Overview of the Autonomic Innervation to the Head and Neck

Parasympathetic and sympathetic cell body locations

1. Sympathetic division of the autonomic NS
   1. preganglionic cell bodies in the intermediolateral cell column of T1 - T4
   2. postganglionic cell bodies in the superior cervical sympathetic ganglion
2. Parasympathetic division of the autonomic NS
   1. preganglionic cell bodies - in the CNS
      1. Edinger-Westphal nucleus (fibers travel in oculomotor n.)
      2. lacrimal nucleus (greater superficial petrosal nerve of facial n.)
      3. superior salivatory nucleus (chorda tympani of fascial n.)
      4. inferior salivatory nucleus (lesser superficial petrosal n. of CN IX via recurrent tympanic branch)
   2. postganglionic cell bodies (listed in order as postganglionic to the preganglionic locations above)
      1. ciliary ganglion (fibers follow trigeminal short ciliary nn.)
      2. pterygopalatine ganglion (follow branches of maxillary n.)
      3. submandibular ganglion (follow lingual n.)
      4. otic ganglion (follow auriculotemporal n.)

Sympathetic GVE functions -- loss of sympathetic GVE results in Horner's syndrome

1. pupil dilation - pupil dilator m.
   1. loss of pupil dilator results in pupil constriction (parasympathetic GVE to pupil constrictor m. is unopposed)
2. elevate superior tarsal plate - superior tarsal m. (Muellers m.) (if paralyzed - ptosis results)
   1. loss of Mueller's muscle causes ptosis
3. vasoconstriction - vessel smooth m.
   1. loss of vasoconstriction causes, red eye (conjunctival injection), flushing, warm skin, nasal congestion (engorged erectile tissue of nasal cavity)
4. sudomotor activity - sweating (exception to pharmacology - cholinergic)
   1. loss of sudomotor causes dry skin
5. Viscous saliva secretion from submandibular gland
   1. loss of viscous saliva reduces protection from trigeminal irritatants

Parasympathetic GVE functions

1. pupil constriction - loss of pupil constrictor muscle causes pupil dilation by the unopposed dilator pupilae muscle
2. accommodation - loss of ciliary m. causes failure to focus on near objects
3. lacrimal secretion - loss of lacrimation causes "dry eye"
4. mucus secretion - loss of mucus secretion causes dry mucosa of nasal cavity and of air sinuses leading to epistaxis (nose bleed)
5. salivation - loss of submandibular gland, sublingual gland, parotid gland causes difficulty in deglutition and digestion

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