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8/12/2019 Parese of Trigeminal Nerve
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PARESE OF TRIGEMINAL NERVE
Oleh : Muh. Irfan Rasul
Pembimbing : Dr. Drg. Nuskah Sudjana, Sp.BM
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Introduction
The biggest and complex nerve in cranial nerves Opthalmicus, maxilary, and mandibulary branch
Mixed nerve : Large sensory part (portio major) &
much smaller motor part (portio minor)
SENSORIS
- NERVUS OPHTALMICUS- NERVUS MAXILLARIS
- NERVUS MANDIBULARIS
MOTORIS
- NERVUS MANDIBULARIS
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Anatomy (sensory)
Ophtalmikus
Forehead &scalp
Eye (conj &cornea)
Nose (tip)
Meninges
frontal sinus
Mucosa nasal
Maxillaris
Upper jaw andteeth
Upper lip
cheek
Palatum
Maxillary,ethmoid &sphenoid sinus
Part meninges
Mandibularis
Lower jaw
Lower teeth tongue
Part of MAE
Meninges
Cheek mucosa
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Anatomy (motoric)
Masseter
temporalis
Median pterygoid
Lateral pterygoid
Muscle ofmastication
Tensor velli palatini
Mylohyoid
Anterior belly of digastric
Tensor tympani
Others
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Ophtalmic division
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Maxillary division
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Mandibular division
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Nucleus of Trigeminal Nerve
1. Motoric nuclei :
Medial pons
2. Mecencephalicusnuclei : lateral pons
3. Sensory nuclei :
dorsolateral pontine
tegmentum
4. Spine nuclei : medulla
spinailis, lower pons
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Sensory portion
Sensory root enters the pons course
dorsomedially & terminate within brainstem:
Nucleus of spinal tract of Vth N (Pain & temp)
Main sensory nucleus (Tactile & proprioceptive
sensation)
Mesencephalic nucleus ( propriceptive )
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Parese nerve trigeminal
Parese nerve trigeminal is a collective term for a
range nervous disorder that result in weakness or
immobility of nerves region.
MANDIBULAR NERVE (MOTORIC FUNCTION)
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Lesions affecting preganglionic trigeminal
nerve roots
Tumour ( meningioma, schwannoma,metastasis, nasopharyngeal ca )
Infection ( granulomatous, infectious ,
carcinomatous meningitis ) Trauma
Aneurysm
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Nuclear lesions
Motor , sensory nuclei primary/met .
Tumours , AV malformations,
demyelinating, Infarction, that affect pons,
medulla and upper cervical cord.
Motor nucleus lesions of dorsal midpons
paresis, atrophy, fasiculations of muscles of
mastication
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Supranuclear lesions
Lesions affecting corticobular pathway -
Contralateral trigeminal motor paresis
(deviation of jaw away from the lesion)
UMN lesions ( pseudobulbar palsy )
trigeminal motor paresis , exaggerated jaw
jerk.Mastication markedly impaired.
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Clinical symptom
Trigeminal motor weakness
Deviation of jaw towards the weak side on opening
Unable to move the jaw contralaterally. Flaccidity of floor of mouth : mylohyoid, digastric
paralysis
Difficulty in hearing high notes : paralysis of tensor
tymapani
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Clinical examination
motor functions
Weakness of muscles ofmastication with inabilityto close the mouth
Bulk & power ofmasseters & pterygoids palpating as pt clinchesthe jaw
Ask pt
to protrude &retract the jaw
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Support Examinaton
Neuroimaging (CT-Scan & MRI)
Elektrophysiology (elektroencephalografi) Fluid and tissue analysis
Evaluation cerebrospinal fluid
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Treatment
Management of parese trigeminal nerve
depend on caused or underline disease.
Sullivan, at all: medication with corticosteroid
Surgery treatment is the last choice after
conservative treatment has done
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