OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also: Anatomy main index; autonomic dysfunction and autonomic neuropathy

• NB. No P/S fibres to limbs, gonads or suprarenal glands!

• III: pregang. bodies in E-W oculomotor nuclei → ciliary ganglion;
• VII: pregang. bodies in inf & sup. salivary nuclei → pterygopalatine ganglion;
• IX: pregang. bodies in salivary nuclei? → otic ganglion;
• X: pregang. bodies in dorsal motor nucleus of the vagus nerve and vagal tone
  • ⇒ terminal ganglia near/in target
  • ie. in walls of heart, lungs, gut;

• 2,3,4: pregang. bodies in lat. grey horns S2-4 → pelvic splanchnic Nn
  • ⇒ inf. hypogastric plexus (pelvic plexus as with symp.)
  • → pelvic viscera via blood vessels or retroperitoneally with post-gang.
  • cell bodies in visceral walls as for vagus:
    • ⇒ supply GIT distal to L colic flexure
    • ⇒ bladder, penis erection;

• glossopharyngeal N & vagus N: cell bodies in inf. ganglia of those nerves
• pelvic splanchnic nerves: cell bodies in post. root ganglia of S2-4
• similar to symp.afferents

• only contain:
  • cell bodies for post-gang. p/s efferents
  • fibres in transit:
    • sensory from trigeminal ganglion cell bodies
    • sympathetic from vascular plexuses
    • afferents?
• Ciliary ganglion:
  • p/s root: from Edinger-Westphal part of oculomotor nucleus
    • via branch of inf. division of oculomotor nerve
  • sensory root: from branch of nasociliary nerve
  • symp. root: from internal carotid plexus
  • branches: short ciliary N to eye
• Pterygopalatine:
  • p/s root: from sup. salivary nucleus
    • ⇒ N. intermedius part of facial N
    • ⇒ N. of pterygoid canal (with symp. roots)
  • sensory root: from branch of maxillary N
  • symp.root: from int. carotid N → deep petrosal N
    • ⇒ N. of pterygoid canal
  • branches:
    • zygomatic & lacrimal Ns → lacrimal gland
    • maxillary N branches
      • ⇒ mucous glands of nose, nasopharynx & palate
    • greater petrosal N → taste (palate)
  • NB. cell bodies in geniculate ganglion of facial N!!
• Submandibular:
  • p/s root: from sup. salivary nucleus
    • ⇒ N. intermedius part of facial N
    • ⇒ chorda tympani → joining lingual N
  • sensory root: branch of lingual N
  • symp. root: via facial artery plexus
  • branches: branches of lingual N → submand/sublingual glands
• Otic:
  • p/s root: inf. salivary nuclei → glossopharyngeal N
    • ⇒ tympanic branch → tympanic plexus
    • ⇒ lesser petrosal N
  • sensory: auriculotemporal N
  • symp. root: via mid. meningeal artery plexus
  • SOMATIC MOTOR ROOT: from N. to med. pterygoid
  • branches:
    • auriculotemporal N filaments → parotid gland
    • somatic motor → tensor tympani & tensor palati

• Pregang. cell bodies in lat.horn cells of T1 → L2 spinal segments
  • ⇒ white myelinated fibres to paravert. symp. ganglia via white rami communicans
  • ⇒ cell bodies post-gang. in either:
    • symp. (paravertebral) trunk
    • collateral ganglia eg. coeliac ganglia
    • suprarenal gland (modified ganglia)

• grey rami communicans to spinal N - ALL limb symp. fibres
• visceral or splanchnic branches to visceral plexuses
  • (cardiac/coeliac/pelvic)
• vascular branches to form plexuses on major arteries
  • (int&ext.carotid/aorta)
• NB. NO sympathetics hitchhike on arteries to limb targets

• T1-3 → sup. cervical ganglion (C1-4 position) → H&N
  • ⇒ int.carotid N & plexus
  • ⇒ through p/s ciliary ganglion (see above)
  • ⇒ deep petrosal N → N of pterygoid canal
  • ⇒ through pterygopalatine p/s ganglion (above)
  • ⇒ ext. carotid N & plexus
  • ⇒ facial artery plexus
  • ⇒ through submandibular p/s ganglion (above)
  • ⇒ middle meningeal artery plexus
  • ⇒ through otic p/s ganglion (above)
• T2-7 → upper T, inf & middle Cx paravertebral ganglia
  • ⇒ upper limb; HENCE T2-3 ganglia destroyed in Cx sympathectomy.
  • ⇒ cardiac visceral branches
  • ⇒ cardiac plexus (T1-5) - joined by p/s vagal fibres
  • ⇒ coronary part - vasomotor to coronary arteries
  • ⇒ cardiac part - SA & AV nodes, bundle, myocardium
  • ⇒ pulmonary part (pulm. plexus) ⇒ lung (T2-7);
  • ⇒ oesoph. (T4-6);
  • ⇒ vascular branches to carotids as above??
• T5-12 → lower thoracic paravetebral ganglia
  • ⇒ 3 splanchnic nerves which pierce the diaphragm → coeliac plexus
    • greater splanchnic N (T5-10)
      • ⇒ stomach/liver/panc.(T6-10)
      • ⇒ gall bladder (T4-10);
      • ⇒ small intestine (T8-11);
    • lesser spl. N (T10,11)
      • ⇒ prox.colon → L.flex.(T10-L1)
    • lowest spl. N (T12)
• T10-L2 → upper lumbar paravertebral ganglia
  • ⇒ 4 lumbar splanchnic Nn → sup. & R&L inf. hypogastric plexuses which are together called the plevic plexus
  • ⇒ distal colon → rect. (L1-2)
  • ⇒ suprarenal gland (T10-L2)
  • ⇒ kidney (T11-L2), ureter (L1-2), via renal plexus?
  • ⇒ bladder trigone, ejacul.(T11-L2)
  • ⇒ vascular branches to common iliac art & med. sacral artery
• L2-S3 paravertebral ganglia
  • ⇒ lower limb HENCE L3/4 ganglia destroyed in Lx sympathectomy.
• sacral paravertebral ganglia
  • ⇒ sacral splanchnic nerves (NOT pelvic splanchnic nerves - P/S!!)
  • ⇒ pelvic plexus as above.
  • ⇒ vascular branches to lat & med sacral arteries

• from sensory end travel to paravert. ganglia then via white rami communicans to cell body in post. root ganglia of spinal nerve with the cell's central process then passing either:
  • to synapse with interneurons in spinal cord as part of a reflex arc
  • ascend to hypothalamus, etc
  • pass up spinal cord as for somatic pain afferents (visceral pain fibres)
• Hence, whereas grey rami communicans carry ONLY post-ganglionic efferents and occur on ALL paravertebral ganglia, white rami communicans carry a mix of pregang. efferents and afferents, and occur ONLY on T1-L2 ganglia.