The Autonomic Nervous System in the Head and Neck

Sympathetic Part
Cervical Part of the Sympathetic Trunk The cervical part of the sympathetic trunk extends upward to the base of the skull and below to the neck of the first rib, where it becomes continuous with the thoracic part of the sympathetic trunk. It lies directly behind the internal and common carotid arteries (i.e., medial to the vagus) and is embedded in deep fascia between the carotid sheath and the prevertebral layer of deep fascia (Fig. 11-49). The sympathetic trunk possesses three ganglia: the superior, middle, and inferior cervical ganglia. Superior Cervical Ganglion The superior cervical ganglion lies immediately below the skull (Fig. 11-60). Branches:

The internal carotid nerve, consisting of postganglionic fibers, accompanies the internal carotid artery into the carotid canal in the temporal bone. It divides into branches around the artery to form the internal carotid plexus. Gray rami communicantes to the upper four anterior rami of the cervical nerves Arterial branches to the common and external carotid arteries. These branches form a plexus around the arteries and are distributed along the branches of the external carotid artery. Cranial nerve branches, which join the 9th, 10th, and 12th cranial nerves Pharyngeal branches, which unite with the pharyngeal branches of the glossopharyngeal and vagus nerves to form the pharyngeal plexus The superior cardiac branch, which descends in the neck and ends in the cardiac plexus in the thorax .

Middle Cervical Ganglion The middle cervical ganglion lies at the level of the cricoid cartilage (Fig. 11-57). Branches

Gray rami communicantes to the anterior rami of the fifth and sixth cervical nerves Thyroid branches, which pass along the inferior thyroid artery to the thyroid gland The middle cardiac branch, which descends in the neck and ends in the cardiac plexus in the thorax .

Inferior Cervical Ganglion The inferior cervical ganglion in most people is fused with the first thoracic ganglion to form the stellate ganglion. It lies in the interval between the transverse process of the seventh cervical vertebra and the neck of the first rib, behind the vertebral artery (Fig. 11-57). Branches

Gray rami communicantes to the anterior rami of the seventh and eighth cervical nerves Arterial branches to the subclavian and vertebral arteries The inferior cardiac branch, which descends to join the cardiac plexus in the thorax

The part of the sympathetic trunk connecting the middle cervical ganglion to the inferior or stellate ganglion is represented by two or more nerve bundles. The most anterior bundle crosses in front of the first part of the subclavian artery and then turns upward behind it. This anterior bundle is referred to as the ansa subclavia (Figs. 11-57 and 11-60).

Parasympathetic Part
The cranial portion of the craniosacral outflow of the parasympathetic part of the autonomic nervous system is located in the nuclei of the oculomotor (3rd), facial (7th), glossopharyngeal (9th), and vagus (10th) cranial nerves. The parasympathetic nucleus of the oculomotor nerve is called the Edinger-Westphal nucleus; those of the facial nerve the lacrimatory and the superior salivary nuclei; that of the glossopharyngeal nerve the inferior salivary nucleus; and that of the vagus nerve the dorsal nucleus of the vagus. The axons of these connector nerve cells are myelinated preganglionic fibers that emerge from the brain within the cranial nerves. These preganglionic fibers synapse in peripheral ganglia located close to the viscera they innervate. The cranial parasympathetic ganglia are the ciliary, the pterygopalatine, the submandibular, and the otic. In certain locations, the ganglion cells are placed in nerve plexuses, such as the cardiac plexus, the pulmonary plexus, the myenteric plexus (Auerbach's plexus), and the mucosal plexus (Meissner's plexus). The last two plexuses are found in the gastrointestinal tract. The postganglionic fibers are nonmyelinated, and they are short in length.

*Otic Ganglion The otic ganglion is a parasympathetic ganglion that is located medial to the mandibular nerve just below the skull, and it is adherent to the nerve to the medial pterygoid muscle. The preganglionic fibers originate in the glossopharyngeal nerve, and they reach the ganglion via the lesser petrosal nerve The postganglionic secretomotor fibers reach the parotid salivary gland via the auriculotemporal nerve. *Submandibular Ganglion The submandibular ganglion is a parasympathetic ganglion that lies deep to the submandibular salivary gland and is attached to the lingual nerve by small nerves (Figs. 11-36 and 11-66). Preganglionic parasympathetic fibers reach the ganglion

Figure 11-57