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Anatomy of the Parasympathetic Nervous System

Majid Ali, M.D.

 

The anatomic organization of the parasympathetic system comprises:

1. Preganglionic neurons in the brain;

2. Preganglionic fibers that leave the central nervous system through the third, seventh, ninth, and tenth nerves, and pass through to the end organ uninterrupted;

3. Postganglionic neurons located in the wall of the organs supplied by the preganglionic fibers; and

4. Postganglionic fibers—measuring from 1 millimeter to several centimeters—that exit the neuron to widely spread throughout the area of supply.

Tenth Cranial (Vagus) Nerve

The tenth cranial (vagus) nerve has the most extensive distribution among the cranial nerves. It comprises both motor and sensory fibers. The deep origin of the nerve can be traced through the fasciculi of the medulla to end in a nucleus of the gray matter, the nucleus vagi situated at the lower part of the floor of the fourth ventricle, close to the origin of the glosso-pharyngeal nerve. The vagus nerve carries nearly 75% of all parasympathetic flow and supplies the heart, the lung, the liver, the pancreas, the gallbladder, the esophagus, the stomach, all of the small intestine, the proximal half of the colon, and the upper portions of the ureters. The SA node, atria, and AV node are innervated by the vagus nerve but the ventricles do not. (â1 receptors located in the SA node, AV node, and the ventricular muscle exert an excitatory effect, increasing heart rate, conduction velocity, and contractility.) The parasympathetic supply of the third nerve flows to the pupillary sphincter and ciliary muscle of the eyes, whereas that of the seventh nerve passes to the nasal, lacrimal, and submandibular glands.

One of the important observations of Langley concerned the enormous disparity between the preganglionic nerves connecting neurons in the brain to autonomic ganglia. For example, the vagus nerve contains an estimated two thousand preganglionic fibers, whereas the number of neurons in the bowel is believed to be as high as over two million. The significance of such anatomic arrangement did not escape Langley, who recognized the high probability that many of the gut neurons were structurally—and, of necessity, functionally —independent of the brain. This fact also influenced Gershon's thinking.2 It may be pointed out here that about 80% of autonomic fibers are sensory-afferent and 20% are motor efferent.

All references appear in tutorial Br31.

 

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