Otitis

Cervical sympathetic trunk: topography, nodes, branches, area of innervation. Thoracic sympathetic trunk Cervical sympathetic trunk

The sympathetic nerve trunk is one of the components of the sympathetic system.

Structure

In accordance with the structure of the sympathetic trunk (Truncus sympathicus), it is paired and consists of nodes that are connected to each other through sympathetic fibers. These formations are located on the sides of the spinal column along its entire length.

Any of the nodes of the sympathetic trunk is a cluster of autonomic neurons that switch preganglionic fibers (most of them) that exit the spinal cord, forming connecting white branches.

The fibers described above are in contact with the cells of the corresponding node or go as part of the internodal branches to the underlying or superior node of the sympathetic trunk.

The connecting white branches are located in the upper lumbar and thoracic regions. There are no branches of this type in the sacral, lower lumbar and cervical nodes.

In addition to the white branches, there are also connecting gray branches, which consist mostly of sympathetic postganglionic fibers and connect the spinal nerves with the nodes of the trunk. Such branches go to each of the spinal nerves, departing from each of the nodes of the sympathetic trunk. As part of the nerves, they are directed to the innervated organs (glands, smooth and striated muscles).

The following sections are conventionally distinguished as part of the sympathetic trunk (anatomy):

Sacral.
Lumbar.
Chest.
Cervical.

Functions

In accordance with the sections of the sympathetic trunk and its constituent ganglia and nerves, several functions of this anatomical formation can be distinguished:

Innervation of the neck and head, as well as control over the contraction of the vessels feeding them.
Innervation (branches from the nodes of the sympathetic trunk are part of the nerves in the pleura, diaphragm, pericardium and liver ligaments).
Innervation of the vascular walls (as part of the nerve plexuses) of the common carotid, thyroid and subclavian arteries, as well as the aorta.
They connect the nerve ganglia with the nerve plexuses.
Participate in the formation of the celiac, aortic, superior mesenteric and renal plexuses.
Innervation of the pelvic organs due to the entry of branches from the cruciate ganglia of the sympathetic trunk into the inferior hypogastric plexus.

Cervical sympathetic trunk

The cervical spine contains three nodes: lower, middle and upper. Let's look at each of them in more detail below.

Top knot

Spindle-shaped formation measuring 20*5 mm. It is located on 2-3 cervical vertebrae (their transverse processes) under the prevertebral fascia.

Seven main branches depart from the node, which carry postganglionic fibers innervating the organs of the neck and head:

Connecting gray rami to the 1st, 2nd, 3rd spinal cervical nerves.
N. jugularis (jugular nerve) is divided into several branches, two of which are attached to the glossopharyngeal and vagus nerves, and one to
N. caroticus internus (internal carotid nerve) enters the outer shell of the internal carotid artery and forms a plexus of the same name there, from which, in the area where the artery enters the canal of the same name on the temporal bone, sympathetic fibers depart, which form a stony deep nerve passing along the pterygoid canal in the sphenoid bones. After leaving the canal, the fibers pass and join the parasympathetic postganglionic nerves from the pterygopalatine ganglion, as well as the maxillary nerve, after which they are sent to the organs in the facial area. In the carotid canal, branches separate from the carotid internal plexus, which penetrate and form a plexus in the tympanic cavity. Inside the skull, the carotid (internal) plexus becomes the cavernous, and its fibers spread through the vessels of the brain, forming the plexus of the ophthalmic, middle cerebral and anterior cerebral arteries. In addition, the cavernous plexus gives off branches that connect to the parasympathetic fibers of the parasympathetic ciliary ganglion and innervate the muscle that dilates the pupil.
N. caroticus externus (carotid external nerve). It forms an external plexus near the artery of the same name and its branches that supply blood to the organs of the neck, face and dura mater of the brain.
The pharyngeal-laryngeal branches accompany the vessels of the pharyngeal wall and form the pharyngeal plexus.
The superior cardiac nerve passes near the cervical portion of the sympathetic trunk. In the chest cavity it forms the superficial cardiac plexus, which is located under the aortic arch.
Branches that are part of the phrenic nerve. Their endings are located in the capsule and ligaments of the liver, pericardium, parietal diaphragmatic peritoneum, diaphragm and pleura.

Middle node

A formation measuring 2*2 mm, located at the level of the 4th cervical vertebra, at the place where the common carotid and inferior thyroid arteries intersect. This node gives rise to four types of branches:

Connecting gray branches that go to the 5th, 6th spinal nerves.
The middle cardiac nerve, which is located behind the chest cavity, the nerve participates in the formation of the cardiac plexus (deep), which is located between the trachea and the aortic arch.
Branches that participate in the organization of the nerve plexuses of the subclavian, common carotid and thyroid inferior arteries.
The internodal branch that connects to the cervical superior sympathetic ganglion.

Bottom knot

The formation is located behind the vertebral and above the subclavian arteries. In rare cases, it combines with the first sympathetic thoracic node and is then called the stellate (cervicothoracic) node. The bottom node gives rise to six branches:

Connecting gray branches going to the 7th, 8th spinal cervical nerves.
A branch going to the plexus vertebralis, spreading in the skull and forming the plexus of the cerebral posterior artery and the basilar plexus.
The inferior cardiac nerve lies behind the aorta on the left, and behind the brachiocephalic artery on the right and is involved in the formation of the deep cardiac plexus.
The branches that enter the phrenic nerve do not form plexuses, but end in the diaphragm, pleura and pericardium.
Branches forming the plexus of the common carotid artery.
Branches to the subclavian artery.

Thoracic region

The thoracic sympathetic trunk includes ganglia thoracica (thoracic nodes) - triangular-shaped nerve formations that lie on the costal necks on the sides of the thoracic vertebrae, under the intrathoracic fascia and parietal pleura.

From the thoracic ganglia there are 6 main groups of branches:

White connecting branches that branch from (their anterior roots) and penetrate the nodes.
The gray connecting branches emerge from the ganglia and are directed to the intercostal nerves.
Branches of the mediastinum. They originate from the 5 sympathetic superior ganglia and pass into the area along with other fibers to form the bronchial and esophageal plexuses.
Cardiac thoracic nerves. They originate from 4-5 sympathetic superior ganglia, participating in the formation of the aortic and deep cardiac plexuses.
The nerve is large splanchnic. Collected from branches 5-9 of the sympathetic thoracic ganglia and covered with intrathoracic fascia. Through the openings between the intermediate and medial crura of the diaphragm, this nerve passes into the abdominal cavity and ends in the ganglia of the celiac plexus. This nerve includes a large number of preganglionic fibers (which switch in the ganglia of the celiac plexus to postganglionic fibers), as well as postganglionic fibers, which have already switched at the level of the thoracic ganglia of the sympathetic trunk.
The small intrasternal nerve. It is formed by branches of 10-12 nodes. Through the diaphragm it descends slightly lateral to n. splanchnicus major and is also part of the celiac plexus. Some of the preganglionic fibers of this nerve in the sympathetic ganglia switch to postganglionic, and some follow to the organs.

Lumbar

The lumbar ganglia of the sympathetic trunk are nothing more than a continuation of the chain of ganglia of the thoracic region. The lumbar region includes 4 nodes, which are located on both sides of the spine on the inner edge of the psoas major muscle. On the right side, the nodes are visualized outward from the vena cava inferior, and on the left - outward from the aorta.

The branches of the lumbar sympathetic trunk are:

White connecting branches arising from the 1st and 2nd lumbar spinal nerves and approaching the 1st and 2nd ganglia.
Gray connecting branches. They unite the lumbar ganglia with all lumbar spinal nerves.
Internal lumbar branches that arise from all ganglia and enter the superior hypogastric, celiac, aortic abdominal, renal and superior mesenteric plexuses.

Sacral section

The lowest section (according to the topography of the sympathetic trunk) is the sacral section, which consists of one unpaired coccygeal ganglion and four paired sacral ganglia. The nodes are located just medial to the sacral anterior foramina.

There are several branches of the sacral portion of the sympathetic trunk:

Connecting gray branches heading to the sacral and spinal nerves.
The splanchnic nerves are part of the autonomic plexuses in the pelvis. Visceral fibers from these nerves form the hypogastric inferior plexus, which lies on branches from the internal iliac artery, through which the sympathetic nerves penetrate the pelvic organs.

The sympathetic trunk (truncus sympathicus) is paired, formed by nodes connected by sympathetic fibers. The sympathetic trunk is located on the lateral surface of the spine along its entire length. Each node of the sympathetic trunk represents a cluster of autonomic neurons, with the help of which most of the preganglionic fibers are switched, emerging from the spinal cord and forming the white connecting branches (rr. communicantes albi). Preganglionic fibers contact vegetative cells in the corresponding node or are sent as part of internodal branches to higher or lower nodes of the sympathetic trunk. The white connecting branches are located in the thoracic and upper lumbar regions. There are no such connecting branches in the cervical, sacral and lower lumbar nodes. The nodes of the sympathetic trunk are also connected by special fibers to the spinal nerves - the gray connecting branches (rr. communicantes grisei), consisting mainly of postganglionic sympathetic fibers. The gray connecting branches extend from each node of the sympathetic trunk to each spinal nerve, within which they are directed to the periphery, reaching the innervated organs - striated muscles, smooth muscles and glands.

The sympathetic trunk is conventionally divided into cervical, thoracic, lumbar and sacral sections.

The cervical sympathetic trunk includes three nodes: superior, middle and inferior.

The upper node (gangl. cervicale superius) has a spindle-shaped shape measuring 5*20 mm. Located on the transverse processes of the II - III cervical vertebrae, covered with prevertebral fascia. Seven main branches depart from the node, containing postganglionic fibers to innervate the organs of the head and neck.
1. Gray connecting branches to the I, II, III cervical spinal nerves.

2. The jugular nerve (n. jugularis) is divided into two branches, the fibers of which join the vagus and glossopharyngeal nerves in the region of their lower nodes, and into a branch, the fibers of which join the hypoglossal nerve.

3. The internal carotid nerve (n. caroticus internus) penetrates the adventitia of the internal carotid artery, where its fibers form the plexus of the same name. From the plexus of this artery at the site of its entry into the carotid canal of the temporal bone, sympathetic fibers are separated, forming the deep petrosal nerve (n. petrosus profundus), passing into the pterygoid canal (canalis pterygoideus) of the sphenoid bone. Having left the canal, they pass through the pterygopalatine fossa, connecting to the postganglionic parasympathetic nerves of the pterygopalatine ganglion and the sensory nerves n. maxillaris, and diverge to the facial organs. Branches extend from the internal carotid plexus in the carotid canal, penetrating into the tympanic cavity, participating in the formation of the plexus of the tympanic cavity (plexus tympanicus). In the cranial cavity, the continuation of the internal carotid plexus is the cavernous one, the fibers of which are distributed along the branches of the cerebral vessels, forming the plexus of the anterior, middle cerebral arteries (plexus arteriae cerebri anterior et medius), as well as the plexus of the ophthalmic artery (plexus ophthalmicus). Branches extend from the cavernous plexus and pass into the ciliary parasympathetic ganglion (gangl. ciliare), connecting to its parasympathetic fibers to innervate the muscle that dilates the pupil (m. dilatator pupillae).

4. The external carotid nerve (n. caroticus externus) is thicker than the previous one. Around the artery of the same name, it forms an external plexus (plexus caroticus externus), from which the fibers are distributed to all its arterial branches, supplying blood to the facial part of the head, the dura mater and the organs of the neck.

5. Laryngopharyngeal branches (rr. laryngopharyngei) are distributed along the vessels of the pharyngeal wall, forming the pharyngeal plexus (plexus pharyngeus).

6. The superior cardiac nerve (n. cardiacus superior) is sometimes absent on the right and descends next to the cervical section of the sympathetic trunk. In the chest cavity, it participates in the formation of the superficial cardiac plexus, located under the aortic arch.

7. The branches that make up the phrenic nerve end in the pericardium, pleura, diaphragm, parietal peritoneum of the diaphragm, ligaments and liver capsule.

The middle node (gangl. cervicale medium), measuring 2x2 mm, is located at the level of the VI cervical vertebra at the intersection of the inferior thyroid and common carotid arteries; often absent. Four types of branches extend from this node:

1. Gray connecting branches to the V and VI cervical spinal nerves.

2. Middle cardiac nerve (n. cardiacus medius), located behind the common carotid artery. In the chest cavity, it takes part in the formation of the deep cardiac plexus, located between the aortic arch and the trachea.

3. Branches involved in the formation of the nerve plexus of the common carotid and subclavian arteries, as well as the plexus of the inferior thyroid artery. Autonomic plexuses are formed in these organs.

4. Internodular branch to the superior cervical sympathetic node.

The lower node (gangl. cervicale inferius) is located above the subclavian artery and behind the vertebral artery. Sometimes it connects with the first thoracic sympathetic node and is called the cervicothoracic (stellate) node (gangl. cervicothoracicum s. stellatum). 6 branches extend from the lower node.
1. Gray connecting branches to the VII and VIII cervical spinal nerves.

2. Branch to the plexus of the vertebral artery (plexus vertebralis), which extends into the skull, where it forms the basilar plexus and the plexus of the posterior cerebral artery.

3. Lower cardiac nerve (n. cardiacus inferior), located on the left behind the aorta, on the right - behind the brachiocephalic artery; takes part in the formation of the deep plexus of the heart.

4. Branches to the phrenic nerve do not form a plexus. Reach the pleura, pericardium and diaphragm.

5. Branches to the plexus of the common carotid artery (plexus caroticus communis).

6. Branches to the subclavian artery (plexus subclavius).

Thoracic nodes (ganglia thoracica) are located on the sides of the thoracic vertebrae on the necks of the ribs, covered with the parietal pleura and intrathoracic fascia (f. endothoracalis). The thoracic sympathetic ganglia have mainly six groups of branches:

1. The white connecting branches enter the nodes from the anterior roots of the intercostal nerves ().

2. Gray connecting branches extend from the nodes to the intercostal nerves.

3. Mediastinal branches (rr. mediastinales) start from the V superior sympathetic nodes and enter the region of the posterior mediastinum. They take part in the formation of the esophageal and bronchial plexuses.

4. Thoracic cardiac nerves (nn. cardiaci thoracici) start from the IV - V superior sympathetic nodes, are part of the deep cardiac plexus and the thoracic aortic plexus.

5. The great splanchnic nerve (n. splanchnicus major) is formed from the branches of the V-IX thoracic sympathetic nodes. The nerve is located under the intrathoracic fascia. Through the hole between the medial and intermediate crura of the diaphragm, the greater splanchnic nerve penetrates the abdominal cavity, ending at the celiac plexus nodes. The nerve contains a large number of preganglionic fibers, which switch in the nodes of the celiac plexus to postganglionic fibers, and fewer postganglionic fibers, which have already switched in the thoracic nodes of the sympathetic trunk.

6. The small splanchnic nerve (n. splanchnicus minor) is formed from the branches of the X-XII nodes. It descends through the diaphragm lateral to the greater splanchnic nerve and reaches the celiac plexus. Preganglionic fibers switch to postganglionic fibers in the sympathetic ganglia, and another group of preganglionic fibers, switched in the thoracic ganglia, are sent to the organs.

The lumbar nodes (ganglia, lumbalia) of the sympathetic trunk are a continuation of the chain of nodes of the thoracic part, located between the lateral and intermediate legs of the diaphragm. They include 3-4 nodes located on the sides of the spine on the medial edge of m. psoas major. On the right, the nodes are visible lateral to the inferior vena cava, and on the left, lateral to the aorta. Branches of the lumbar sympathetic ganglia:

1. White connecting branches approach only the I, II nodes from the I and II lumbar spinal nerves.

2. The gray communicating rami connects the lumbar ganglia with all lumbar spinal nerves.

3. Lumbar splanchnic nerves (nn. splanchnici lumbales) from all nodes are connected to the celiac (plexus celiacus), renal (plexus renalis), superior mesenteric (plexus mesentericus superior), abdominal aortic (plexus aorticus) and superior hypogastric (plexus hypogastricus superior) , plexus.

The sacral nodes (ganglia sacralia) of the sympathetic trunk include 3-4 paired sacral and 1 unpaired coccygeal nodes, which are located medial to the anterior sacral foramina.
1. Gray communicating branches go to the spinal and sacral nerves.

2. The splanchnic nerves (nn. splanchnici sacrales) participate in the formation of the autonomic plexuses of the pelvis. The visceral branches form the inferior hypogastric plexus (plexus hypogastricus inferior), located on the branches of the internal iliac artery; along its branches, the sympathetic nerves reach the pelvic organs.

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(plexus cervicalis) is formed by the anterior branches of the 4 upper cervical spinal nerves (C I -C IV), which have connections with each other. The plexus lies lateral to the transverse processes between the vertebral (posterior) and prevertebral (anterior) muscles (Fig. 1). The nerves emerge from under the posterior edge of the sternocleidomastoid muscle, slightly above its middle, and spread in a fan-like manner upward, forward and downward. The following nerves depart from the plexus:

Rice. 1.

1 - hypoglossal nerve; 2 - accessory nerve; 3, 14 - sternocleidomastoid muscle; 4 - great auricular nerve; 5 - lesser occipital nerve; 6 - greater occipital nerve; nerves to the anterior and lateral rectus capitis muscles; 8 - nerves to the long muscles of the head and neck; 9 - trapezius muscle: 10 - connecting branch to the brachial plexus; 11 - phrenic nerve: 12 - supraclavicular nerves; 13 - lower belly of the omohyoid muscle; 15 - neck loop; 16 - sternohyoid muscle; 17 - sternothyroid muscle; 18 - upper belly of the omohyoid muscle: 19 - transverse nerve of the neck; 20 - lower root of the neck loop; 21 - upper root of the cervical loop; 22 - thyrohyoid muscle; 23 - geniohyoid muscle

1. Lesser occipital nerve(p. occipitalis mino) (from C I - C II) spreads upward to the mastoid process and further to the lateral parts of the back of the head, where it innervates the skin.

2. Greater auricular nerve(p. auricularis major) (from C III - C IV) runs along the sternocleidomastoid muscle upward and anteriorly, to the auricle, innervates the skin of the auricle (posterior branch) and the skin above the parotid salivary gland (anterior branch).

3. Transverse cervical nerve(p. transverses colli) (from C III - C 1 V) goes anteriorly and at the anterior edge of the sternocleidomastoid muscle it is divided into upper and lower branches that innervate the skin of the anterior neck.

4. Supraclavicular nerves(pp. supraclaviculares) (from C III - C IV) (numbering from 3 to 5) spread downwards in a fan-shaped manner under the subcutaneous muscle of the neck; They branch in the skin of the posterior lower part of the neck (lateral branches), in the region of the clavicle (intermediate branches) and the upper anterior part of the chest to the third rib (medial branches).

5. Phrenic nerve(n. phrenicis) (from C III - C IV and partly from C V), predominantly a motor nerve, goes down the anterior scalene muscle into the chest cavity, where it passes to the diaphragm in front of the root of the lung between the mediastinal pleura and the pericardium. Innervates the diaphragm, gives off sensory branches to the pleura and pericardium (rr. pericardiaci), sometimes to the cervicothoracic nerve plexus. In addition, it sends diaphragmatic-abdominal branches (rr. phrenicoabdominales) to the peritoneum covering the diaphragm. These branches contain nerve ganglia (ganglii phrenici) and connect to the celiac nerve plexus. The right phrenic nerve especially often has such connections, which explains the phrenicus symptom - irradiation of pain to the neck area due to liver disease.

6. Lower root of the cervical loop (radix inferior ansae cervicalis) is formed by nerve fibers from the anterior branches of the second and third spinal nerves and goes anteriorly to connect with upper spine (radix superior), arising from the hypoglossal nerve (XII pair of cranial nerves). As a result of the connection of both roots, a cervical loop is formed ( ansa cervicalis), from which branches extend to the scapulohyoid, sternohyoid, thyrohyoid and sternothyroid muscles.

7. Muscular branches (rr. musculares) go to the prevertebral muscles of the neck, to the levator scapula muscle, as well as to the sternocleidomastoid and trapezius muscles.

It lies in front of the transverse processes of the cervical vertebrae on the surface of the deep muscles of the neck (Fig. 2). Each cervical region has 3 cervical nodes: superior, middle ( ganglia cervicales superior et media) and cervicothoracic (stellate) ( ganglion cervicothoracicum (stellatum)). The middle cervical node is the smallest. The stellate node often consists of several nodes. The total number of nodes in the cervical region can range from 2 to 6. Nerves extend from the cervical nodes to the head, neck and chest.

Rice. 2.

1 - glossopharyngeal nerve; 2 - pharyngeal plexus; 3 - pharyngeal branches of the vagus nerve; 4 - external carotid artery and nerve plexus; 5 - superior laryngeal nerve; 6 - internal carotid artery and sinus branch of the glossopharyngeal nerve; 7 - carotid glomus; 8 - carotid sinus; 9 - superior cervical cardiac branch of the vagus nerve; 10 - upper cervical cardiac nerve: 11 - middle cervical ganglion of the sympathetic trunk; 12 - middle cervical cardiac nerve; 13 - vertebral node; 14 - recurrent laryngeal nerve: 15 - cervicothoracic (stellate) node; 16 - subclavian loop; 17 - vagus nerve; 18 - lower cervical cardiac nerve; 19 - thoracic cardiac sympathetic nerves and branches of the vagus nerve; 20 - subclavian artery; 21 — gray connecting branches; 22 - superior cervical node of the sympathetic trunk; 23 - vagus nerve

1. Gray connecting branches(rr. communicantens grisei) - to the cervical and brachial plexuses.

2. Internal carotid nerve(n. caroticus internus) usually departs from the upper and middle cervical nodes to the internal carotid artery and forms around it internal carotid plexus(plexus caroticus internus), which extends to its branches. Branches off from the plexus deep petrosal nerve (n. petrosus profundus) to the pterygopalatine ganglion.

3. The jugular nerve (p. jugularis) starts from the upper cervical ganglion, within the jugular foramen it is divided into two branches: one goes to the upper node of the vagus nerve, the other to the lower node of the glossopharyngeal nerve.

4. Vertebral nerve(p. vertebralis) extends from the cervicothoracic node to the vertebral artery, around which it forms vertebral plexus (plexus vertebralis).

5. Cardiac cervical superior, middle and inferior nerves (pp. cardiaci cervicales superior, medius et inferior) originate from the corresponding cervical nodes and are part of the cervicothoracic nerve plexus.

6. External carotid nerves(p. carotid externi) extend from the upper and middle cervical nodes to the external carotid artery, where they participate in the formation external carotid plexus (plexus caroticus externus), which extends to the branches of the artery.

7. Laryngopharyngeal branches(rr. laryngopharyngei) go from the superior cervical ganglion to the pharyngeal nerve plexus and as a connecting branch to the superior laryngeal nerve.

8. Subclavian branches(rr. subclavii) depart from subclavian loop (ansa subclavia), which is formed by the division of the internodal branch between the middle cervical and cervicothoracic nodes.

Cranial division of the parasympathetic nervous system

Centers cranial region The parasympathetic part of the autonomic nervous system is represented by nuclei in the brain stem (mesencephalic and bulbar nuclei).

Mesencephalic parasympathetic nucleus - accessory nucleus of the oculomotor nerve(nucleus accessories n. oculomotorii)- located at the bottom of the midbrain aqueduct, medial to the motor nucleus of the oculomotor nerve. Preganglionic parasympathetic fibers go from this nucleus as part of the oculomotor nerve to the ciliary ganglion.

The following parasympathetic nuclei lie in the medulla oblongata and pons:

1) superior salivary nucleus(nucleus salivatorius superior), associated with the facial nerve, - in the bridge;

2) inferior salivary nucleus(nucleus salivatorius inferior), associated with the glossopharyngeal nerve, - in the medulla oblongata;

3) dorsal nucleus of the vagus nerve(nucleus dorsalis nervi vagi), - in the medulla oblongata.

Preganglionic parasympathetic fibers pass from the cells of the salivary nuclei as part of the facial and glossopharyngeal nerves to the submandibular, sublingual, pterygopalatine and auricular nodes.

Peripheral department The parasympathetic nervous system is formed by preganglionic nerve fibers originating from the indicated cranial nuclei (they pass through the corresponding nerves: III, VII, IX, X pairs), the nodes listed above and their branches containing postganglionic nerve fibers.

1. Preganglionic nerve fibers running as part of the oculomotor nerve follow to the ciliary ganglion and end at synapses on its cells. They depart from the node short ciliary nerves(pp. ciliares breves), in which, along with sensory fibers, there are parasympathetic: they innervate the sphincter of the pupil and the ciliary muscle.

2. Preganglionic fibers from the cells of the superior salivary nucleus spread as part of the intermediate nerve, from it through the greater petrosal nerve they go to the pterygopalatine ganglion, and through the chorda tympani - to the submandibular and hypoglossal nodes, where they end in synapses. From these nodes, postganglionic fibers follow along their branches to the working organs (submandibular and sublingual salivary glands, glands of the palate, nose and tongue).

3. Preganglionic fibers from the cells of the inferior salivary nucleus go as part of the glossopharyngeal nerve and further along the lesser petrosal nerve to the ear ganglion, on the cells of which they end in synapses. Postganglionic fibers from the cells of the ear ganglion emerge as part of the auriculotemporal nerve and innervate the parotid gland.

Preganglionic parasympathetic fibers, starting from the cells of the dorsal ganglion of the vagus nerve, pass as part of the vagus nerve, which is the main conductor of parasympathetic fibers. Switching to postganglionic fibers occurs mainly in small ganglia of the intramural nerve plexuses of most internal organs, therefore postganglionic parasympathetic fibers appear to be very short compared to preganglionic fibers.

Human anatomy S.S. Mikhailov, A.V. Chukbar, A.G. Tsybulkin

The disease has different names: if one node is affected - sympathoglionitis, if several nodes are affected - polyganglionitis, or truncitis. Sometimes they talk about ganglioneuritis, since it is very difficult to determine which structures are predominantly affected, nodes or nerves. It should not be confused with lesions of the spinal ganglia, which are also diagnosed as ganglionitis or ganglioneuritis.

Etiology and pathogenesis

Sympathetic ganglionitis most often occurs in acute infectious diseases (influenza, measles, diphtheria, pneumonia, tonsillitis, scarlet fever, dysentery, sepsis, erysipelas) and chronic infections (tuberculosis, syphilis, brucellosis, rheumatism). Primary viral lesions are probably also possible. Metabolic disorders, intoxication, and neoplasms (both primary ganglioneuromas and metastatic ones) are important.

Clinical picture

There are sympathoglionitis: cervical, upper and lower thoracic, lumbar, sacral. The main symptom is periodically exacerbating burning pain that has no precise boundaries. Paresthesia, hypoesthesia or hyperesthesia, pronounced disorders of pilomotor, vasomotor, secretory and trophic innervation are detected

Lesions of the four cervical sympathetic nodes have a special clinical picture: superior, middle, accessory and stellate (not all people have the middle and accessory nodes).

Upper cervical ganglion lesion manifested by a violation of the sympathetic innervation of the eye (Bernard-Horner syndrome). Vasomotor disturbances are often observed in the same half of the face. When this node is irritated, dilation of the pupil (mydriasis), widening of the palpebral fissure, and exophthalmos (Pourfur du Petit syndrome) occur. The main feature of lesions of the upper cervical sympathetic ganglion is that the localization of painful manifestations does not correspond to the zone of innervation of any somatic nerve. Pain can spread to half the face and even the entire half of the body (according to the hemitype), which is explained by the involvement of the entire sympathetic chain in the process. With very severe pain in the face and teeth, damage to this node can cause the mistaken removal of several teeth. One of the provoking factors is hypothermia, but various inflammatory processes, surgical interventions on the neck, etc. can also play a role. With a long duration of the disease, patients become emotionally labile, explosive, and sleep is disturbed. Changes in the psyche often develop according to the type of astheno-hypochondriacal syndrome.

Prosopalgia with sympathetic truncinitis differs from other forms of facial sympathalgia by significant irradiation: increasing in intensity, pain in the face radiates throughout the entire half of the body.

Damage to the stellate ganglion characterized by pain and sensitivity disorders in the upper limb and upper chest.

At lesions of the upper thoracic nodes pain and skin manifestations are combined with autonomic-visceral disorders (difficulty breathing, tachycardia, pain in the heart). More often, such manifestations are more pronounced on the left.

Damage to the lower thoracic and lumbar nodes leads to disruption of the cutaneous-vegetative innervation of the lower torso, legs and vegetative-visceral disorders of the abdominal organs.

Treatment

During an exacerbation, analgesics (paracetamol) and tranquilizers are prescribed. In case of pronounced pain syndrome, novocaine is administered intravenously or a preganglionic novocaine blockade is performed (50-60 ml of a 0.5% novocaine solution is administered paravertebrally at the level of the II and III thoracic vertebrae; for a course of 8-10 blockades every 2-3 days). Tegretol is effective. In acute cases, anti-infective treatment is simultaneously carried out. If damage to the sympathetic trunk is caused by influenza infection, gamma globulin is prescribed. In cases of bacterial infection (tonsillitis, pneumonia, rheumatism), a course of treatment with antibiotics is carried out. When the tone of the sympathetic part of the autonomic nervous system increases, anticholinergic, ganglion-blocking, neuroplegic and antispasmodic drugs are indicated. Some antihistamines have anticholinergic properties, so diphenhydramine, diprazine, etc. are also prescribed. When sympathetic structures are suppressed, cholinomimetic drugs (ephedrine, glutamic acid), as well as calcium gluconate, calcium chloride are prescribed. Electrophoresis of novocaine, amidopyrine, ganglerone, and potassium iodide is used on the area of the affected areas of the sympathetic trunk. UV irradiation (erythemal doses), diadynamic or sinusoidal modulated currents, cold mud applications, radon baths, massage are indicated. Diphenin, multivitamins, phosphorus and iron preparations, lecithin, aloe, and vitreous are prescribed. Rarely, for pain that is not amenable to drug therapy, a sympathectomy is performed.

Sympathetic trunk (truncus sympathicus) - a paired formation located on the side of the spine (Fig. 9-67, 9-68). Of all the organs of the posterior mediastinum, it is located most laterally and corresponds to the level of the rib heads. Consists of the nodes of the sympathetic trunk (nodi trunci sumpathici), connected by internodal branches (rami interganglionares).

Each node of the sympathetic trunk (ganglion trunci sympathici) gives off a white connecting branch (ramus communicans albus) and gray connecting branch (ramus communicans griseus). In addition to the connecting branches, a number of branches depart from the sympathetic trunk that take part in the formation of reflexogenic zones - vegetative plexuses on the vessels and organs of the thoracic and abdominal cavities.

Greater splanchnic nerve (p. splan-chnicus major) begins with five roots from V to IX thoracic nodes. Having united into one trunk, the nerve goes to the diaphragm, penetrates the abdominal cavity between the legs of the diaphragm and takes part in the formation of the celiac plexus (plexus coeliacus).

Lesser splanchnic nerve (p. splanchnicus

minor) starts from the tenth-eleventh thoracic sympathetic nodes and penetrates together with the greater splanchnic nerve into the abdominal cavity, where it is partially part of the celiac plexus (plexus coeliacus), superior mesenteric plexus (plexus mesentericus superior) and forms the renal plexus (plexus renalis).

Inferior splanchnic nerve (n. splanchnicus imus s. minimus s. tertius) starts from the twelfth thoracic sympathetic node and also enters the renal plexus.

Thoracic cardiac nerves (pp. cardiaci thoracici) depart from the second to fifth thoracic sympathetic nodes, pass forward and medially, take part in the formation of the aortic plexus (plexus aorticus). The branches of the thoracic aortic plexus on the arteries arising from the thoracic aorta form the periarterial plexuses.

Numerous subtle sympathetic non-

ditches extending from the thoracic nodes of the sympathetic trunk - esophageal branches (rami esophagei), pulmonary branches (ramipulmonales)-

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Rice. 9-67. Sympathetic trunk. 1 - celiac plexus, 2 - small splanchnic nerve, 3 - greater splanchnic nerve, 4 - thoracic nodes of the sympathetic trunk, 5 - azygos vein, 6 - right superior intercostal vein, 7 - subclavian loop, 8 - subclavian artery, 9 - brachial plexus , 10 - anterior scalene muscle, 11 - phrenic nerve, 12 - anterior branches of the cervical nerves, 13 - superior cervical ganglion of the sympathetic trunk, 14 - hypoglossal nerve, 15 - vagus nerve, 16 - middle cervical ganglion of the sympathetic trunk, 17 - general carotid artery, 18 - cervicothoracic node, 19 - brachiocephalic trunk, 20 - esophagus, 21 - lung, 22 - thoracic aorta, 23 - celiac trunk. (From: Sinelnikov V.D.

Topographic anatomy of the breast

Rice. 9-68. The course of the fibers of the spinal nerves, their connection with the sympathetic trunk (diagram). 1 - anterior branch (spinal nerve), 2 - posterior branch (spinal nerve), 3 - gray communicating branch, 4 - somatic sensory nerve fibers of the cells of the spinal ganglion, 5 - trunk of the spinal nerve, 6 - white communicating branch, 7 - spinal ganglion , 8 - dorsal root, 9 - dorsal horn, 10 - posterior cord, 11 - lateral cord, 12 - white matter, 13 - lateral horn, 14 - gray matter, 15 - central canal, 16 - central intermediate gray matter, 17- node of the autonomic plexus, 18 - anterior median fissure, 19 - anterior cord, 20 - anterior horn, 21 - sympathetic prenodal nerve fibers of the cells of the lateral horn of the spinal cord, 22 - sympathetic postnodal nerve fibers of the cells of the nodes of the autonomic plexuses, 23 - sympathetic postnodal fibers to the spinal cord nerve, 24 - anterior root, 25 - motor fibers of the cells of the anterior horn of the spinal cord, 26 - sympathetic post-nodal nerve fibers of the cells of the nodes of the sympathetic trunk, 27 - nodes of the sympathetic trunk. (From: Sinelnikov V.D. Atlas of human anatomy. - M., 1974. - T. III.)

take part in the formation of the esophageal plexus (plexus esophageus) and pulmonary plexus (plexus pulmonalis).

CELLULAR SPACES OF THE MEDIASTINUM

Intrathoracic fascia (fascia endothoracica) lines the inner surface of the chest and below passes to the diaphragm, pre-

rotating into the phrenic-pleural fascia (fascia phrenicopleuralis). The spurs of the intrathoracic fascia cover the mediastinal pleura and also approach the organs and neurovascular formations of the mediastinum, forming fascial sheaths. Fascial spurs limit the following interfascial spaces.

The prepericardial space is located posterior to the layer of intrathoracic fascia lining the transverse thoracic muscle

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(i.e. transversus thoracis). Posteriorly, this space is limited by the fascial sheaths of the thymus and vessels located anterior to the trachea, and the pericardium. From below, the prepericardial space is limited by the phrenic-pleural fascia, communicating through the sternocostal triangle with the preperitoneal tissue. From above, this space communicates with the pre-visceral space of the neck.

The pretracheal space is limited on the left by the aortic arch and the initial sections of its branches, and on the right by the mediastinal pleura and azygos vein. Anteriorly, this space is limited by the fascial sheath of the thymus and the posterior wall of the pericardium, A behind - the trachea and the fascial sheet stretched between the main bronchi.

The peri-esophageal space in the upper mediastinum is separated from the sides and back by the leaves of the intrathoracic fascia adjacent to the mediastinal pleura and the prevertebral fascia, and in front by the trachea, to which the esophagus is directly adjacent. In the posterior mediastinum, the paraesophageal space is located between the posterior wall of the pericardium and the layer of intrathoracic fascia lining the aorta. The lower part of the paraesophageal space is divided into anterior and posterior sections by fascial spurs connecting the lateral walls of the fascial sheath of the esophagus with the mediastinal pleura below the roots of the lungs. The paraesophageal space communicates from above with the retrovisceral space of the neck, and from below through the aortic opening of the diaphragm and the lumbocostal triangle - with the retroperitoneal space.

Purulent inflammation of the mediastinal tissue - mediastinitis - can occur in the chest cavity. There are anterior and posterior media astinitis.

With anterior purulent mediastinitis, purulent melting of tissue along the intercostal spaces, destruction of the pericardium - purulent pericarditis or empyema of the pleural cavity - are observed.

With posterior mediastinitis, pus penetrates the subpleural tissue and can descend down into the retroperitoneal tissue through the openings of the diaphragm - the lumbar-costal triangle, aortic or esophageal openings. Sometimes pus breaks into the trachea or esophagus. Factors contributing to the spread of purulent inflammatory processes in the mediastinum:

Uneven development of fascial bundles and fiber, as a result of which different parts of the mediastinum are not delimited from each other.

Mobility of the pleural layers and diaphragm, constant spatial and volumetric changes in the organs and vessels of the mediastinum. /