The Trigeminal Nerve

THE TRIGEMINAL NERVE
Property of Dr. Michelle C. Sunico, UP College of Dentistry. Please do not copy without permission from the author.
BASIC POINTS
The trigeminal nerve is the largest of the twelve cranial nerves. It arises from the trigeminal ganglion or semilunar ganglion at the petrous portion on the temporal bone. It is a mixed nerve, with both motor and sensory fibers. The trigeminal nerve has three main divisions: 1. V1 or the ophthalmic division exits the skull thru the superior orbital fissure. This is the smallest division and is purely sensory. 2. V2 or the maxillary division exits the skull thru the foramen rotundum. The maxillary nerve is a purely sensory nerve. 3. V3 or mandibular division exits the skull thru the foramen ovale. This is the largest division and is a mixed nerve, containing both sensory and motor fibers.
Ophthalmic N. Maxillary N.
Mandibular N.
Mandibular N. Opthalmic N. Maxillary N.
AREAS OF INNERVATION OF CNV
V1
V2
V3
The ophthalmic division (V1) exits the skull thru the superior orbital fissure. Its branches innervate the scalp, the upper eyelid. It is the smallest division of the trigeminal nerve and is a purely sensory or afferent nerve.
OPHTHALMIC NERVE (V1)
THE MAXILLARY NERVE

The maxillary nerve courses forward through the wall of the cavernous sinus and leaves the skull through the foramen rotundum. It crosses the pterygopalatine fossa, where it anastomoses with branches from the sphenopalatine ganglion, a parasympathetic ganglion. The maxillary nerve is a purely sensory nerve. The branches of the maxillary nerve are: 1. Inside the cranium nerve to the dura 2. At the pterygopalatine fossa area a. Branches from the sphenopalatine ganglion (click here) b. Zygomatic nerve i. Zygomaticofacial ii. Zygomaticotemporal c. Posterior superior alveolar nerve (PSAN) enters the alveolar canal thru the posterior superior alveolar foramina to innervate the pulps of the maxillary molars except the mesiobuccal root of the first molar.
3. At the infraorbital canal a. Middle superior alveolar nerve (MSAN) innervates the pulps of the maxillary premolars and the mesiobuccal root of the first molar. b. Anterior superior alveolar nerve (ASAN) innervates the pulps of the maxillary anteriors. 3. Terminal branches (exit through the infraorbital foramen) a. Inferior palpebral sensory to the lower eyelid b. Lateral nasal sides of the nose c. Superior labial upper lip
F. ROTUNDUM
INFRAORBITAL FORAMEN
TRIGEMINAL GANGLION
INFRAORBITAL CANAL
PTERYGOPALATINE PTERYGOPALATINE FOSSA AREA FOSSA AREA PETROUS PORTION OF THE TEMPORAL BONE
POST. SUPERIOR ALV. FORAMINA
THE MAXILLARY NERVE
NERVE TO THE DURA Z. FACIAL N. INF. PALPEBRAL INF. PALPEBRAL ZYGOMATIC N. LATERAL NASAL LATERAL NASAL SUPERIOR LABIAL SUPERIOR LABIAL ANT. SUP. ALV. N. ANT. SUP. ALV. N. (ASAN) (ASAN) INFRAORBITAL N. MIDDLE SUP. ALV. N. MIDDLE SUP. ALV. N. POST-SUP ALVEOLAR N. (PSAN) (MSAN) (MSAN) Z. TEMPORAL N.
SUPERIOR DENTAL PLEXUS
THE SPHENOPALATINE GANGLION

The sphenopalatine ganglion is part of the parasympathetic nervous system. This gangliion gives off several branches, containing visceral motor as well as sensory fibers, to the mucous membrane of the mouth, nose and pharynx. Its branches are: 1. Orbital branch 2. Posterior lateral nasal 3. Palatine nerves a. Nasopalatine nerve exits thru the nasopalatine or incisive foramen. Innervates the palatal mucosa of the anterior maxillary teeth b. Greater/ Anterior palatine nerve exits thru the greater/anterior palatine foramen. Innervates the palatal mucosa of the posterior maxillary teeth. c. Middle palatine nerve exits thru the lesser/posterior palatine foramen together with the lesser palatine nerve. Innervates the soft palate. d. Lesser/Posterior palatine nerve exits thru the lesser palatine
BRANCHES FROM THE SPHENOPALATINE GANGLION

ORBITAL NERVE
POSTERIOR LATERAL NASAL
SPHENOPALATINE GANGLION
NASOPALATINE N.
GREATER PALATINE OR ANTERIOR PALATINE N.
MIDDLE PALATINE N.
LESSER PALATINE OR POST. PALATINE N.
THE MANDIBULAR NERVE

The mandibular nerve exits the skull thru the foramen ovale. For a short distance, the nerve is undivided where it gives of several branches to muscles of the inner ear, soft palate, mastication and dura. It then divides into an anterior trunk and a larger posterior trunk. The posterior trunk, after giving branches to the temporal area, mylohyoid muscle and the tongue enters the mandibular canal thru the mandibular foramen where it becomes known as the inferior alveolar nerve. Inside the canal, it gives off dental branches to innervate the roots of the mandibular teeth. At the area of the mandibular premolars, a small branch exits thru the mental foramen to innervate the lower lip and chin. Inside the canal, the inferior alveolar nerve continues as the incisive nerve to innervate the mandibular anterior teeth. The smaller anterior trunk gives off branches to the buccal mucosa of the mandibular posterior teeth and most of the muscles of mastication.
THE BRANCHES OF THE MANDIBULAR NERVE

I. Undivided Nerve 1. 2. 3. 4. 5. II. 1. Nerve to the dura sensory Internal Pterygoid muscle - motor Tensor veli palatini - motor Tensor tympani - motor Nerve to the mastoid cells sensory Anterior Trunk a. b. c. d. Buccinator (long buccal) sensory External pterygoid ms. - motor Temporalis ms. - motor Masseteric nerve - motor
Divided Nerve
2. Posterior trunk a. Auriculotemporal b. Lingual c. Mylohyoid nerve d. Inferior alveolar nerve ---- incisive nerve e. Mental nerve
DURA (N. TENTORII)
MASTOID CELLS
INT. PTERYGOID MUSCLE TENSOR VELI PALATINI ANT. TRUNK
UNDIVIDED N. TENSOR TYMPANI
POST. TRUNK
DIVIDED N.
N. TO EXT. PTERYGOID MS.
N. TO TEMPORALIS
N. TO MASSETER
LONG BUCCAL N.
LINGUAL N.
MANDIBULAR FORAMEN
MD A IB NU LRA ACN A L
LINGUAL N.
MANDIBULAR FORAMEN
MD A IB NU LRA ACN A L
INFERIOR ALV. N. MYLOHYOID N. MENTAL FORAMEN
LINGUAL N.
MENTAL N.
MENTAL FORAMEN
INCISIVE N.
INNERVATION OF THE TONGUE

SENSORY ANTERIOR 2/3 Lingual Nerve branch of the Trigeminal Nerve MOTOR Hypoglossal Nerve (XII) innervates the intrinsic and extrinsic muscles of the tongue
POSTERIOR 1/3
Glossopharyngeal Hypoglossal Nerve Nerve (IX) (XII)
Taste
Chorda Tympani branch from the Facial Nerve (VII)
THE CHORDA TYMPANI

Mandibular nerve
Lingual n.
Chorda tympani, special branch from the Facial Nerve (CNVII) for the sensation of taste.
Inferior alveolar n.
Mylohyoid n.
Monheims Textbook of Dental Anesthesia http://medinfo.ufl.edu
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THE TRIGEMINAL NERVE

Mandibular N. Opthalmic N. Maxillary N.

AREAS OF INNERVATION OF CNV

OPHTHALMIC NERVE (V1)

THE MAXILLARY NERVE

POST. SUPERIOR ALV. FORAMINA

THE MAXILLARY NERVE

SUPERIOR DENTAL PLEXUS

THE SPHENOPALATINE GANGLION

BRANCHES FROM THE SPHENOPALATINE GANGLION

POSTERIOR LATERAL NASAL

GREATER PALATINE OR ANTERIOR PALATINE N.

LESSER PALATINE OR POST. PALATINE N.

THE MANDIBULAR NERVE

THE BRANCHES OF THE MANDIBULAR NERVE

DURA (N. TENTORII)

INT. PTERYGOID MUSCLE TENSOR VELI PALATINI ANT. TRUNK

UNDIVIDED N. TENSOR TYMPANI

N. TO EXT. PTERYGOID MS.

INFERIOR ALV. N. MYLOHYOID N. MENTAL FORAMEN

INNERVATION OF THE TONGUE

Glossopharyngeal Hypoglossal Nerve Nerve (IX) (XII)

Chorda Tympani branch from the Facial Nerve (VII)

THE CHORDA TYMPANI

Monheims Textbook of Dental Anesthesia http://medinfo.ufl.edu

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