Inervatia cap si gat

Inervatia cap si gat

Nervi spinali cervicali ( 8 )
- nv. mixti
- inervatia somatica cap,gat,membre sup.,diafragm
- contin neurofibre simpatice
- traiect orizontal
- posterior de artera vertebrala
- nv. C1 = arc post. atlas
- C2 = post.procesului articular sup.axis
- nv. C3-C8= ant de artic.interapofizare
- ram.: meningee spinala =
ram.discale,ligamentare,meningee
- nv. spinal dupa gaura intervertebrala = 2 ramuri
ventrala si dorsala
- ram. ventrale constituie plexul cervical si brahial
- ram. dorsale - nv. cervicali dorsali
Nervi cervicali dorsali
Inerveaza:pielea reg.
nucale,m.paravertebrali,articulatiile coloanei
cervicale
Nv.C1 = nv. suboccipital inv.- m.mare/mic
drept post. cap,m.oblic sup./post. cap.,m.
semispinos cap, ram. cutanata.
Nv.C2 = nv. occipital mare (Arnold)- inv.m.
splenius,m.lung al capului ,m.semispinos
cap,pielea reg. occipitale
Nv.C3 = inv. pielea reg. cefei
Nv.C4-C8= inv.m.erectori coloana cervicala
(C5-C8 + ram. cutanate)
Plexul cervical
Destinat: - muschi ant-lat.gat
- diafragm
- pielea reg. cervicale si supero-laterala
torace
- Constituire: ram. ventrale nervi C1-C4
arcade anastomotice
- Raport:anterior- m.ridicator scapula
m.scalen mijlociu
lama prevertebrala-fascia cervic.

Plex cervical
Ramuri colaterale:
-1.nv.occipital mic( ram.mastoidiana)=senzitiv C2-C3
-2.nv.auricular mare(ram. auriculara)=senzitiv C3
-3.nv.transvers al gatului= senzitiv C2-C3
-4.nv.supraclaviculari (3) =senzitivi C3-C4, nv.
mediali,nv.intermediari,nv.laterali
-5.ramuri musculare pt.: - m.intertransversari
- m. drept lat.,m.drept ant.,m.lung cap/gat C2-C4
- m.ridicator scapula,m.scalen mijlociu,m.ant.C3-C4
Plex cervical
Ramuri terminale
1. ansa cervicala C2 - C3 - motor
inv. m.sterno-hioidian
m.sterno-tiroidian
m.omo-hioidian(p. post.)
2. nv. frenic - C4-C3-C5- mixt
- diafragm
- pericard, pleura
- peritoneul diafragmatic
Nerv frenic ( NF)
Traiect cervical NF fata ant.m.scalen ant.
- anatomie de suprafata: 1/3 medial clavicula+ linia gonion-1/2 clavicula
- clinic: punctul cervical in NEVRALGIA FRENICULUI = in fosa
supraclaviculara mica
Traiect toracic
- ant. de hilul pulmonar
- NF stang- medial = crosa aortica
- post. nv. Vag
- ant.pericardul ventricul stang
- NF drept- situat ant. de tr.br-cefalic dr.
- ant.: pericard. atriul drept, VCI
-ram. terminale: ram. frenico-abdominale ant.,lat.,post.- ganglion celiac
-ram. colaterale: ram. timice,pleurale, pericardice, pt. VCS
-anastomoze: cu NF contralateral,nv X,ganglionii celiaci

-FUNCTIE: motorie - nerv inspirator principal-moduleaza presiunea intra-
abdominala !
paralizie = imobilizare hemidiafragm; compresiune = sughit
senzitiva: pleura,pericard,peritoneu diafragmatic - dureri
Trunchiul simpatic cervical
Situatie : paravertebrala
Limite:baza craniului-stramt. sup.torace
Inervatia: cap,gat.membre sup.,mediastin
sup.
Constituit:3 ganglioni:sup.,mijlociu,cervico-
toracic ( stelar) + ram. interganglionare
Simpaticul cervical
1.ganglion cervical superior (GCS)
-fusiform,40/5 mm.,nivel C4,retrostiliana

2.ganglion cervical mijlociu (GCM)
-mic,inconstant,nivel C6

3.ganglion cervico-toracic ( stelat )
-forma stelara,in fosa retro-pleurala,post. de
C7(proces transvers) si col coasta I

Simpaticul cervical
Ramuri colaterale:
1. GCS - a.ram.comunicante-destinate nv.C1-C4
- b.ram.anastomotice ( nv.IX,X )
- c.nv. carotidieni interni-plex carotidian
- d.nv.carotidieni externi-plex
maxilar,facial,lingual,tiroidian sup.
- e.nv.laringeo-faringieni-plex faringian
- f.nv. cardiac cervical superior-plex cardiac


Simpaticul cervical
Ramuri colaterale GCM
a. ram.comunicante- destinate nv. C4-C5
b.ANSA VIEUSSENS ( ansa subclaviculara)
c.plex tiroidian inferior- ramuri pt.nv. Recurent
d.ram. pt. plexul carotidian comun
e.nervul cardiac cervical mijlociu-plex cardiac
post.
Simpaticul cervical
Ganglion cervico-toracic ( stelat )
- ram. comunicante-destinate nv. C5-C8
- ram. pt. nervul frenic
- ram. pt. plexul subclavicular
- nerv. cardiac inferior-plex cardiac post.
- ram. esofagiene si traheale
Sistematizarea simpaticului cervical
Ramurile comunicante = gri
Ganglionul cervico-toracic = PASAJ
OBLIGATORIU pt. TOATE FIBRELE
PREGANGLIONARE ce vin din simpaticul
cervical situat in maduva spinarii port.
toracica T1-T5 ( coloana intermedio-laterala)
Neuroni preganglionari (in mielomereT1-T5)
Neuroni postganglionari ( GCS,GCM,GCT)
Neuroni preganglionari
Situati in mielomereleT1-T5:
T1-T2 centrul cilio-spinal Budge pt.ochi-
iris,muschi,glande lacrimale
T1-T3- pt. glande salivare
T1-T3- pt. glande sudoripare cap/gat
T1-T5- pt.cord- cardio-accelerator
T3-T5- pt. bronhii,plamani
T2-T5- pt.membre sup.,glande mamare
Neuroni postganglionari
Ganglion cervical superior(GCS)
-contine corpi neuronali- destinatie oculara
-imprumuta plexul carotidian intern
-se ataseaza nv. III- m. ridicator pleoapa sup
-nv. nazo-ciliar + ganglion ciliar- pt. IRIS(m.
dilatator al pupilei)
-nv.canal pterigoid,ggl.pterigo-
palatin,nv.maxilar,nv.lacrimal-pt. GLANDA
LACRIMALA
-Sindrom Claude Bernard-Horner = leziunea
GCS: mioza,ptoza palpebrala,enoftalmie
Neuroni postganglionari
Ganglion cervical sup. si mijlociu
- contin corpi neuronali destinati glandelor
salivare
- fibrele imprumuta: - calea plexului
carotidian extern
- formeaza: - plexul facial/lingual = pt.
glandele submandib.,sublinguale,linguale
- plexul maxilar/temporal = pt.
gl.parotide
Neuroni postganglionari
In GCS,GCM,GCT = localizati corpi
neuronali destinati : pt. - cord
- gl.sebacee cap/gat
In GCT ( stelat ) = neuroni pt.:
- bronhii, plamani
- arterele membrul sup. si gl.mamare