INNERVATION and LYMPHATIC SYSTEM OF HEAD and NECK

Annisaa Chusida

Sistema Nervosum

Terdiri dari :1. Central Nervous System ~ brain ~ spinal cord2. Peripheral Nervous System ~ spinal nerves ~ cranial nervesBerdasar sifat dapat dibagi :1. Somatic2. Autonomic : ~ sympathetic ~ parasympathetic

CENTRAL NERVOUS SYSTEM• Spinal Cord - 2/3 superior columna vertebralis - lanjutan dr medulla oblongata - ~ 31 pasang spinal nerves• Brain 1. Hindbrain = Rhombencephalon - Myelencephalon = Med. Oblongata - Metencephalon = Pons - Cerebellum

2. Midbrain = Mesencephalon

Medulla Oblongata + Pons + Midbrain

= Brain stem

3. Forebrain = Prosencephalon

- Telencephalon = Cerebrum

- Diencephalon : Thalamus

Hypothalamus

Epithalamus

Subthalamus

Autonomic Nervous System

• Visceral component• Neuron pd CNS dan PNS• Control internal environment• Innervation : - secretory glands - smooth muscle - cardiac muscle• Function ~ changes in somatic activities• Sympathetic ~ trunkus simpatikus ( basis cranii s.d

coccyx )• Parasympathetic Efferent fibres dr CNS Hanya pd N. Cranialis ttt ( N III, VII, IX, X )

Peripheral Nervous System

Terdiri dari :

• 31 pasang spinal nerves

- 8 Cerv, 12 Th, 5 Lumb, 5 Sacral,

1 Coccyx

- Sifat mixed ( sensoris dan motoris )

- Asal : spinal cord ~ radix ventralis

~ radix dorsalis

12 pasang cranial nervesbbrp bersifat mixed, sebagian murni sensoris atau motoris

V: Trigeminal (3 nerves in 1!)

• V1. Ophthalmic– Exits with eye muscle group (superior orbital fissure, through

orbit to superior orbital notch/foramina)– Sensory to forehead, nasal cavity

• V2. Maxillary– Exits foramen rotundum through wall of maxillary sinus to inferior

orbital foramina)– Sensory to cheek, upper lip, teeth, nasal cavity

• V3. Mandibular– Exits foramen ovale to mandibular foramen to mental foramen– Motor to jaw muscles--Masseter, temporalis, pterygoids, digastric– Sensory to chin– Sensory to tongue

TRIGEMINAL NEURALGIA(Tic Douloureux)

• Pada dewasa atau lansia

• Excruciating pain biasanya pd daerah distribusi nervus V2 ( sensoris )

• Nyeri : sentuhan pd trigger point, menggosok gigi, mengunyah

• Etiologi : vascular compressing NV ~ compressive neuropathy

VII: Facial Nerve(exits cranial cavity with VIII--internal auditory

meatus)• Facial muscles (five branches fan out over face

from stylomastoid foramen)– Temporal– Zygomatic– Buccal– Mandibular– Cervical

• “chorda tympani” (crosses interior ear drum to join V3 )– Taste to anterior 2/3 of tongue– Submandibular, sublingual salivary glands

• Lacrimal glands

FACIAL NERVE DISORDERS

• Unilateral facial weakness is a common neurologic sign.

• Bell's Palsy

Etiologi : neuritis N VII ( immune / virus )

Inflamasi ~ swelling

Terjadi paralisis wajah ~ Px tdk bisa

mengangkat alis, menutup mata dan menarik bibir

Nervus Glossopharyngeus

- Sensori pd middle ear

- Parasimpatis : gland. Parotis

- membrana mucosa oropharyng

- 1/3 posterior lidah

- taste fibres pd papilla circumvallata

Nervus Vagus

• Daerah innervasi luas : dr kepala - leher, jantung, pulmo, saluran cerna

• Somatic motor unt laryng dan pharyng

Nervus Accesorius

• Terdiri dari : - Spinal Accessory Nerve Purely Motor ~ M. sternocleidomastoideus ~ M. trapezius - Cranial Accessory Nerve Bergabung dg NX ~ otot intrinsik laryng dan pharyng

Nervus Hypoglossus

- Innervasi otot ekstrinsik dan intrinsik lidah - Keluar dari kranium melalui canalis

hipoglosi, berjalan berdekatan dg NX dan Spinal Accessory Nerve ~ pd daerah carotid sheath ~ sekitar angulus mandibula ~ ke permukaan M. hyoglossus

- Lesi : - wasting tongue - deviation tongue to affected side ( saat protrusi )

• N IX, X dan XI keluar dari kranium bersama-sama melalui foramen jugulare

• Foramen Jugulare Syndrome

Adanya tumor : tumor primer nasopharyng atau tumor metastase pd lymph node cervicalis superior ( primer: lidah, pharyng, laryng )

Gejala : sakit belakang telinga, headache, paralisa laryngomotor fibres, dysphagia

LYMPHATIC SYSTEM

1. Lnn. Submentalis

Letak : diantara kedua venter anterior M. digastricus

Afferent : medial bibir bawah, dasar mulut, ujung lidah

Efferent : lnn. Cervicalis profundus dan submentalis

2.Lnn. Submandibularis

Letak : antara mandibula dan gland.submandibularis

Afferent : mata, pipi, hidung, bibir atas, bibir bawah lateral, gingiva, margo anterolateral lidah

Efferent : lnn. Cervicalis profundus

3. Lnn Cervicalis Superficialis

Letak : V. Jugularis Externa

Afferent : daerah parotis

Efferent :lnn. Cervicalis profundus

4. Lnn. Cervicalis Profundus

Terdiri dari : Superior dan Inferior

Letak di sekitar V. Jugularis Interna