INNERVATION and LYMPHATIC SYSTEM OF HEAD and NECK
Annisaa Chusida
Sistema Nervosum
Terdiri dari :1. Central Nervous System ~ brain ~ spinal cord2. Peripheral Nervous System ~ spinal nerves ~ cranial nervesBerdasar sifat dapat dibagi :1. Somatic2. Autonomic : ~ sympathetic ~ parasympathetic
CENTRAL NERVOUS SYSTEM• Spinal Cord - 2/3 superior columna vertebralis - lanjutan dr medulla oblongata - ~ 31 pasang spinal nerves• Brain 1. Hindbrain = Rhombencephalon - Myelencephalon = Med. Oblongata - Metencephalon = Pons - Cerebellum
2. Midbrain = Mesencephalon
Medulla Oblongata + Pons + Midbrain
= Brain stem
3. Forebrain = Prosencephalon
- Telencephalon = Cerebrum
- Diencephalon : Thalamus
Hypothalamus
Epithalamus
Subthalamus
Autonomic Nervous System
• Visceral component• Neuron pd CNS dan PNS• Control internal environment• Innervation : - secretory glands - smooth muscle - cardiac muscle• Function ~ changes in somatic activities• Sympathetic ~ trunkus simpatikus ( basis cranii s.d
coccyx )• Parasympathetic Efferent fibres dr CNS Hanya pd N. Cranialis ttt ( N III, VII, IX, X )
Peripheral Nervous System
Terdiri dari :
• 31 pasang spinal nerves
- 8 Cerv, 12 Th, 5 Lumb, 5 Sacral,
1 Coccyx
- Sifat mixed ( sensoris dan motoris )
- Asal : spinal cord ~ radix ventralis
~ radix dorsalis
12 pasang cranial nervesbbrp bersifat mixed, sebagian murni sensoris atau motoris
V: Trigeminal (3 nerves in 1!)
• V1. Ophthalmic– Exits with eye muscle group (superior orbital fissure, through
orbit to superior orbital notch/foramina)– Sensory to forehead, nasal cavity
• V2. Maxillary– Exits foramen rotundum through wall of maxillary sinus to inferior
orbital foramina)– Sensory to cheek, upper lip, teeth, nasal cavity
• V3. Mandibular– Exits foramen ovale to mandibular foramen to mental foramen– Motor to jaw muscles--Masseter, temporalis, pterygoids, digastric– Sensory to chin– Sensory to tongue
TRIGEMINAL NEURALGIA(Tic Douloureux)
• Pada dewasa atau lansia
• Excruciating pain biasanya pd daerah distribusi nervus V2 ( sensoris )
• Nyeri : sentuhan pd trigger point, menggosok gigi, mengunyah
• Etiologi : vascular compressing NV ~ compressive neuropathy
VII: Facial Nerve(exits cranial cavity with VIII--internal auditory
meatus)• Facial muscles (five branches fan out over face
from stylomastoid foramen)– Temporal– Zygomatic– Buccal– Mandibular– Cervical
• “chorda tympani” (crosses interior ear drum to join V3 )– Taste to anterior 2/3 of tongue– Submandibular, sublingual salivary glands
• Lacrimal glands
FACIAL NERVE DISORDERS
• Unilateral facial weakness is a common neurologic sign.
• Bell's Palsy
Etiologi : neuritis N VII ( immune / virus )
Inflamasi ~ swelling
Terjadi paralisis wajah ~ Px tdk bisa
mengangkat alis, menutup mata dan menarik bibir
Nervus Glossopharyngeus
- Sensori pd middle ear
- Parasimpatis : gland. Parotis
- membrana mucosa oropharyng
- 1/3 posterior lidah
- taste fibres pd papilla circumvallata
Nervus Vagus
• Daerah innervasi luas : dr kepala - leher, jantung, pulmo, saluran cerna
• Somatic motor unt laryng dan pharyng
Nervus Accesorius
• Terdiri dari : - Spinal Accessory Nerve Purely Motor ~ M. sternocleidomastoideus ~ M. trapezius - Cranial Accessory Nerve Bergabung dg NX ~ otot intrinsik laryng dan pharyng
Nervus Hypoglossus
- Innervasi otot ekstrinsik dan intrinsik lidah - Keluar dari kranium melalui canalis
hipoglosi, berjalan berdekatan dg NX dan Spinal Accessory Nerve ~ pd daerah carotid sheath ~ sekitar angulus mandibula ~ ke permukaan M. hyoglossus
- Lesi : - wasting tongue - deviation tongue to affected side ( saat protrusi )
• N IX, X dan XI keluar dari kranium bersama-sama melalui foramen jugulare
• Foramen Jugulare Syndrome
Adanya tumor : tumor primer nasopharyng atau tumor metastase pd lymph node cervicalis superior ( primer: lidah, pharyng, laryng )
Gejala : sakit belakang telinga, headache, paralisa laryngomotor fibres, dysphagia
LYMPHATIC SYSTEM
1. Lnn. Submentalis
Letak : diantara kedua venter anterior M. digastricus
Afferent : medial bibir bawah, dasar mulut, ujung lidah
Efferent : lnn. Cervicalis profundus dan submentalis
2.Lnn. Submandibularis
Letak : antara mandibula dan gland.submandibularis
Afferent : mata, pipi, hidung, bibir atas, bibir bawah lateral, gingiva, margo anterolateral lidah
Efferent : lnn. Cervicalis profundus
3. Lnn Cervicalis Superficialis
Letak : V. Jugularis Externa
Afferent : daerah parotis
Efferent :lnn. Cervicalis profundus
4. Lnn. Cervicalis Profundus
Terdiri dari : Superior dan Inferior
Letak di sekitar V. Jugularis Interna