Sensory and motor innervation of upper airway
-
Upload
dr-jeyasekharan-medical-trust -
Category
Healthcare
-
view
209 -
download
2
Transcript of Sensory and motor innervation of upper airway
![Page 1: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/1.jpg)
Sensory and Motor Innervationof Upper Airway
R.Srihari
![Page 2: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/2.jpg)
Topics for discussion
• Nose
• Pharynx
• Larynx
• Oral Cavity
![Page 3: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/3.jpg)
Nose
• Parts:
– External nose
– Nasal Septum
Nasal Cavity
– Lateral Wall
![Page 4: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/4.jpg)
• External Nose:– Parts: .Root .Dorsum .Tip .Ala .Anterior Nares
.Nasal Septum .Columella
– Partly cartilaginous Superior and Inferior nasal Cartilage
Septal Cartilage
Partly Bony .Nasal bones .Bridge of nose
.Frontal process of maxilla
![Page 5: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/5.jpg)
![Page 6: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/6.jpg)
• Sensory innervation:
TRIGEMINAL
Ophthalmic Maxillary
(Infratrochlear, External Nasal) (Infraorbital)
Branch of Ant. Ethmoidal
![Page 7: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/7.jpg)
![Page 8: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/8.jpg)
![Page 9: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/9.jpg)
• Motor Supply:
BUCCAL BRANCH OF FACIAL NERVE
![Page 10: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/10.jpg)
![Page 11: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/11.jpg)
• Nasal Cavity:
– Two parts:
• Nasal Septum
• Lateral Wall
![Page 12: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/12.jpg)
• Nasal Septum:
![Page 13: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/13.jpg)
![Page 14: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/14.jpg)
• Lateral Wall:
![Page 15: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/15.jpg)
![Page 16: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/16.jpg)
• Summary of nasal innervation:– Infratrochlear nerve: Ophthalmic branch of Trigeminal
nerve
– Infraorbital nerve: Maxillary branch of Trigeminal nerve
– Anterior ethmoid nerve: Continuation of nasociliarynerve from ophthalmic nerve
– Anterior superior alveolar nerve: Branch of infraorbital nerve
![Page 17: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/17.jpg)
• Posterior superior nasal nerves: branch of maxillary nerve
• Palatine nerves: sensory branches of maxillary nerve
![Page 18: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/18.jpg)
Pharynx
![Page 19: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/19.jpg)
![Page 20: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/20.jpg)
• Muscles of pharynx:
– Constrictors
• Superior
• Middle
• Inferior
– Stylopharyngeus
– Palatophayngeus
– Salpingopharyngeus
![Page 21: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/21.jpg)
![Page 22: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/22.jpg)
![Page 23: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/23.jpg)
![Page 24: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/24.jpg)
![Page 25: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/25.jpg)
![Page 26: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/26.jpg)
• Nerve Supply:
– Motor
– Sensory
– Special Sensory (Taste)
![Page 27: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/27.jpg)
• Pharyngeal plexus:
– Pharyngeal br. Of Vagus carrying fibresOf cranial accessory N.
- Pharyngeal br. Of Glossopharyngeal N.
-Pharyngeal br. Of SuperiorCervical ganglion
![Page 28: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/28.jpg)
• Motor fibres:
– Derived from cranial accessory nerve via branches of vagus
SUPPLIES ALL MUSCLES OF PHARYNX EXCEPT STYLOPHAYNGEUS
SUPPLIED BY GLOSSOPHAYNGEAL N.
![Page 29: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/29.jpg)
• Inferior Constrictor receives additional branches from external and recurrent laryngeal nerve
![Page 30: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/30.jpg)
• Sensory Supply:
– Nasopharynx Maxillary nerve via pterygopalatine ganglion
– Oropharynx Glossopharyngeal nerve and partly via vagus
– Laryngopharynx internal laryngeal nerve (Vagus)
![Page 31: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/31.jpg)
• Taste sensations:
– From vallecula and epiglottis – internal laryngeal branch of vagus
– Parasympathetic secretomotor fibres to the pharynx from greater petrosal nerve (VII CN)
![Page 32: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/32.jpg)
Clinical Relevance
• Gag reflex:– The pharyngeal reflex or gag reflex is a reflex contraction of the back
of the throat, evoked by touching the roof of the mouth, the back of the tongue, the area around the tonsils and the back of the throat. It, along with other aero digestive reflexes such as reflexive pharyngeal swallowing, prevents something from entering the throat except as part of normal swallowing and helps prevent choking.
Reflex:– the sensory limb is mediated predominantly by CN IX
(glossopharyngeal nerve)– the motor limb by CN X (vagus nerve).
![Page 33: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/33.jpg)
Larynx
![Page 34: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/34.jpg)
![Page 35: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/35.jpg)
![Page 36: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/36.jpg)
Muscles of larynx:
![Page 37: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/37.jpg)
![Page 38: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/38.jpg)
• Posterior cricoarytenoid – Abductor
• Lateral cricoarytenoid – Adductor
• Transverse arytenoid – Adductor
• Oblique arytenoid – Adductor
• Aryepiglotticus - Closing inlet of larynx
• Thyroepiglotticus- Opening inlet of larynx
• Thyroarytenoid- Relaxation
• Cricothyroid- Tensor
![Page 39: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/39.jpg)
• Nerve Supply:
![Page 40: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/40.jpg)
• Motor Supply:
– Superior laryngeal nerve
– Recurrent laryngeal nerve
![Page 41: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/41.jpg)
• Superior laryngeal nerve:
– Arises from the inferior ganglion of vagus with small branch from the superior cervical ganglion
– Descends in the lateral wall of the pharynx passing posterior to internal carotid artery at the level of greater horn of hyoid
– Giving rise to internal and external branches
![Page 42: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/42.jpg)
• Internal branch is entirely sensory except for a motor filament to the arytenoid muscle
• Divides into superior and inferior branches
• Superior branch supplies lower part of pharynx, epiglottis, valleculla, vestibule of larynx
![Page 43: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/43.jpg)
• Inferior branch supplies the aryepiglottic fold and mucous membrane of posterior part of rima glottidis (opening between aryepiglotticfold and true cords)
• External branch supplies motor fibres to the cricothyroid muscle
![Page 44: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/44.jpg)
• Recurrent laryngeal nerve:– Goes along the laryngeal branch of inferior thyroid
artery and traverses upwards deep to the lower pharynx
– Supplies all muscles of the larynx except cricothyroid
– Provides sensory supply to the mucous membrane below the level of the vocal cords
![Page 45: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/45.jpg)
Clinical Aspects
• During swallowing the inlet of the larynx is protected by aryepiglotticus
• Coughing/Sneezing Full adduction of vocal cords during expiration leading to increased intrathoracic pressure followed by sudden abduction of the cords
![Page 46: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/46.jpg)
• Sensory stimulation of the laryngeal region during laryngoscopy can stimulate vagusnerve BRADYCARDIA if severe can lead to cardiac arrest
![Page 47: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/47.jpg)
Oral Cavity
![Page 48: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/48.jpg)
![Page 49: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/49.jpg)
• Parts :
– Vestibule
– Lips
– Cheeks
– Oral cavity proper
![Page 50: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/50.jpg)
• Palate:– Hard : Greater palatine and nasopalatine branch of
pterygopalatine ganglion (Maxillary nerve)
– Soft:• Muscles-
– Tensor palati –tightens soft palate
– Levator palati – elevates soft palate and opens eustacian tube
– Musculae uvulae- lifts the uvula
– Palatoglossus – closes the orophryngeal isthmus
– Palatopharyngeus- pulls up wall of phaynx and shortens it during swallowing
![Page 51: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/51.jpg)
• Nerve Supply:
– Motor Supply:
• All except tensor veli palatiCranial part of accessory via Vagus nerve
• Tensor veli palatiMandibular nerve
![Page 52: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/52.jpg)
– Sensory innervation:
• Glossopharyngeal nerve
• Middle and posterior lesser palatine nerves Branches of Maxillary nerve via Pterygopalatine ganglion
– Special Sensory:
• Via Greater petrosal nerve to Geniculate ganglion of Facial nerve
– Secretomotor fibres:
• Lesser palatine nerves Superior salivatory nucleus via greater petrosal nerve
![Page 53: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/53.jpg)
![Page 54: Sensory and motor innervation of upper airway](https://reader033.fdocuments.net/reader033/viewer/2022052602/55a205791a28abe4648b4649/html5/thumbnails/54.jpg)
Thank You