with inferior branch of CN III
Ciliary ganglion (suspended b/t nasociliary & inf. CN III; lateral to optic n.) ~synapse~
 jump onto nasociliary n. (V1)
short ciliary nerves (ride short ciliary aa)

ciliaris muscle (accomodation of lens) & sphincter of pupil
Facial Nerve Parasympathetics (VII)
Superior Salivatory Nucleus (brain stem)
Lacrimal Nucleus


 nervus intermedius 
/ \ pass thru geniculate ganglion
greater petrosal n.   chorda tympani
 (joins deep petrosal: symp)
 pass thru petrotympanic fissure
nerve of Pterygoid Canal (Vidian’s)
 hitchhike on lingual nerve (V3)

submandibular ganglion ~synapse~
Pterygopalatine Ganglion ~synapse~
(medial to mandible; b/f lingual n. goes under Wharton’s duct)
(just below maxillary of CN V)


 hitchhike on maxillary n.
submandibular
 hop back on lingual n.
 jump to zygomaticotemporal n.
gland

lacrimal gland (in orbital cavity)
sublingual gland
& mucous glands of nasal & oral cavities
Glossopharyngeal Parasympathetics (IX)
Inferior Salivatory Nucleus (medulla oblongata)

tympanic branch of CN IX (Jacobsen’s nerve)
 go to middle ear
tympanic plexus

lesser petrosal n.
 reenters cranial cavity via temporal bone, runs alongside V3
otic ganglion (medial to V3, suspended just below foramen ovale) ~synapse~
 hitchhike on auriculotemporal nerve (V3)
 & then on branch of facial n.
parotid gland
note: otic ganglion also transmits (but not synapse) V3 motor fibers
to supply two muscles: 1) tensor tympani, 2) tensor veli palatini
Vagus Parasympathetics (X)
Dorsal Motor Nucleus of the Vagus Nerve & Nucleus Ambiguus


Sup/Inf Cardiac Nerves
ganglia w/in viscera of neck,

thorax, & abdomen
Cardiac Plexus

slow down heart rate

no parasympathetic distribution to head or neck structures
Summary of Autonomic Ganglia of the Head
Ganglion
Nerve Roots
Ciliary
para: oculomotor * short ciliary n
ciliaris & pupillary sphincter
sym: sup cerv ganglia  int carotid n.
 long/short ciliary nn 
vasomotor tone for b.v. in eyeball
sens: opthalmic n.  nasociliary n.  cornea, iris, ciliary body
Pterygopalatine
para: facial  nervus intermedius
 greater petrosal n.  nerve of
pterygoid canal * V2 
mucous glands in nasal/oral cavities &
zygomaticotemporal n.  lacrimal n. lacrimal gland
sym: SCG  ICN  deep petrosal n. b.v. and glands in nasopharynx, nasal
 n. of pterygoid canal 
cavity, and palate
sens: trigeminal ganglion  V2
 pterygopalatine nerves 
nasal cavity & palate (gen. sensation)
Submandibular
para: facial  nervus intermedius
 chorda tympani  lingual n * submandibular & sublingual glands
sym: SCG  ECN 
smooth muscle & b.v. in 2 glands
sens: trigem ganglion  V3 
2 glands & their capsules
Otic
para: glossopharyngeal  tympanic
branch of IX  tympanic plexus
 lesser petrosal n. *
auriculotemporal n.  VII branch  parotid gland
sym: SCG  ECN 
b.v. of parotid gland
sens: V3  auriculotemporal n. 
capsule of parotid gland
motor: V3  motor fibers to
tensor tympani & tensor palati
* = synapse in ganglion
SCG = superior cervical ganglion
Target Distribution
 = pass thru ganglion but does NOT synapse
ICN = internal carotid nerve
ECN = external carotid nerve