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The Parasympathetic Ganglia of the Head and Neck – Neuroanatomy

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 Asian Journal of Research in Medicine and Medical Science

4(1): 127-132, 2022; Article no.AJRMMS.1121

The Parasympathetic Ganglia of the Head and Neck -

Neuroanatomy
Georges Aoun a,b*
a
Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese
University, Beirut, Lebanon.
b
Department of Basic Sciences, Head and Neck Anatomy Division, Faculty of Dental Medicine,
Lebanese University, Beirut, Lebanon.

Author’s contribution

The sole author designed, analysed, interpreted and prepared the manuscript.

Received 15 August 2022

Review Article Accepted 19 October 2022
Published 25 October 2022

ABSTRACT

There are four parasympathetic ganglia located within the head: the ciliary, the otic, the
pterygopalatine, and the submandibular. They are related to cranial nerves that have
parasympathetic activities, such as the oculomotor (CN III), the facial (CN VII), and the
glossopharyngeal (CN IX) nerves. Cranial parasympathetic fibers originate from brainstem nuclei
and synapse in the peripheral parasympathetic ganglia. This article reviews the anatomy and
physiology of these ganglia.

Keywords: Otic ganglion; pterygopalatine ganglion; ciliary ganglion; submandibular ganglion.

1. INTRODUCTION ganglion (CG), and the submandibular ganglion

“The human body’s smooth functioning depends
on coordination between somatic and visceral
components of the nervous system. The visceral
component, usually known as the autonomic
nervous system, is formed by parasympathetic
and sympathetic fibers. It has at least two sets of
neurons: preganglionic and postganglionic
neurons” [1]. “Cranial parasympathetic fibers
originate from brainstem nuclei and synapse in
the peripheral parasympathetic ganglia. In the
head and neck regions, there are four peripheral
parasympathetic ganglia: the otic ganglion (OG),
the pterygopalatine ganglion (PPG), the ciliary
_____________________________________________________________________________________________________
(SMG)” [2]. “Postganglionic parasympathetic
fibers exit the ganglia toward the target organs to
provide them with parasympathetic innervations”
[1]. This review aims to describe the anatomy
and physiology of the head and neck
parasympathetic ganglia.
2. HEAD AND NECK
PARASYMPATHETIC GANGLIA
2.1 Otic Ganglion
“Located in the infratemporal fossa immediately
below the foramen ovale, the OG is the smallest

*Corresponding author: Email: dr.georgesaoun@gmail.com;


of the four parasympathetic ganglia of the head
region. It is yellowish-brown, oval and flattened,
and approximately 2×1.5×0.4 mm in size” [3,4].
“It is inferior to the greater wing of the sphenoid
bone, superior to the levator veli palatini muscle,
on the medial aspect of the mandibular nerve
laterally, and the lateral aspect of the cartilage of
the auditory tube” [3,5]. “Even though the OG is
located close to the mandibular nerve,
functionally, it is related to the glossopharyngeal
nerve” [6].
“The OG has parasympathetic, sympathetic,
sensory, and motor roots. The preganglionic
parasympathetic fibers arise from the inferior
salivatory nucleus, located in the dorsal part of
the pons just above the junction with the medulla
oblongata” [3,7]. “They travel within the
glossopharyngeal nerve and branch off the
tympanic nerve (Jacobson's nerve) to form the
tympanic plexus in the middle ear and then exit
through the foramen ovale to enter the
infratemporal fossa and join the OG as the lesser
petrosal nerve; in some cases, the lesser
petrosal nerve exits the middle cranial fossa
through the foramen spinosum or the
sphenopetrosal fissure. In the OG, the
preganglionic parasympathetic fibers synapse
with postganglionic parasympathetic fibers that
Fig. 1. Parasympathetic and sympathetic roots of the otic ganglion
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Aoun; AJRMMS, 4(1): 127-132, 2022; Article no.AJRMMS.1121
communicate mainly with the auriculotemporal
nerve, which conveys them to the parotid
gland, producing vasodilator and secretomotor
effects; some postganglionic fibers may project
to the jaw’s vessels and cerebral circulation”
[3].
The sympathetic fibers are postganglionic,
arising from the superior cervical ganglion made
up of the paravertebral ganglia of cervical
vertebrae one to four (C1-C4) and giving rise to
the carotid plexus, whose fibers run with the
external carotid artery and, after that, the middle
meningeal artery plexus. “These sympathetic
fibers traverse the OG without synapsing and
travel with the auriculotemporal nerve to the
parotid gland, where they induce
vasoconstriction effects” [8] (Fig. 1).
“The sensory fibers of the OG rise from the
glossopharyngeal nerve via the tympanic plexus
and lesser petrosal nerve” [9].
“As for the motor fibers, they originate from the
mandibular nerve and pass through the OG
without synapsing. They innervate the medial
pterygoid muscle, the tensor veli palatini muscle,
and the tensor tympani muscle via the medial
pterygoid nerve” [8].

2.2 Pterygopalatine Ganglion
Located within the pterygopalatine fossa, the
PPG, also referred to as the sphenopalatine
ganglion, is the largest parasympathetic ganglion
among the four ganglia [10-12]. Roots from the
maxillary nerve suspend this ganglion near the
sphenopalatine foramen, anterior to the vidian
canal. The PPG includes parasympathetic,
sympathetic, and sensory nerve fibers
[10,12].
It receives preganglionic parasympathetic fibers
from the vidian nerve, houses postganglionic
parasympathetic fibers, and acts as a pathway
for postganglionic sympathetic and sensory
fibers which pass without synapse through it
[12,13]. “The autonomic fibers that arise from the
PPG travel with branches of the maxillary nerve,
particularly the zygomatic nerve, which regulates
secretomotor functions of the lacrimal gland via a
connection with the lacrimal nerve. Moreover,
other fibers provide sensation from many
structures that include the mucous membranes
Fig. 2. The pterygopalatine ganglion
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Aoun; AJRMMS, 4(1): 127-132, 2022; Article no.AJRMMS.1121
of the oropharynx, nasopharynx, nasal cavity,
and upper part of the oral cavity” [10,12] (Fig. 2).
2.3 Ciliary Ganglion
“The CG is small and irregularly shaped. It is
located close to the orbital apex between the
optic nerve and the lateral rectus muscle, about 1
cm in front of the medial end of the superior
orbital fissure. It is embedded in orbital fat and is
connected to the nasociliary nerve” [1]. The CG
has a parasympathetic root, a sensory root, and
a sympathetic root.
“Preganglionic parasympathetic fibers arise from
the Edinger-Westphal nucleus located in the
midbrain dorsal to the oculomotor nucleus close
to the level of the superior colliculus” [14]. “Then
these fibers pass through the inferior division of
the oculomotor nerve and reach the CG, where
they synapse with postganglionic fibers.
Postganglionic fibers pass through the short
ciliary nerve and end by supplying the sphincter
pupillae and the ciliary muscles” [1].

“The sensory fibers arise from the short ciliary
nerves, branches of the CG. They carry general
sensations from the cornea, iris, and ciliary body”
[15].
“As for the sympathetic fibers, they originate from
the superior cervical sympathetic ganglion and
travel with the internal carotid artery before
entering the orbit through the superior orbital
fissure with the short and long ciliary nerves.
They pass through the CG without synapse and
supply the ocular blood vessels and the iris
dilator muscle” [1,15] (Fig. 3).
2.4 Submandibular Ganglion
“The SMG appears small and fusiform. It is
located superiorly to the hyoglossus muscle,
laterally to the submandibular gland, under the
lingual nerve, and is functionally related to the
facial nerve via the chorda tympani” [16].
“Similar to other parasympathetic ganglia of the
head and neck, the SMG is the site of synapse
for parasympathetic fibers and carries other
Fig. 3. The ciliary ganglion
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Aoun; AJRMMS, 4(1): 127-132, 2022; Article no.AJRMMS.1121
types of fibers that do not synapse in the
ganglion.
Preganglionic parasympathetic fibers originate
from the superior salivatory nucleus located in
the pons, leave the facial nerve in the chorda
tympani, and join the lingual nerve to reach the
submandibular ganglion where they synapse,
and postganglionic parasympathetic fibers
innervate the sublingual and submandibular
glands. They are secretomotor to these glands.
Some of these postganglionic fibers reach the
sublingual gland after re-entering the lingual
nerve through connecting nerve filaments”
[17,18].
Preganglionic sympathetic fibers originate from
the T1 spinal segment, synapse in the superior
cervical sympathetic ganglion, and the
postganglionic fibers travel with the plexus
around the facial artery and supply the
submandibular gland.
As for the sensory fibers, they arise from the
lingual nerve.

Fig. 4. The submandibular ganglion
3. CONCLUSION
The autonomic nervous system has two main
roots: parasympathetic and sympathetic. These
roots are made from fibers (preganglionic and
postganglionic) as well as clusters of nerve cells
called ganglia. Nerve fibers from these ganglia
innervate internal organs of the body.
CONSENT
It is not applicable.
ETHICAL APPROVAL
It is not applicable.
COMPETING INTERESTS
Author has declared that no competing interests
exist.
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