The sympathetic nervous system

Tutor: Dr. Eman Allam.

Student: Hashim Omar Kamil Qalalweh.

ID: 168.
 Sympathetic supply to the head and neck:
Eye:
Preganglionic sympathetic fibers originate from neurons in
the intermediolateral column of the thoracic spinal cord, at the level
of thoracic spinal nerve 1 (T1) and thoracic spinal nerve 2 (T2). They
form synapses in the superior cervical ganglion.

The sympathetic root of ciliary ganglion is one of three roots of

the ciliary ganglion, a tissue mass behind the eye. It
contains postganglionic sympathetic fibers whose cell bodies are
located in the superior cervical ganglion. Their axons ascend with
the internal carotid artery as a plexus of nerves, the carotid plexus.
Sympathetic fibers innervating the eye separate from the carotid
plexus within the cavernous sinus. They run forward through
the superior orbital fissure and merge with the long ciliary nerves
(branches of the nasociliary nerve) and the short ciliary
nerves (from the ciliary ganglion). Sympathetic fibers in the short
ciliary nerves pass through the ciliary ganglion without forming syna
Function:
 Exophthalmos is a bulging of the eye anteriorly out of the orbit.
Exophthalmos can be either bilateral or unilateral
.A mydriatic pupil will remain excessively large even in a bright
environment.
 The excitation of the radial fibres of the iris which increases the
pupillary aperture is referred to as a mydriasis. More generally,
mydriasis also refers to the natural dilation of pupils, for
instance in low light conditions or under sympathetic
stimulation.
 The upper eyelid is raised by the levator palpebrae superior
muscle. The bulk of levator palpebrae superioris is a skeletal
muscle that is innervated by the caudal-central nucleus of the
oculomotor nuclear complex. A small portion of this muscle, the
tarsal muscle, consists of smooth muscle fibers that receive
innervation from sympathetic postganglionic fibers arising from
the superior cervical ganglia.
 The lacrimal gland follow the same course that was described
for the sympathetic innervation of the sublingual and
submandibular glands .The effects of activation of the
sympathetic nervous system on secretion of the lacrimal glands
are not clearly established.

Salivary gland:
Direct sympathetic innervation of the salivary glands takes place via
preganglionic nerves in the thoracic segments T1-T3 which synapse
in the superior cervical ganglion with postganglionic neurons that
release norepinephrine, which is then received by β-adrenergic
receptors on the acinar and ductal cells of the salivary glands.
Function:
Norepinephrine β-adrenergic receptors on the acinar and ductal cells
of the salivary glands, leading to an increase in cyclic adenosine
monophosphate (cAMP) levels and the corresponding increase of
saliva secretion.

The Skin:
Blood Vessels of the Skin: The postganglionic axons of the SCG
innervate blood vessels in the skin and cause the vessels to constrict.
Constriction of the blood vessels causes a decrease in blood flow to
the skin leading to paling of the skin and retention of body heat. This
plays into the fight-or-flight response, decreasing blood flow to facial
skin and redirecting the blood to more important areas like the blood
vessels of muscles.

Sweat gland:
The sweat glands are innervated by the sympathetic nervous system and
are part of the fight or flight response system. Their innervation consists of
two parts, a preganglionic and postganglionic neuron. The preganglionic
neuron is short, originates from the thoracolumbar (T5) region of the spinal
cord, uses acetylcholine as its neurotransmitter, and synapses with the
postganglionic neuron via a nicotinic acetylcholine. The postganglionic
neuron for sweat gland innervation differs from other sympathetic
postganglionic neurons in that it releases acetylcholine to act on muscarinic
receptors.

The sudomotor axon reflex employs the same mechanism as the skin axon-
reflex flare, but the neural pathway consists of an axon reflex mediated by
the postganglionic sympathetic axon (C fibers) that innervates sweat
glands.

Function:
The vast majority of sweat glands in the body are innervated by
sympathetic cholinergic neurons. Sympathetic postganglionic neurons
typically secrete norepinephrine and are named sympathetic adrenergic
neurons; however, the sympathetic postganglionic neurons that innervate
sweat glands secrete acetylcholine and hence are termed sympathetic
cholinergic neurons. Sweat glands, piloerector muscles, and some blood
vessels are innervated by sympathetic cholinergic neurons.
Sympathetic supply to the thoracic viscera:
Heart:
The sympathetic cardiac nerves are six postganglionic branches of the
sympathetic nervous system which run from the cervical ganglia of
the sympathetic trunk to the cardiac plexus. They are named after the
ganglion from which they emerge:

 Superior cervical ganglion: superior cardiac nerve.

 Middle cervical ganglion: middle cardiac nerve.
 Inferior or stellate cervical ganglion: inferior cardiac nerve.

The nerves descend to the root of the neck with the following
relations:

 posterior: prevertebral fascia overlying anterolateral surface of

vertebral bodies
 anterior:
o and superior: common carotid artery
o and inferior: subclavian artery
 laterally: sympathetic trunk

Entering the superior mediastinum, they ramify to contribute to the

plexuses on the surfaces of the esophagus and the trachea. However,
their major target is the deep part of the cardiac plexus. The
exception to this rule is the left superior cardiac nerve which passes
over the arch of the aorta anterior to the vagus nerve; it alone
contributes to the superficial cardiac plexus.

Sympathetic fibres from the first five thoracic segments also supply
the cardiac plexuses.
Function:
Activation of the sympathetic nervous system results in an increase in
heart rate by increasing the pacemaker activity of the sinoatrial node
cells. Impulse conduction at the atrioventricular node and the
contractile force of atrial and ventricular muscle fibers are increased.

Sympathetic adrenergic nerves travel along arteries and nerves and

are found in the adventitia (outer wall of a blood vessel). Varicosities,
which are small enlargements along the nerve fibers, are the site of
neurotransmitter (norepinephrine) release. Capillaries receive no
innervation. Activation of vascular sympathetic nerves causes
contraction of the vascular smooth muscle and vasoconstriction of
arteries and veins mediated by alpha-adrenoceptors.
Lung:
Sympathetic neurons supplying the lung were located in stellate ganglia
and in thoracic sympathetic chain (T1-T4); those supplying the trachea
resided in the superior cervical and stellate ganglia.

The pulmonary plexus (paravertebral) is an autonomic plexus formed from

pulmonary branches of vagus nerve and the sympathetic trunk. It
innervates the bronchial tree and the visceral pleura. According to the
relation of nerves to the root of the lung, the pulmonary plexus is divided
into the anterior pulmonary plexus, which lies in front of the lung and the
posterior pulmonary plexus, which lies behind the lung.

Cardiopulmonary nerves are splanchnic nerves that are postsynaptic and

sympathetic. They originate in cervical and upper thoracic ganglia and
innervate the thoracic cavity. All major sympathetic cardiopulmonary
nerves arise from the stellate ganglia and the caudal halves of the cervical
sympathetic trunks below the level of the cricoid cartilage.
Function:
Activation of the sympathetic nervous system results in
bronchodilation.

Bronchodilatation widening of the bore of a bronchus by relaxation of

the circular muscles in its wall. Bronchodilator drugs are used in the
treatment of ASTHMA.

Increased vascular resistance is mediated by α-adrenoreceptors

upon sympathetic nerve stimulation. Noradrenergic fibers are
activated by baroreceptors in the pulmonary artery and proximal
airway segments. Chemoreceptors respond to decreased arterial
PO2 levels to increase sympathetic nerve stimulation by the
sympathetic chain neurons
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