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Sacral Plexus & Nerves ANS Major arteries Accessory arteries Major veins Accessory veins Cavity lymphatics Perineum lymphatics Gross Anatomy From School.

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Presentation on theme: "Sacral Plexus & Nerves ANS Major arteries Accessory arteries Major veins Accessory veins Cavity lymphatics Perineum lymphatics Gross Anatomy From School."— Presentation transcript:

1 Sacral Plexus & Nerves ANS Major arteries Accessory arteries Major veins Accessory veins Cavity lymphatics Perineum lymphatics Gross Anatomy From School

2 1.Location: 1.Location: lies ant to& covered with pelvic fascia w/ nerves exiting in greater sciatic foramen

3 2. Comp: 2. Comp: Ventral rami of:

4 a) lumbosacral trunk –

5

6 1. Sciatic n. – 1. Sciatic n. – largest; major n. of LL a) comp: b) exits:

7 c) splits into: 1. Tibial n. – 1. Tibial n. –

8 2. Common fibular n. – superficial & deep fibular nerves

9 2. Pudendal n. –

10 a) comp:

11 b) Exits: inf to piriformis m., crosses over lig, & re-enters in lesser sciatic f. 

12 Pudendal canal c) Enters Pudendal canal – medial border of  neurovascular bundle

13 d) Pudendal n. in canal divides into: 1. Inf rectal n. – 1. Inf rectal n. – near entrance of pudendal canal  a) motor: a) motor: ext. anal sphincter & levator ani b) sensory: b) sensory: skin of anal triangle

14 2. Dorsal n of penis (clitoris) – 2. Dorsal n of penis (clitoris) – descends in pudendal canal & in F = F = primary

15 3. Perineal n. – 3. Perineal n. – descends in canal & & divides into:

16 a) Deep perineal n. – a) Deep perineal n. – enters motor: motor: muscles of deep & sup perineal pouches sensory: sensory: vestibule & inf. vagina

17 b) Superficial perineal n. – b) Superficial perineal n. – becomes  posterior scrotal or labial n. - posterior scrotal or labial n. - sensory

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19 3. Other branches of sacral plexus: Name Spinal SegFunction Sup gluteal Inf gluteal N. to obturator internus N. to quadratus femoris Post femoral cutaneous n Perforating cutaneous n. N. to piriformis N. to levator ani, coccygeus, ext anal sphincter

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22 1. Sacral paravertebral trunk (2) – 1. Sacral paravertebral trunk (2) – ganglia of the sympathetic trunk in pelvic cavity; a) courses over ala & descends medial to ant. sacral foramina b) Ganglion impar –

23 2. Sacral prevertebal trunk – 2. Sacral prevertebal trunk – carries sympathetic, parasymp, & visceral afferent fibers for pelvic organs &

24 3. Superior hypogastric plexus – distributes sacral prevertebal fibers to 

25 4. Rt & lt hypogastric nerves – 4. Rt & lt hypogastric nerves – descend into pelvic cavity and connect with 

26 5. Rt & Lt inf hypogastric plexus (2) – 5. Rt & Lt inf hypogastric plexus (2) – composed of:

27 Pelvic splanchnic n. -

28 6. Subsidiary plexuses – 6. Subsidiary plexuses – inn by inf. hypogastric plx: a) Rectal plexus b) Vesicle plexus b) Vesicle plexus

29 c) Uterovaginal (Prostatic) plexus – 1. Cavernous n. – 1. Cavernous n. – from prostatic plexus  erectile tissues of penis

30 1. Def: major artery of the perineum 2. Origin: 2. Origin: bifurcation of common iliac lumbosacral joint 3. bifurcates 3. bifurcates at pelvic brim into: ant. and post trunks

31 a) Anterior trunk – a) Anterior trunk – pelvic viscera, perineum, gluteal region, medial thigh, placenta b) Posterior trunk - b) Posterior trunk - post abdominal & pelvic walls + gluteal region of hip

32 4. Posterior Trunk (Prox  dist): a) iliolumbar a. – ascends a) iliolumbar a. – ascends above pelvic brim along lumbosacral trunk: 1. iliac branch – 1. iliac branch – serves iliac fossa 2. lumbar branch – 2. lumbar branch – lower post abdominal wall

33 b) Lateral sacral a (2) – b) Lateral sacral a (2) – ant. sacral foramina to serve sacrum & skin c) Sup. gluteal a. – c) Sup. gluteal a. – greater sciatic notch, above piriformis to serve gluteal region

34 5. Anterior Trunk (prox  dist): a) Umbilical a –adjacent to pelvic inlet a) Umbilical a –adjacent to pelvic inlet ascends in ant. abdominal wall to umbilicus; one branch:

35 Superior vesical a.– Superior vesical a.– serves distal ureter, superior surface of bladder, ductus deferens

36 b) Obturator a – b) Obturator a – below margin of pelvic brim, descends through obturator foramen w/ n. (above) & v. (below); serves medial thigh compartment

37 c) Inf. vesical (vaginal) a. – c) Inf. vesical (vaginal) a. – inf. bladder, ureter, seminal vesicle, & prostate (vagina), part of rectum)

38 d) Middle rectal a – d) Middle rectal a – serves rectum; anastomoses w/: 1. Superior rectal a – 1. Superior rectal a – from inf. mesenteric 2. Inferior rectal a - 2. Inferior rectal a - from internal pudendal

39 e) Internal pudendal a. – e) Internal pudendal a. – main artery of perineum 1. greater sciatic foramen - inf to piriformis 2. re-enters in lesser sciatic f.  thru pudendal canal

40 3. Branches of int. pudendal a.: a) Inf. rectal a. – a) Inf. rectal a. – ischioanal fossa  middle rect. a. b) Perineal a. – b) Perineal a. – pudendal canal  sup. pouch w/ branches:

41 1. Post. scrotal (labial) a. – 1. Post. scrotal (labial) a. – in superficial pouch 2. Dorsal artery of penis (clitoris) – 2. Dorsal artery of penis (clitoris) – through  supplies superficial penis / clitoris & has two branches:

42 3. Deep artery of penis (clitoris) –terminal branch of perineal artery 3. Deep artery of penis (clitoris) –terminal branch of perineal artery =serves the crus & corpora cavernosum

43 a) Artery of bulb of penis (vestibular bulb) – a) Artery of bulb of penis (vestibular bulb) – in deep pouch to serve corpus spongiusum b) Urethral a. – b) Urethral a. – indeep pouch serves urethra

44 1. Uterine a –through broad ligament f) Additional anterior trunk branches in women: 1. Uterine a –through broad ligament a) ascends lat. to uterine wall to uterine tubes  anastomizes w/ ovarian a. b) descends lat to vaginal wall 

45 2. vaginal a– 2. vaginal a– to vagina & anastomizes w/ uterine artery

46 g) Inferior gluteal a – g) Inferior gluteal a – terminal branch of anterior trunk exits in gr sciatic f., inf to piriformis

47 1. Median sacral a – 1. Median sacral a bifurcation of abdominal aorta, descends in midline ant to sacrum, anastomizes w/ iliolumbar and lat. Sacral arteries

48 2. Ovarian a. – 2. Ovarian a. – in suspensory lig, anast. With ant branch of int. iliac

49 3. Ext. pudendal a. – 3. Ext. pudendal a. – from femoral artery courses medially to serve anterior perineum skin

50 1. Most veins follow arteries  internal iliac v.

51 2. Pelvic plexuses of veins – 2. Pelvic plexuses of veins – networks of veins on surfaces of most pelvic viscera: a) Dorsum vein of penis (clitoris) – a) Dorsum vein of penis (clitoris) – parallels dorsal artery of penis/clitoris 

52 b) Prostatic (vesical) venous plexus – b) Prostatic (vesical) venous plexus – prostate & bladder 

53 c) External rectal plexus –subcutaneous around perianal skin  inf rectal v. (external anal sphincter)  middle rectal v  internal iliac v.

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56 1. Internal rectal plexus –in submucsa of anal canal 1. Internal rectal plexus –in submucsa of anal canal drains into superior rectum v.  inf mesenteric  hepatic portal system

57 2. Gonadal (testicular or ovarian) v - a) left  b) right  3. Median sacral v.

58 1. Visceral lymphatics: a) int. & ext. iliac nodes  b) common iliac nodes 

59 c) lateral aortic & preaortic nodes  d) lumbar trunks  e) thoracic duct –

60 2. Perineum lymphatics: Superficial inguinal nodes a) superficial penis & scrotum (clitoris & labium major)  Superficial inguinal nodes  ext. iliac nodes

61 deep inguinal nodesexternal iliac nodes b) glans penis, glans clitoris, labia minora, inferior vagina  deep inguinal nodes  external iliac nodes

62 lateral aorticprearotic nodes c) testes: spermatic cord  post abdominal wall  lateral aortic & prearotic nodes

63 lateral aortic & preaortic nodes d) ovaries, uterus, uterine tubes: suspensory ligament  post abdominal wall  lateral aortic & preaortic nodes

64 internal iliac nodes e) deep perineum  internal iliac nodes  CI nodes


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