Trigeminal Trigeminal NerveNerveDr.B.B.GosaiDr.B.B.Gosai

Cranial Nerve V - Trigeminal NerveCranial Nerve V - Trigeminal Nerve • Trigeminal nerve Trigeminal nerve is the largest cranial nerve and contain both is the largest cranial nerve and contain both

motor and sensory fibres. motor and sensory fibres. • Trigeminal nerve Nuclei: Trigeminal nerve Nuclei:

• Main sensory nucleusMain sensory nucleus: located in posterior part of pons lateral : located in posterior part of pons lateral to motor nucleus.to motor nucleus.

• Spinal nucleusSpinal nucleus: Extends into the medulla oblongata and upper : Extends into the medulla oblongata and upper part of spinal cord up to second cervical segment.part of spinal cord up to second cervical segment.

• Mesencephalic nucleusMesencephalic nucleus: Column of unipolar neurons in grey : Column of unipolar neurons in grey matter around cerebral aqueduct.matter around cerebral aqueduct.

• Motor nucleusMotor nucleus: Located in pons medial to main sensory nucleus.: Located in pons medial to main sensory nucleus.• Sensory Components of Trigeminal nerveSensory Components of Trigeminal nerve: Sensation of pain : Sensation of pain

temperature, touch and pressure >> semilunar (trigeminal ganglion) temperature, touch and pressure >> semilunar (trigeminal ganglion) >> central processes go to sensory trigeminal nuclei >> pain and >> central processes go to sensory trigeminal nuclei >> pain and temperature go to Spinal nucleus and touch and pressure go to Main temperature go to Spinal nucleus and touch and pressure go to Main sensory nucleus and joint sensation from head go to Mesencephalic sensory nucleus and joint sensation from head go to Mesencephalic nucleus.nucleus.

• Motor Component of Trigeminal nerveMotor Component of Trigeminal nerve: Supplies muscles of : Supplies muscles of mastication, tensor tympani, tensor veli palatini, mylohyoid and mastication, tensor tympani, tensor veli palatini, mylohyoid and anterior belly of digastricanterior belly of digastric

Motor root Motor root Passes forward in posterior fossaPasses forward in posterior fossaPierces the duramater beneath Pierces the duramater beneath

attachment of tentorium to tip of attachment of tentorium to tip of petrous part of temporal bone.petrous part of temporal bone.

Enters the meckel’s caveEnters the meckel’s cave leaves skull via Foramen Ovale. leaves skull via Foramen Ovale. It joins the mandibular div of Vth N to It joins the mandibular div of Vth N to

form mandibular nerve – supplies form mandibular nerve – supplies masticatory muscles .masticatory muscles .

Masseter : close the jaw , protrude it slightlyMasseter : close the jaw , protrude it slightly

Temporalis : close the jaw , retract it slightlyTemporalis : close the jaw , retract it slightly

Medial pterygoids : close the jaw & protrude itMedial pterygoids : close the jaw & protrude it

Lateral pterygoids : open the jaw & protrude itLateral pterygoids : open the jaw & protrude it

When pterygoids contract on one side- pull the When pterygoids contract on one side- pull the mandible contralaterally -- Unilateral pterygoid mandible contralaterally -- Unilateral pterygoid weakness – jaw deviates towards side of weak weakness – jaw deviates towards side of weak musclemuscle

Motor root also supply Mylohyoid, Ant.belly of Motor root also supply Mylohyoid, Ant.belly of digastric, Tensor veli palatini, Tensor tympanidigastric, Tensor veli palatini, Tensor tympani

Sensory portionSensory portionTrigeminal / gasserian / semilunar Trigeminal / gasserian / semilunar

ganglion ganglion Situated just beside pons in a shallow Situated just beside pons in a shallow

depression in petrous apex – meckel’s depression in petrous apex – meckel’s cavecave

Sensory root enters the pons course Sensory root enters the pons course dorsomedially & terminate within dorsomedially & terminate within brainstem Nuclei: brainstem Nuclei:

Nucleus of spinal tract of Vth NNucleus of spinal tract of Vth N Main/Principal sensory nucleusMain/Principal sensory nucleus Mesencephalic nucleus Mesencephalic nucleus

Fibres – pain & temp – enter spinal tract Fibres – pain & temp – enter spinal tract of trigeminal & descend to various levels of trigeminal & descend to various levels depending on their somatotropic origin, depending on their somatotropic origin, then synapse in adjacent nucleus of then synapse in adjacent nucleus of spinal tract.spinal tract.

The axons of second order neurons cross The axons of second order neurons cross midline, aggregate as trigeminothalamic midline, aggregate as trigeminothalamic tract & ascend to VPM tract & ascend to VPM

From VPM , fibres project through From VPM , fibres project through thalamic radiations to sensory cortex in thalamic radiations to sensory cortex in post central gyruspost central gyrus

Main sensory nucleus Main sensory nucleus Lateral ponsLateral ponsPosterolateral to motor nucleusPosterolateral to motor nucleusTactile & proprioceptive sensationTactile & proprioceptive sensationAfferent fibers – light touch , Afferent fibers – light touch ,

pressure – enter this nucleus – pressure – enter this nucleus – synapse – second order neurons synapse – second order neurons which cross midline en route to VPM which cross midline en route to VPM Thalamic nucleus.Thalamic nucleus.

Mesencephalic nucleusMesencephalic nucleusExtends cephalad from main sensory Extends cephalad from main sensory

nucleus to sup.colliculus of nucleus to sup.colliculus of mesencephalon.mesencephalon.

Receives proprioceptive impulses Receives proprioceptive impulses from masticatory muscles, from masticatory muscles, extraocular & muscles of facial extraocular & muscles of facial expression.expression.

Cranial Nerve Nuclei

1. Somatic efferent2. Special visceral efferent3. General visceral efferent4. General visceral afferent5. Special visceral afferent6. General somatic afferent 7. Special somatic afferent

Functional components Functional components General somatic afferent: Sensory for General somatic afferent: Sensory for

face.face.Special Visceral efferent : Nerve of Special Visceral efferent : Nerve of

first branchial arch.first branchial arch.

Cranial Nerve Nuclei

Sensory Nuclei of V NerveSensory Nuclei of V Nerve

Attachment of Cranial Nerves to Brain

Optic nerve

Internal carotid artery

Trigeminal ganglia

Occulomotor nerve

Abducent nerve

Trochlear nerve

Ophthalmic nerve

Maxillary nerve

Ophthalmic artery

VII & VIII Nerves

IX, X & IX Nerves

XII Nerve

Exit of Cranial Nerves

Cranial Nerve V - Trigeminal NerveCranial Nerve V - Trigeminal Nerve • Course of Trigeminal nerve Course of Trigeminal nerve emerge as small motor root emerge as small motor root

and large sensory root from the anterior aspect of pons. and large sensory root from the anterior aspect of pons. Sensory root form crescent shaped trigeminal ganglion which Sensory root form crescent shaped trigeminal ganglion which lie in pouch of dura mater called as trigeminal cave (Meckel’s lie in pouch of dura mater called as trigeminal cave (Meckel’s cave). Three divisions emerge from anterior aspect of cave). Three divisions emerge from anterior aspect of ganglion. Three divisions are Ophthalmic, Maxillary and ganglion. Three divisions are Ophthalmic, Maxillary and Mandibular. Motor root unite with Mandibular division: Mandibular. Motor root unite with Mandibular division: • Ophthalmic divisionOphthalmic division: sensory nerve >> superior orbital : sensory nerve >> superior orbital

fissure >>orbit >> supply orbital structures and forehead. fissure >>orbit >> supply orbital structures and forehead.

• Maxillary divisionMaxillary division: sensory nerve >> foramen rotundum : sensory nerve >> foramen rotundum >> Supply deep structures of head and skin of middle of >> Supply deep structures of head and skin of middle of the face. the face.

• Mandibular divisionMandibular division: sensory and motor nerve >> : sensory and motor nerve >> foramen oval >> Supply muscles of mastication and skin of foramen oval >> Supply muscles of mastication and skin of lower part of face. lower part of face.

2 Roots:2 Roots: Larger Sensory Root Larger Sensory Root Smaller Motor Root Smaller Motor Root

3 primary divisions:3 primary divisions:Ophthalmic Ophthalmic ( V1) - sensory( V1) - sensory- innervates the upper portion - innervates the upper portion of the faceof the faceMaxillary Maxillary (V2)- sensory – (V2)- sensory – innervates the mid face regioninnervates the mid face regionMandibular Mandibular (V3) -(V3) -sensory+motor – innervates the sensory+motor – innervates the lower facial regionlower facial region

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Divisions of Cranial Nerve VDivisions of Cranial Nerve V Ophthalmic Ophthalmic

FrontalFrontal LacrimalLacrimal NasociliaryNasociliary

MaxillaryMaxillary MandibularMandibular

Ophthalmic NerveOphthalmic Nerve

Frontal NerveFrontal Nerve Branch of ophthalmic division Branch of ophthalmic division of of

trigeminal nerve.trigeminal nerve. Enters the orbit through upper part of superior Enters the orbit through upper part of superior

orbital fissure.orbital fissure. Pass forwards on upper surface of levator Pass forwards on upper surface of levator

palpebrae superioris.palpebrae superioris. It divides into It divides into Supratorchlear and Supratorchlear and

Supraorbital nerves.Supraorbital nerves. SupplySupply: Skin of forehead. Supraorbital nerve : Skin of forehead. Supraorbital nerve

in addition supply Frontal air sinus also.in addition supply Frontal air sinus also.

Lacrimal NerveLacrimal Nerve Branch of ophthalmic division Branch of ophthalmic division of of

trigeminal nerve.trigeminal nerve. Enters the orbit through upper part of Enters the orbit through upper part of

superior orbital fissure.superior orbital fissure. Pass forwards along the upper border of Pass forwards along the upper border of

lateral rectus muscle.lateral rectus muscle. It is joined by Zygomaticotemporal nerve It is joined by Zygomaticotemporal nerve

which later leave to supply parasympathetic which later leave to supply parasympathetic fibers to lacrimal gland.fibers to lacrimal gland.

SupplySupply: skin of lateral part of eyelid.: skin of lateral part of eyelid.

Nasociliary NerveNasociliary Nerve Branch of ophthalmic division Branch of ophthalmic division of of

trigeminal nerve.trigeminal nerve. Enters the orbit through lower part of Enters the orbit through lower part of

superior orbital fissure.superior orbital fissure. It crosses the optic nerve from lateral It crosses the optic nerve from lateral

to medial side along with ophthalmic to medial side along with ophthalmic artery.artery.

Run along the upper border of Medial rectus Run along the upper border of Medial rectus muscle and ends by dividing into Anterior muscle and ends by dividing into Anterior ethmiodal nerve and Infratrochlear nerve.ethmiodal nerve and Infratrochlear nerve.

Nasociliary NerveNasociliary Nerve Branches of Nasociliary nerve:Branches of Nasociliary nerve:

Communicating branchCommunicating branch to Ciliary ganglion is sensory to Ciliary ganglion is sensory nerve.nerve.

Long ciliary nervesLong ciliary nerves: two or three in number crosses optic : two or three in number crosses optic nerve and pierces sclera of eyeball. They carry sympathetic nerve and pierces sclera of eyeball. They carry sympathetic fibers for Dilator pupillae.fibers for Dilator pupillae.

Posterior ethmoidal nervePosterior ethmoidal nerve: supplies ethmoidal and : supplies ethmoidal and sphenoidal air sinuses.sphenoidal air sinuses.

Infratrochlear nerveInfratrochlear nerve: supplies skin of medial part of eyelid : supplies skin of medial part of eyelid and adjacent part of nose.and adjacent part of nose.

Anterior ethmoidal nerveAnterior ethmoidal nerve: enter in cranial cavity and : enter in cranial cavity and enter the nose near cribriform plate of ethmoid. Supplies enter the nose near cribriform plate of ethmoid. Supplies mucus membrane of nose and appear on face as external mucus membrane of nose and appear on face as external nasal nerve to supply skin of nose up to tip of nose.nasal nerve to supply skin of nose up to tip of nose.

Maxillary NerveMaxillary Nerve

Maxillary NerveMaxillary Nerve Introduction:Introduction: The Maxillary Nerve or second division of the trigeminal nerve, is a The Maxillary Nerve or second division of the trigeminal nerve, is a

sensory nerve for upper jaw teeth, palate, nasal cavity and face.sensory nerve for upper jaw teeth, palate, nasal cavity and face. Course and Relations:Course and Relations: Begins at the middle of the Trigeminal ganglionBegins at the middle of the Trigeminal ganglion (semilunar (semilunar

ganglion) in the cranial cavity. ganglion) in the cranial cavity. Passing horizontally forward, it Passing horizontally forward, it leaves the skull through the leaves the skull through the

foramen rotundum.foramen rotundum. It then It then crosses the pterygopalatine fossacrosses the pterygopalatine fossa, inclines lateralward on , inclines lateralward on

the back of the maxilla.the back of the maxilla. Enters the orbit Enters the orbit through the inferior orbital fissure.through the inferior orbital fissure. It traverses It traverses the infraorbital groove and canalthe infraorbital groove and canal in the floor of the in the floor of the

orbit.orbit. Appears upon the face at the Appears upon the face at the infraorbital forameninfraorbital foramen.. At its termination on face, the nerve At its termination on face, the nerve divides into branches which divides into branches which

spread outspread out upon the side of the nose, the lower eyelid, and the upon the side of the nose, the lower eyelid, and the upper lip.upper lip.

Branches:Branches: Branches in the cranial cavity:Branches in the cranial cavity:

Middle Meningeal nerveMiddle Meningeal nerve supplies dura matter. supplies dura matter.

Branches in the pterygopalatine fossa:Branches in the pterygopalatine fossa:

Zygomatic nerveZygomatic nerve: Enter in orbit through inferior orbital fissure and divide into : Enter in orbit through inferior orbital fissure and divide into ZygomaticotemporalZygomaticotemporal nervenerve (Contain fibres for lacrimal gland and also supply skin if (Contain fibres for lacrimal gland and also supply skin if the side of forehead) and the side of forehead) and Zygomaticofacial nerveZygomaticofacial nerve-emerge on face and supply skin of -emerge on face and supply skin of prominence of cheek.prominence of cheek.

Posterior Superior Alveolar Nerve arise just before the infraorbital groovePosterior Superior Alveolar Nerve arise just before the infraorbital groove; ; they are generally two in number, but sometimes arise by a single trunk. They they are generally two in number, but sometimes arise by a single trunk. They descend on the tuberosity of the maxilladescend on the tuberosity of the maxilla and give off several twigs to the gums and give off several twigs to the gums and neighboring parts of the mucous membrane of the cheek. and neighboring parts of the mucous membrane of the cheek. They then enter the They then enter the posterior alveolar canals on the infratemporal surface of the maxilla,posterior alveolar canals on the infratemporal surface of the maxilla, and, and, passing from behind forward in the substance of the bone, communicate with the passing from behind forward in the substance of the bone, communicate with the middle superior alveolar nerve, and give off middle superior alveolar nerve, and give off branches to the lining membrane of branches to the lining membrane of the maxillary sinusthe maxillary sinus and and three twigs to each molar tooththree twigs to each molar tooth; these twigs enter the ; these twigs enter the foramina at the apices of the roots of the teeth.foramina at the apices of the roots of the teeth.

Sphenopalatine (Pterygopalatine) BranchesSphenopalatine (Pterygopalatine) Branches two in number, descend to two in number, descend to SSphenopalatine (Pterygopalatine) ganglion.phenopalatine (Pterygopalatine) ganglion.

Branches in Infraorbital canal: Branches in Infraorbital canal:

Maxillary Nerve in the Infraorbital canal is known as Infraorbital Maxillary Nerve in the Infraorbital canal is known as Infraorbital Nerve.Nerve.

   Middle Superior Alveolar NerveMiddle Superior Alveolar Nerve arise in the posterior part of the arise in the posterior part of the

infraorbital canalinfraorbital canal, and , and runs downward and forward in a canal in the runs downward and forward in a canal in the lateral wall of the maxillary sinuslateral wall of the maxillary sinus to to supply the two premolar teethsupply the two premolar teeth. . It forms a superior dental plexus with the anterior and posterior superior It forms a superior dental plexus with the anterior and posterior superior alveolar branches.alveolar branches.

Anterior Superior Alveolar NerveAnterior Superior Alveolar Nerve arises from maxillary nerve arises from maxillary nerve just just before its exit from the infraorbital foramenbefore its exit from the infraorbital foramen; it ; it descends in a canal descends in a canal in the anterior wall of the maxillary sinus (Canalis sinuosus)in the anterior wall of the maxillary sinus (Canalis sinuosus), and , and divides into branches which divides into branches which supply the incisor and canine teeth.supply the incisor and canine teeth. It It communicates with the middle superior alveolar branchcommunicates with the middle superior alveolar branch, and gives off , and gives off a a nasal branchnasal branch, which passes through a minute canal in the lateral wall of , which passes through a minute canal in the lateral wall of the inferior meatus, and the inferior meatus, and supplies the mucous membrane of the supplies the mucous membrane of the anterior part of the inferior meatus and the floor of the nasal cavityanterior part of the inferior meatus and the floor of the nasal cavity, , communicating with the nasal branches from the sphenopalatine ganglion.communicating with the nasal branches from the sphenopalatine ganglion.

Branches on face:Branches on face:

Inferior Palpebral NerveInferior Palpebral Nerve ascend behind the Orbicularis oculi. ascend behind the Orbicularis oculi. They They supply the skin and conjunctiva of the lower eyelidsupply the skin and conjunctiva of the lower eyelid, , joining at the lateral angle of the orbit with the facial and joining at the lateral angle of the orbit with the facial and zygomaticofacial nerves.zygomaticofacial nerves.

External Nasal NerveExternal Nasal Nerve supply the skin of the side of the supply the skin of the side of the nose and of the nasal septumnose and of the nasal septum, and join with the terminal twigs , and join with the terminal twigs of the nasociliary nerve.of the nasociliary nerve.

Superior Labial NerveSuperior Labial Nerve- the largest and most numerous - - the largest and most numerous - distributed to the distributed to the skin of the upper lip, the mucous skin of the upper lip, the mucous membrane of the mouth, and labial glands.membrane of the mouth, and labial glands.

Sphenopalatine Sphenopalatine (Pterygopalatine) Ganglion:(Pterygopalatine) Ganglion:

LocationLocation: in the pterygopalatine fossa, close to the sphenopalatine foramen and is : in the pterygopalatine fossa, close to the sphenopalatine foramen and is situated just below the maxillary nerve as maxillary nerve crosses the fossa and situated just below the maxillary nerve as maxillary nerve crosses the fossa and attached to Maxillary nerve by two twigs. attached to Maxillary nerve by two twigs.

Shape:Shape: Triangular or heart-shaped, and. Triangular or heart-shaped, and.    Roots of Sphenopalatine (Pterygopalatine) Ganglion:Roots of Sphenopalatine (Pterygopalatine) Ganglion:

It receives a sensory, a motor, and a sympathetic root.It receives a sensory, a motor, and a sympathetic root.

Sensory RootSensory Root: Comes from : Comes from maxillary nerve.maxillary nerve.

Motor Root (Parasympathetic root):Motor Root (Parasympathetic root): Preganglioninc fibresPreganglioninc fibres: Lacrimatory : Lacrimatory nucleus of facial nerve>>Nervous intermedius of nucleus of facial nerve>>Nervous intermedius of Facial nerveFacial nerve>>>>Greater Greater petrosal nervepetrosal nerve>> >> Nerve of Petrygoid canalNerve of Petrygoid canal >> >>Pterygopalatine ganglion: Pterygopalatine ganglion: Relay stationRelay station>>>>Postganglionic fibresPostganglionic fibres: Enter : Enter Maxillary nerveMaxillary nerve>>>>Zygomatic Zygomatic branchbranch>>>>Zygomaticotemoral nerveZygomaticotemoral nerve>>communicate with Lacrimal >>communicate with Lacrimal nerve>>nerve>>Lacrimal gland. Postganglionic branches from ganglion also Lacrimal gland. Postganglionic branches from ganglion also supply Nose, palate and Pharynx.supply Nose, palate and Pharynx.

Sympathetic Root: Deep Petrosal Nerve formed from catorid plexus.Sympathetic Root: Deep Petrosal Nerve formed from catorid plexus.

Branches of Sphenopalatine (Pterygopalatine) Ganglion:Branches of Sphenopalatine (Pterygopalatine) Ganglion:

These are divisible into four groups, viz., These are divisible into four groups, viz., orbitalorbital, , palatinepalatine, , posterior superior posterior superior nasalnasal, and , and pharyngealpharyngeal..

Orbital branchesOrbital branches enter the orbit by the inferior orbital fissure, and supply the enter the orbit by the inferior orbital fissure, and supply the periosteum in orbit, the mucous membrane of the periosteum in orbit, the mucous membrane of the posterior ethmoidal and posterior ethmoidal and sphenoidal sinusessphenoidal sinuses..

PalatinePalatine nerves are distributed to the nerves are distributed to the roof of the mouth, soft palate, tonsil, roof of the mouth, soft palate, tonsil, and lining membrane of the nasal cavityand lining membrane of the nasal cavity. Most of their fibers are derived from . Most of their fibers are derived from the sphenopalatine branches of the maxillary nerve. They are three in number: the sphenopalatine branches of the maxillary nerve. They are three in number: anterior, middle, and posterior palatine nerves.anterior, middle, and posterior palatine nerves.

Posterior superior nasalPosterior superior nasal branches are distributed branches are distributed to the septum and lateral to the septum and lateral wall of the nosewall of the nose. They enter the posterior part of the nasal cavity by the . They enter the posterior part of the nasal cavity by the sphenopalatine foramen and supply the mucous membrane covering the superior sphenopalatine foramen and supply the mucous membrane covering the superior and middle nasal conchæ, the lining of the posterior ethmoidal cells, and the and middle nasal conchæ, the lining of the posterior ethmoidal cells, and the posterior part of the septum. posterior part of the septum. One branch, longer and larger than the others, One branch, longer and larger than the others, is named the nasopalatine nerve.is named the nasopalatine nerve.

Pharyngeal nervePharyngeal nerve is a small branch arising from the posterior part of the is a small branch arising from the posterior part of the ganglion. It passes through the pharyngeal canal and ganglion. It passes through the pharyngeal canal and supplysupply to the mucous to the mucous membrane of the membrane of the nasal part of the pharynx, behind the auditory tubenasal part of the pharynx, behind the auditory tube..

Applied Anatomy-Maxillary nerveApplied Anatomy-Maxillary nerve

For upper jaw dental surgery following important nerve blocks For upper jaw dental surgery following important nerve blocks are done.are done.

Maxillary Nerve BlockMaxillary Nerve Block: Complete Maxillary nerve block is commonly not : Complete Maxillary nerve block is commonly not required. The indications for complete maxillary nerve block are few for required. The indications for complete maxillary nerve block are few for example procedures requiring anesthesia of multiple teeth and example procedures requiring anesthesia of multiple teeth and surrounding areas.surrounding areas.

Posterior Superior Alveolar Nerve BlockPosterior Superior Alveolar Nerve Block: Used to anesthetize 1: Used to anesthetize 1stst, 2, 2ndnd and 3and 3rdrd Molar teeth and associated gingival tissue. Molar teeth and associated gingival tissue.

Middle Superior Alveolar nerve block: Middle Superior Alveolar nerve block: for Premolarsfor Premolars Anterior Superior Alveolar nerve block: Anterior Superior Alveolar nerve block: for canine and incisorsfor canine and incisors Infraorbital Nerve BlockInfraorbital Nerve Block: Used to anesthetize 1: Used to anesthetize 1stst, 2, 2ndnd Premolar, canine Premolar, canine

and incisor teeth. It combines both Anterior superior Alveolar and Middle and incisor teeth. It combines both Anterior superior Alveolar and Middle Superior Alveolar Nerve block.Superior Alveolar Nerve block.

Greater Palatine Nerve BlockGreater Palatine Nerve Block: Used to anesthetize soft and hard : Used to anesthetize soft and hard palate tissue behind maxillary molars.palate tissue behind maxillary molars.

Nasopalatine Nerve Block:Nasopalatine Nerve Block: For anterior palate from canine to canine. For anterior palate from canine to canine.

MAXILLARY BRANCH OF V2 MAXILLARY BRANCH OF V2 Second division of the trigeminal nerve.Second division of the trigeminal nerve.

Is a sensory nerve.Is a sensory nerve. It begins - middle of semilunar ganglion as a It begins - middle of semilunar ganglion as a

flattened plexiform band, passing horizontally flattened plexiform band, passing horizontally forward - leaves the skull , forward - leaves the skull , foramen rotundum.foramen rotundum.

Then crosses - pterygopalatine fossa - enters the Then crosses - pterygopalatine fossa - enters the orbit through the inferior orbital fissure - it orbit through the inferior orbital fissure - it traverses the infraorbital groove and canal in the traverses the infraorbital groove and canal in the floor of the orbit and appears on the face - floor of the orbit and appears on the face - infraorbital foramen infraorbital foramen

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In the cranium Middle Meningeal NerveIn the Pterygopalatine

fossaZygomatic

SphenopalatinePosterior Superior

AlveolarIn the Infraorbital Canal Anterior Superior

AlveolarMiddle Superior Alveolar

On the Face Inferior PalpebralExternal NasalSuperior Labial

Branches of Maxillary Nerve

Maxillary divison(v2)Maxillary divison(v2)From middle of the gaserion ganglion it travels From middle of the gaserion ganglion it travels

anteriorly & downwords anteriorly & downwords

Branche Within cranium –Branche Within cranium –Middle minengial nerve Middle minengial nerve

Run along with middle minengial Run along with middle minengial artery, sensory innervation to dura artery, sensory innervation to dura matter.matter.

Exit cranium from foramen rotundum Exit cranium from foramen rotundum 4444

Within pterigopalatine fossaWithin pterigopalatine fossa Zygomatic Zygomatic pterygopalatine nerve pterygopalatine nerve

inferior.orbital fissureinferior.orbital fissure pterygopalatine ganglion pterygopalatine ganglionZygomatico temporal zygomatico facialZygomatico temporal zygomatico facialSkin of forehead to skin of cheekSkin of forehead to skin of cheek

Orbital Orbital nasal/nasopalatine nasal/nasopalatine palatine palatine pharyngeal pharyngealPeriosteum roof of nasal cavity,Periosteum roof of nasal cavity, greater palatine nerve greater palatine nerve pharyngial canalpharyngial canalof orbit mucous memb.&ant. Part of orbit mucous memb.&ant. Part g.p.foramen g.p.foramen supplies to nasal supplies to nasal

of nasal septum,of nasal septum, runs muco periosteum & part of pharynx runs muco periosteum & part of pharynx incisive canalincisive canal hard palate hard palate incisive foramenincisive foramen supplies soft tissues ant. to supplies soft tissues ant. to rt.&lt. nasopalatine nervert.&lt. nasopalatine nerve 1 1stst PM PM supplies hard palate -1 to 3 supplies hard palate -1 to 3 Lesser palatine nerveLesser palatine nerve lesser palatine foramen &supplieslesser palatine foramen &supplies mucous memb. Of soft palate &mucous memb. Of soft palate & tonsillar region.tonsillar region. 4545

Post. Superior alveolar nervePost. Superior alveolar nerve11stst trunk trunk 22ndnd trunk trunkExternal to bone External to bone inters into maxillainters into maxillaBuccal gingiva Buccal gingiva sensory innervation to sensory innervation to In maxillary molarsIn maxillary molars sinus, alveolus, pulp of sinus, alveolus, pulp of

maxillary maxillary molars(molars(exceptionexception -mesio -mesio buccal root of 1buccal root of 1stst

molars)molars)

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In infra orbital canalIn infra orbital canalMSA nerveMSA nerve ASA nerveASA nerve

11stst & 2 & 2ndnd PM region PM region supplies antarior supplies antarior wall ofwall ofMesiobuccal root of 1Mesiobuccal root of 1stst M M maxillray sinus & maxillray sinus &

supplies 1 to 3.supplies 1 to 3.PDL, buccal soft tissue, bonePDL, buccal soft tissue, bone(in 30% cases, it is absent then(in 30% cases, it is absent thenPsa & Asa Psa & Asa Provides its supplies).Provides its supplies).

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In the face In the face

Inferior pulpaberal external nasal sup. LabialInferior pulpaberal external nasal sup. LabialSkin of lower eyelid skin of lateral skin,mucous Skin of lower eyelid skin of lateral skin,mucous

aspect of nose aspect of nose memb.,upper memb.,upper

lip. lip.

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MAXILLARY NERVE BRANCHESMAXILLARY NERVE BRANCHES A. ZygoticaticotemporalA. Zygoticaticotemporal

B. ZygomaticofacialB. Zygomaticofacial

C. Post. Sup. Alveolar C. Post. Sup. Alveolar

D. NasopalatineD. Nasopalatine

E. Greater PalatineE. Greater Palatine

F. Lesser PalatineF. Lesser Palatine

G. Mid. & Ant. Alveolar G. Mid. & Ant. Alveolar

H. InfraorbitalH. Infraorbital

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Mandibular Mandibular NerveNerve

The mandibular nerve supplies:The mandibular nerve supplies: The teeth and gums of the mandible. The teeth and gums of the mandible. The skin in the temporal region, part of the The skin in the temporal region, part of the

auricle, including the external meatus and auricle, including the external meatus and tympanum.tympanum.

The lower lip, the lower part of the face The lower lip, the lower part of the face The muscles of mastication. The muscles of mastication. The mucosa of the anterior two-thirds, The mucosa of the anterior two-thirds,

(presulcal part) of the tongue and the (presulcal part) of the tongue and the mucosa of the floor of the oral cavity.mucosa of the floor of the oral cavity.

Mandibular NerveMandibular Nerve

Mandibular nerve:Mandibular nerve:Origin and courseOrigin and course

A branch of trigeminal A branch of trigeminal (V cranial) nerve. It Has(V cranial) nerve. It Has

A Large Sensory A Large Sensory root:root: Arises from Arises from lateral part of lateral part of trigeminal ganglia in trigeminal ganglia in middle cranial fossamiddle cranial fossa

A small motor rootA small motor root : : which passes under the which passes under the ganglion to unite with ganglion to unite with the sensory root just the sensory root just outside the skull. outside the skull.

Mandibular nerveTrigeminal gangliaTrigeminal ganglia

Motor rootMandibular nerveMandibular nerve

Mandibular nerveMandibular nerve

Passes through Passes through foramen ovale to foramen ovale to infratemporal fossa infratemporal fossa

Here it lies between Here it lies between the tensor veli palatini the tensor veli palatini (medial) and the (medial) and the lateral pterygoid.lateral pterygoid.

Mandibular nerveMandibular nerve Just beyond this Just beyond this

junction a junction a meningeal branch meningeal branch and the nerve to and the nerve to the medial the medial pterygoid leaves pterygoid leaves the medial side of the medial side of the nerve.the nerve.

The nerve then The nerve then divides into a small divides into a small anterior and large anterior and large posterior trunk.posterior trunk.

As it As it descends descends from the from the foramen foramen ovale, the ovale, the nerve is about nerve is about 4 cm from the 4 cm from the surface and a surface and a little anterior little anterior to the neck of to the neck of the mandible.the mandible.

Mandibular NerveMandibular Nerve( ( in infratemporal fossain infratemporal fossa))

Branches: Branches: From trunk:From trunk:1.1. Meningeal branchMeningeal branch2.2. Nerve to medial pterygoid Nerve to medial pterygoid

musclemuscleFrom Anterior Division:From Anterior Division:1.1. Anterior and posterior Deep Anterior and posterior Deep

temporal nervestemporal nerves2.2. Nerve to lateral Pterygoid Nerve to lateral Pterygoid

musclemuscle3.3. Nerve to Messetor muscleNerve to Messetor muscle4.4. Buccal nerve ( only sensory Buccal nerve ( only sensory

nerve)nerve)From Posterior Division:From Posterior Division:1.1. Auriculotemporal nerveAuriculotemporal nerve2.2. Lingual nerve Lingual nerve 3.3. Inferior alveolar nerve Inferior alveolar nerve

Meningeal branch

Nerve to medial pterygoid

Buccal nerve

Anterior and posterior Deep temporal nerves

Nerve to Messetor

Nerve to lateral Pterygoid

Auriculotemporal nerve

1. Lingual nerve

1. Inferior alveolar nerve

Nerve to Mylohyoid

Infra temporal fossa ( Medial View)Infra temporal fossa ( Medial View)

Mandibular NerveMandibular NerveBranches: Branches: From trunk:From trunk:1.1. Meningeal branchMeningeal branch2.2. Nerve to medial Nerve to medial

pterygoid musclepterygoid muscle From Anterior Division:From Anterior Division:1.1. Anterior and posterior Anterior and posterior

Deep temporal nervesDeep temporal nerves2.2. Nerve to lateral Nerve to lateral

Pterygoid musclePterygoid muscle3.3. Nerve to Messetor Nerve to Messetor

musclemuscle4.4. Buccal nerve ( only Buccal nerve ( only

sensory nerve)sensory nerve) From Posterior From Posterior

Division:Division:1.1. Auriculotemporal nerveAuriculotemporal nerve2.2. Lingual nerve Lingual nerve 3.3. Inferior alveolar nerve Inferior alveolar nerve

Mandibullar division v3Mandibullar division v3Origin Origin motor root motor root sensory root sensory root

motor nucleus of pons motor nucleus of pons gasserion ganglion gasserion ganglion & medulla & medulla oblongataoblongata

Foramen ovaleForamen ovaleBranches from undivided nerve:Branches from undivided nerve:

Nervus spinosum Nervus spinosum medial pterygoid medial pterygoidenters along middle minengial enters along middle minengial medial pterygoid medial pterygoid artery through foramen artery through foramen muscle muscle spinosum spinosum

small branches to tensorsmall branches to tensorto supply dura matter,mastoid air cells. velli palatini, tensor to supply dura matter,mastoid air cells. velli palatini, tensor rr tympani. tympani.

Runs under the lateral pterygoid musclesRuns under the lateral pterygoid muscles6262

Branches From antarior division:Branches From antarior division:Buccal/long buccal n. masseteric deep temporal lateral pterygoid Buccal/long buccal n. masseteric deep temporal lateral pterygoid

Sensory supply to mucous Sensory supply to mucous Memb. Of cheek &buccal Memb. Of cheek &buccal part of mand. Molars.part of mand. Molars.Passes between the two Passes between the two heads of lateral pterygoidheads of lateral pterygoid motor supply to related musclesmotor supply to related musclesAt the level of occlusal plane At the level of occlusal plane Between 2Between 2ndnd &3 &3rdrd molar it molar it crosses ant. crosses ant. Border of the ramus & Border of the ramus & enters into cheek enters into cheek through buccinator muscles.through buccinator muscles.

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Branches from posterior division:Branches from posterior division:Auriculo temporal lingual nerveAuriculo temporal lingual nerve inferior alveolar nerve inferior alveolar nerveSensory supply to medial to IAN& lateral Sensory supply to medial to IAN& lateral medial to lingual nerve & medial to lingual nerve & parotid gland, parotid gland, pterygoid muscle. pterygoid muscle. lateral pterygoid,runs on lateral pterygoid,runs on external auditory external auditory medial surface of ramus medial surface of ramusmeatus,TMJ, meatus,TMJ, in pterygomandibular space. Along with inf. alveolar in pterygomandibular space. Along with inf. alveolar

Temporal region. sensory supply to ant. 2/3Temporal region. sensory supply to ant. 2/3 rdrd artery & vein. artery & vein.

of the tongue, mucous memb. Supplies mandi. molarsof the tongue, mucous memb. Supplies mandi. molars of floor of of floor of the mouth,lingual before entering mentalthe mouth,lingual before entering mentalaspect of the gingiva foramen it divides intoaspect of the gingiva foramen it divides into mylohyoid nerve.mylohyoid nerve. in mental foramen in mental foramen

incisive nerve mental nerve incisive nerve mental nerve mandi. Incisors & PM’s chin & lower mandi. Incisors & PM’s chin & lower lips. lips.

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MANDIBULAR NERVE MANDIBULAR NERVE BRANCHES (posterior division)BRANCHES (posterior division)

A. AuriculotemporalA. AuriculotemporalB. LingualB. Lingual

C. Inferior AlveolarC. Inferior AlveolarD. N. to the D. N. to the MylohyoidMylohyoidE. MentalE. MentalF. BuccalF. Buccal

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Infratemporal fossa

Lingual NerveLingual Nerve

Applied Anatomy-Lingual nerveApplied Anatomy-Lingual nerve

The lingual nerve is at great risk during The lingual nerve is at great risk during surgical removal of (impacted) lower surgical removal of (impacted) lower third molars. After such operations up to third molars. After such operations up to 10% of patients may have symptoms, 10% of patients may have symptoms, which are usually temporary, of nerve which are usually temporary, of nerve damage. The nerve is also at risk during damage. The nerve is also at risk during operations to remove the submandibular operations to remove the submandibular salivary gland, during which the duct salivary gland, during which the duct must be dissected from the lingual must be dissected from the lingual nerve.nerve.

Inferior alveolar nerve blockInferior alveolar nerve block The surface marking of the inferior alveolar nerve from the The surface marking of the inferior alveolar nerve from the

inside of the oral cavity is important in giving nerve blocks. inside of the oral cavity is important in giving nerve blocks. The mandibular foramen lies midway between the anterior The mandibular foramen lies midway between the anterior

and posterior borders of the ascending ramus of the and posterior borders of the ascending ramus of the mandible about 1 cm above the occlusal surfaces of the mandible about 1 cm above the occlusal surfaces of the lower teeth. lower teeth.

With either technique the buccal and lingual nerves can be With either technique the buccal and lingual nerves can be blocked en passant.blocked en passant.

The inferior dental nerve may be damaged during the The inferior dental nerve may be damaged during the extraction of an impacted lower third molar tooth. The roots extraction of an impacted lower third molar tooth. The roots of such teeth are commonly grooved and, very rarely, of such teeth are commonly grooved and, very rarely, perforated by the nerve. perforated by the nerve.

It is also frequently damaged in fractures of the posterior It is also frequently damaged in fractures of the posterior tooth-bearing part of the mandible.tooth-bearing part of the mandible.

Mental nerve blockMental nerve block Incisive nerve blockIncisive nerve blockGow-Gates Technique of Mandibular Gow-Gates Technique of Mandibular

blockblock

OTIC GANGLIONOTIC GANGLION::

Small, oval shaped,reddish-gray color ganglionSmall, oval shaped,reddish-gray color ganglion- situated immediately below the foramen ovale.- situated immediately below the foramen ovale. Lies - medial surface of the mandibular nerve.Lies - medial surface of the mandibular nerve.

DISTRIBUTION:DISTRIBUTION: A filament to the A filament to the

Tensor tympani.Tensor tympani.Tensor veli palatini.Tensor veli palatini.

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SUBMAXILLARY GANGLION:SUBMAXILLARY GANGLION:

Small size & fusiform in shape. Small size & fusiform in shape. Situated above the deep portion of the submaxillary Situated above the deep portion of the submaxillary

gland.gland.

DISTRIBUTION:DISTRIBUTION: Arise - from the lower part of the ganglion.Arise - from the lower part of the ganglion. Supply - mucous membrane of the mouth and the duct Supply - mucous membrane of the mouth and the duct

of the submaxillary gland.of the submaxillary gland.

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TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA

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TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIAINTRODUCTION:INTRODUCTION: Causes facial pain. Causes facial pain.  TN develops in mid to late life. TN develops in mid to late life. The condition is the most frequently The condition is the most frequently

occurring of all the nerve pain occurring of all the nerve pain disorders. disorders.

The pain which comes and goes - The pain which comes and goes - feels like bursts of sharp, stabbing, feels like bursts of sharp, stabbing, electric-shocks.electric-shocks.

This pain can last from a few This pain can last from a few seconds to a few minutes.seconds to a few minutes.

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