Cardiopulmonary nerves

Last updated October 01, 2019

Cardiopulmonary nerves are splanchnic nerves that are postsynaptic and sympathetic.^[1] They originate in cervical and upper thoracic ganglia ^[1] and innervate the thoracic cavity.^[1]

The splanchnic nerves are paired visceral nerves, carrying fibers of the autonomic nervous system as well as sensory fibers from the organs. All carry sympathetic fibers except for the pelvic splanchnic nerves, which carry parasympathetic fibers.

The sympathetic nervous system (SNS) is one of the two main divisions of the autonomic nervous system, the other being the parasympathetic nervous system.

The cervical ganglia are paravertebral ganglia of the sympathetic nervous system. Preganglionic nerves from the thoracic spinal cord enter into the cervical ganglions and synapse with its postganglionic fibers or nerves. The cervical ganglion has three paravertebral ganglia:

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. Parasympathetic cardiopulmonary nerves arise from the recurrent laryngeal nerves and the thoracic vagus immediately distal to them. These interconnect with the sympathetic cardiopulmonary nerves to form the ventral and dorsal cardiopulmonary plexuses.^[2]

Stellate ganglion Controls bloodflow to each leg, arm or hand; may amplify pain perception.

The stellate ganglion is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion, which exists in 80% of cases. Sometimes the second and the third thoracic ganglia are included in this fusion. Stellate ganglion is relatively big compared to much smaller thoracic, lumbar and sacral ganglia and it is polygonal in shape. Stellate ganglion is located at the level of C7, anterior to the transverse process of C7 and the neck of the first rib, superior to the cervical pleura and just below the subclavian artery. It is superiorly covered by the prevertebral lamina of the cervical fascia and anteriorly in relation with common carotid artery, subclavian artery and the beginning of vertebral artery which sometimes leaves a groove at the apex of this ganglion.

Cricoid cartilage It is a signet ring shape cartilage

The cricoid cartilage, or simply cricoid or cricoid ring, is the only complete ring of cartilage around the trachea. It forms the back part of the voice box and functions as an attachment site for muscles, cartilages, and ligaments involved in opening and closing the airway and in producing speech.

The recurrent laryngeal nerve (RLN) is a branch of the vagus nerve that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. There are two recurrent laryngeal nerves, right and left, in the human body. The right and left nerves are not symmetrical, with the left nerve looping under the aortic arch, and the right nerve looping under the right subclavian artery then traveling upwards. They both travel alongside of the trachea. Additionally, the nerves are one of few nerves that follow a recurrent course, moving in the opposite direction to the nerve they branch from, a fact from which they gain their name.

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The peripheral nervous system (PNS) is one of two components that make up the nervous system of bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of the nerves and ganglia outside the brain and spinal cord. The main function of the PNS is to connect the CNS to the limbs and organs, essentially serving as a relay between the brain and spinal cord and the rest of the body. Unlike the CNS, the PNS is not protected by the vertebral column and skull, or by the blood–brain barrier, which leaves it exposed to toxins and mechanical injuries.

The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, and thus influences the function of internal organs. The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. This system is the primary mechanism in control of the fight-or-flight response.

A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into the corresponding cervical, thoracic, lumbar, sacral and coccygeal regions of the spine. There are eight pairs of cervical nerves, twelve pairs of thoracic nerves, five pairs of lumbar nerves, five pairs of sacral nerves, and one pair of coccygeal nerves. The spinal nerves are part of the peripheral nervous system.

The cervical plexus is a plexus of the anterior rami of the first four cervical spinal nerves which arise from C1 to C4 cervical segment in the neck. They are located laterally to the transverse processes between prevertebral muscles from the medial side and vertebral from lateral side. There is anastomosis with accessory nerve, hypoglossal nerve and sympathetic trunk.

The pterygopalatine ganglion is a parasympathetic ganglion found in the pterygopalatine fossa. It is largely innervated by the greater petrosal nerve ; and its axons project to the lacrimal glands and nasal mucosa. The flow of blood to the nasal mucosa, in particular the venous plexus of the conchae, is regulated by the pterygopalatine ganglion and heats or cools the air in the nose. It is one of four parasympathetic ganglia of the head and neck, the others being the submandibular ganglion, otic ganglion, and ciliary ganglion.

A nerve plexus is a plexus of intersecting nerves. A nerve plexus is composed of afferent and efferent fibers that arise from the merging of the anterior rami of spinal nerves and blood vessels. There are five spinal nerve plexuses, except in the thoracic region, as well as other forms of autonomic plexuses, many of which are a part of the enteric nervous system. The nerves that arise from the plexuses have both sensory and motor functions. These functions include muscle contraction, the maintenance of body coordination and control, and the reaction to sensations such as heat, cold, pain, and pressure. There are several plexuses in the body, including:

The renal plexus is formed by filaments from the celiac ganglia and plexus, aorticorenal ganglia, lower thoracic splanchnic nerves and first lumbar splanchnic nerve and aortic plexus.

The superior cervical ganglion (SCG) is part of the autonomic nervous system (ANS), more specifically it is part of the sympathetic nervous system, a division of the ANS most commonly associated with the fight or flight response. The ANS is composed of pathways that lead to and from ganglia, groups of nerve cells. A ganglion allows a large amount of divergence in a neuronal pathway and also enables a more localized circuitry for control of the innervated targets. The SCG is the only ganglion in the sympathetic nervous system that innervates the head and neck. It is the largest and most rostral (superior) of the three cervical ganglia. The SCG innervates many organs, glands and parts of the carotid system in the head.

Sympathetic trunk paired bundle of nerve fibers that run from the base of the skull to the coccyx

The sympathetic trunks are a paired bundle of nerve fibers that run from the base of the skull to the coccyx.

Each spinal nerve receives a branch called a gray ramus communicans from the adjacent paravertebral ganglion of the sympathetic trunk. The gray rami communicantes contain postganglionic nerve fibers of the sympathetic nervous system and are composed of largely unmyelinated neurons. This is in contrast to the white rami communicantes, in which heavily myelinated neurons give the rami their white appearance.

Sympathetic ganglion ganglia of the sympathetic nervous system

Sympathetic ganglia are the ganglia of the sympathetic nervous system. They deliver information to the body about stress and impending danger, and are responsible for the familiar fight-or-flight response. They contain approximately 20,000–30,000 nerve cell bodies and are located close to and on either side of the spinal cord in long chains. Sympathetic ganglia are the tissue from which neuroblastoma tumours arise.

The branches of the ciliary ganglion are the short ciliary nerves.

The lateral grey column is one of the three grey columns of the spinal cord ; the others being the anterior and posterior grey columns. The lateral grey column is primarily involved with activity in the sympathetic division of the autonomic motor system. It projects to the side as a triangular field in the thoracic and upper lumbar regions of the postero-lateral part of the anterior grey column.

Thoracic splanchnic nerves are splanchnic nerves that arise from the sympathetic trunk in the thorax and travel inferiorly to provide sympathetic innervation to the abdomen. The nerves contain preganglionic sympathetic fibers and general visceral afferent fibers.

The middle cervical ganglion is the smallest of the three cervical ganglia, and is occasionally absent. It is placed opposite the sixth cervical vertebra, usually in front of, or close to, the inferior thyroid artery. It sends gray rami communicantes to the fifth and sixth cervical nerves, and gives off the middle cardiac nerve.

The inferior cervical ganglion is situated between the base of the transverse process of the last cervical vertebra and the neck of the first rib, on the medial side of the costocervical artery.

Along the length of the sympathetic trunks are ganglia known as ganglia of sympathetic trunk, sympathetic ganglia or paravertebral ganglia. The ganglia are distinguished as cervical, thoracic, lumbar, and sacral and, except in the neck, they closely correspond in number to the vertebrae.

The thoracic ganglia are paravertebral ganglia. The thoracic portion of the sympathetic trunk typically has 12 thoracic ganglia. Emerging from the ganglia are thoracic splanchnic nerves that help provide sympathetic innervation to abdominal structures. The thoracic part of sympathetic trunk lies posterior to the costovertebral pleura and is hence not a content of the posterior mediastinum

References

1 2 3 Moore, Keith L.; Agur, A. M. R. (2002). Essential Clinical Anatomy (2nd ed.). Lippincott. p. 164. ISBN 978-0-7817-2830-0.
↑ Janes, R. D.; Brandys, J. C.; Hopkins, D. A.; Johnstone, D. E.; Murphy, D. A.; Armour, J. A. (1986). "Anatomy of human extrinsic cardiac nerves and ganglia". The American Journal of Cardiology. 57 (4): 299–309. doi:10.1016/0002-9149(86)90908-2. PMID 3946219.

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[Moore164-1] 1 2 3 Moore, Keith L.; Agur, A. M. R. (2002). Essential Clinical Anatomy (2nd ed.). Lippincott. p. 164. ISBN 978-0-7817-2830-0.

[2] Janes, R. D.; Brandys, J. C.; Hopkins, D. A.; Johnstone, D. E.; Murphy, D. A.; Armour, J. A. (1986). "Anatomy of human extrinsic cardiac nerves and ganglia". The American Journal of Cardiology. 57 (4): 299–309. doi:10.1016/0002-9149(86)90908-2. PMID 3946219.