Trigeminal nerve dr. gosai

Trigeminal NerveTrigeminal Nerve
Dr.B.B.GosaiDr.B.B.Gosai

Cranial Nerve V - Trigeminal NerveCranial Nerve V - Trigeminal Nerve
• Trigeminal nerveTrigeminal nerve is the largest cranial nerve and contain both motor andis the largest cranial nerve and contain both motor and
sensory fibres.sensory fibres.
• Trigeminal nerve Nuclei:Trigeminal nerve Nuclei:
• Main sensory nucleusMain sensory nucleus : located in posterior part of pons lateral to motor: located in posterior part of pons lateral to motor
nucleus.nucleus.
• Spinal nucleusSpinal nucleus : Extends into the medulla oblongata and upper part of: Extends into the medulla oblongata and upper part of
spinal cord up to second cervical segment.spinal cord up to second cervical segment.
• Mesencephalic nucleusMesencephalic nucleus : Column of unipolar neurons in grey matter: Column of unipolar neurons in grey matter
around cerebral aqueduct.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) >> centraltemperature, touch and pressure >> semilunar (trigeminal ganglion) >> central
processes go to sensory trigeminal nuclei >> pain and temperature go toprocesses go to sensory trigeminal nuclei >> pain and temperature go to
Spinal nucleus and touch and pressure go to Main sensory nucleus and jointSpinal nucleus and touch and pressure go to Main sensory nucleus and joint
sensation from head go to Mesencephalic nucleus.sensation from head go to Mesencephalic nucleus.
• Motor Component of Trigeminal nerveMotor Component of Trigeminal nerve : Supplies muscles of: Supplies muscles of
mastication, tensor tympani, tensor veli palatini, mylohyoid and anterior bellymastication, tensor tympani, tensor veli palatini, mylohyoid and anterior belly
of digastricof digastric

Motor rootMotor root
Passes forward in posterior fossaPasses forward in posterior fossa
Pierces the duramater beneathPierces the duramater beneath
attachment of tentorium to tip of petrousattachment of tentorium to tip of petrous
part of temporal bone.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 formIt joins the mandibular div of Vth N to form
mandibular nerve – supplies masticatorymandibular nerve – supplies masticatory
muscles .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 theWhen pterygoids contract on one side- pull the
mandible contralaterally -- Unilateral pterygoidmandible contralaterally -- Unilateral pterygoid
weakness – jaw deviates towards side of weakweakness – jaw deviates towards side of weak
musclemuscle
 Motor root also supply Mylohyoid, Ant.belly ofMotor root also supply Mylohyoid, Ant.belly of
digastric, Tensor veli palatini, Tensor tympanidigastric, Tensor veli palatini, Tensor tympani

Sensory portionSensory portion
Trigeminal / gasserian / semilunarTrigeminal / gasserian / semilunar
ganglionganglion
Situated just beside pons in a shallowSituated just beside pons in a shallow
depression in petrous apex – meckel’sdepression in petrous apex – meckel’s
cavecave
Sensory root enters the pons courseSensory root enters the pons course
dorsomedially & terminate withindorsomedially & 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 nucleusMesencephalic nucleus

Fibres – pain & temp – enter spinal tract ofFibres – pain & temp – enter spinal tract of
trigeminal & descend to various levelstrigeminal & descend to various levels
depending on their somatotropic origin,depending on their somatotropic origin,
then synapse in adjacent nucleus of spinalthen synapse in adjacent nucleus of spinal
tract.tract.
The axons of second order neurons crossThe axons of second order neurons cross
midline, aggregate as trigeminothalamicmidline, aggregate as trigeminothalamic
tract & ascend to VPMtract & ascend to VPM
From VPM , fibres project throughFrom VPM , fibres project through
thalamic radiations to sensory cortex inthalamic radiations to sensory cortex in
post central gyruspost central gyrus

Main sensory nucleusMain sensory nucleus
Lateral ponsLateral pons
Posterolateral to motor nucleusPosterolateral to motor nucleus
Tactile & proprioceptive sensationTactile & proprioceptive sensation
Afferent fibers – light touch , pressure –Afferent fibers – light touch , pressure –
enter this nucleus – synapse – secondenter this nucleus – synapse – second
order neurons which cross midline enorder neurons which cross midline en
route to VPM Thalamic nucleus.route to VPM Thalamic nucleus.

Mesencephalic nucleusMesencephalic nucleus
Extends cephalad from main sensoryExtends cephalad from main sensory
nucleus to sup.colliculus ofnucleus to sup.colliculus of
mesencephalon.mesencephalon.
Receives proprioceptive impulses fromReceives proprioceptive impulses from
masticatory muscles, extraocular &masticatory muscles, extraocular &
muscles of facial expression.muscles of facial expression.

Cranial Nerve Nuclei
1. Somatic efferent
2. Special visceral efferent
3. General visceral efferent
4. General visceral afferent
5. Special visceral afferent
6. General somatic afferent
7. Special somatic afferent

Functional componentsFunctional components
General somatic afferent: Sensory forGeneral somatic afferent: Sensory for
face.face.
Special Visceral efferent : Nerve of firstSpecial Visceral efferent : Nerve of first
branchial arch.branchial arch.

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 nerveCourse of Trigeminal nerve emerge as small motor root andemerge as small motor root and
large sensory root from the anterior aspect of pons. Sensory rootlarge sensory root from the anterior aspect of pons. Sensory root
form crescent shaped trigeminal ganglion which lie in pouch of duraform crescent shaped trigeminal ganglion which lie in pouch of dura
mater called as trigeminal cave (Meckel’s cave). Three divisionsmater called as trigeminal cave (Meckel’s cave). Three divisions
emerge from anterior aspect of ganglion. Three divisions areemerge from anterior aspect of ganglion. Three divisions are
Ophthalmic, Maxillary and Mandibular. Motor root unite withOphthalmic, Maxillary and Mandibular. Motor root unite with
Mandibular division:Mandibular division:
• Ophthalmic divisionOphthalmic division : sensory nerve >> superior orbital fissure: sensory nerve >> superior orbital fissure
>>orbit >> supply orbital structures and forehead.>>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 the face.Supply deep structures of head and skin of middle of the face.
• Mandibular divisionMandibular division : sensory and motor nerve >> foramen: sensory and motor nerve >> foramen
oval >> Supply muscles of mastication and skin of lower part ofoval >> Supply muscles of mastication and skin of lower part of
face.face.

2 Roots:2 Roots:
Larger Sensory RootLarger Sensory Root
Smaller Motor RootSmaller Motor Root
3 primary divisions:3 primary divisions:
OphthalmicOphthalmic ( V1) - sensory( V1) - sensory
- innervates the upper portion- innervates the upper portion
of the faceof the face
MaxillaryMaxillary (V2)- sensory –(V2)- sensory –
innervates the mid face regioninnervates the mid face region
MandibularMandibular (V3)(V3)
-sensory+motor – innervates-sensory+motor – innervates
the lower facial regionthe lower facial region
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Divisions of Cranial Nerve VDivisions of Cranial Nerve V
 OphthalmicOphthalmic
 FrontalFrontal
 LacrimalLacrimal
 NasociliaryNasociliary
 MaxillaryMaxillary
 MandibularMandibular

Ophthalmic NerveOphthalmic Nerve

Frontal NerveFrontal Nerve
 Branch of ophthalmic divisionBranch of ophthalmic division of trigeminalof trigeminal
nerve.nerve.
 Enters the orbit through upper part of superiorEnters the orbit through upper part of superior
orbital fissure.orbital fissure.
 Pass forwards on upper surface of levatorPass forwards on upper surface of levator
palpebrae superioris.palpebrae superioris.
 It divides intoIt divides into Supratorchlear andSupratorchlear and
Supraorbital nerves.Supraorbital nerves.
 SupplySupply: Skin of forehead. Supraorbital nerve in: Skin of forehead. Supraorbital nerve in
addition supply Frontal air sinus also.addition supply Frontal air sinus also.

Lacrimal NerveLacrimal Nerve
nerve.nerve.
 Enters the orbit through upper part of superiorEnters the orbit through upper part of superior
 Pass forwards along the upper border of lateralPass forwards along the upper border of lateral
rectus muscle.rectus muscle.
 It is joined by Zygomaticotemporal nerve whichIt is joined by Zygomaticotemporal nerve which
later leave to supply parasympathetic fibers tolater leave to supply parasympathetic fibers to
lacrimal gland.lacrimal gland.
 SupplySupply: skin of lateral part of eyelid.: skin of lateral part of eyelid.

Nasociliary NerveNasociliary Nerve
nerve.nerve.
 Enters the orbit through lower part of superiorEnters the orbit through lower part of superior
 It crosses the optic nerve from lateral toIt crosses the optic nerve from lateral to
medial side along with ophthalmic artery.medial side along with ophthalmic artery.
 Run along the upper border of Medial rectusRun along the upper border of Medial rectus
muscle and ends by dividing into Anteriormuscle 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 nerve.to Ciliary ganglion is sensory nerve.
 Long ciliary nervesLong ciliary nerves : two or three in number crosses optic nerve: two or three in number crosses optic nerve
and pierces sclera of eyeball. They carry sympathetic fibers forand pierces sclera of eyeball. They carry sympathetic fibers for
Dilator pupillae.Dilator pupillae.
 Posterior ethmoidal nervePosterior ethmoidal nerve : supplies ethmoidal and sphenoidal: supplies ethmoidal and sphenoidal
air sinuses.air sinuses.
 Infratrochlear nerveInfratrochlear nerve : supplies skin of medial part of eyelid and: supplies skin of medial part of eyelid and
adjacent part of nose.adjacent part of nose.
 Anterior ethmoidal nerveAnterior ethmoidal nerve : enter in cranial cavity and enter the: enter in cranial cavity and enter the
nose near cribriform plate of ethmoid. Supplies mucus membranenose near cribriform plate of ethmoid. Supplies mucus membrane
of nose and appear on face as external nasal nerve to supply skinof nose and appear on face as external nasal nerve to supply skin
of nose up to tip of nose.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 aThe 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, itPassing horizontally forward, it leaves the skull through theleaves the skull through the
foramen rotundum.foramen rotundum.
 It thenIt then crosses the pterygopalatine fossacrosses the pterygopalatine fossa , inclines lateralward, inclines lateralward
on the back of the maxilla.on the back of the maxilla.
 Enters the orbitEnters the orbit through the inferior orbital fissure.through the inferior orbital fissure.
 It traversesIt traverses the infraorbital groove and canalthe infraorbital groove and canal in the floor of thein the floor of the
orbit.orbit.
 Appears upon the face at theAppears upon the face at the infraorbital forameninfraorbital foramen ..
 At its termination on face, the nerveAt its termination on face, the nerve divides into branchesdivides into branches
which spread outwhich spread out upon the side of the nose, the lower eyelid, andupon the side of the nose, the lower eyelid, and
the upper lip.the 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 the(Contain fibres for lacrimal gland and also supply skin if the
side of forehead) andside 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; they
are generally two in number, but sometimes arise by a single trunk. Theyare generally two in number, but sometimes arise by a single trunk. They descend on thedescend on the
tuberosity of the maxillatuberosity of the maxilla and give off several twigs to the gums and neighboring parts ofand give off several twigs to the gums and neighboring parts of
the mucous membrane of the cheek.the mucous membrane of the cheek. They then enter the posterior alveolar canalsThey then enter the posterior alveolar canals
on the infratemporal surface of the maxilla,on the infratemporal surface of the maxilla, and, passing from behind forward in theand, passing from behind forward in the
substance of the bone, communicate with the middle superior alveolar nerve, and give offsubstance of the bone, communicate with the middle superior alveolar nerve, and give off
branches to the lining membrane of the maxillary sinusbranches to the lining membrane of the maxillary sinus andand three twigs to eachthree twigs to each
molar toothmolar tooth; these twigs enter the foramina at the apices of the roots of the teeth.; these twigs enter the foramina at the apices of the roots of the teeth.
 Sphenopalatine (Pterygopalatine) BranchesSphenopalatine (Pterygopalatine) Branches two in number, descend totwo 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 Nerve.Maxillary Nerve in the Infraorbital canal is known as Infraorbital Nerve.

 Middle Superior Alveolar NerveMiddle Superior Alveolar Nerve arise in the posterior part of thearise in the posterior part of the
infraorbital canalinfraorbital canal , and, and runs downward and forward in a canal in theruns downward and forward in a canal in the
lateral wall of the maxillary sinuslateral wall of the maxillary sinus toto supply the two premolar teethsupply the two premolar teeth . It forms. It forms
a superior dental plexus with the anterior and posterior superior alveolar branches.a superior dental plexus with the anterior and posterior superior alveolar branches.
 Anterior Superior Alveolar NerveAnterior Superior Alveolar Nerve arises from maxillary nervearises from maxillary nerve just before itsjust before its
exit from the infraorbital foramenexit from the infraorbital foramen ; it; it descends in a canal in the anteriordescends in a canal in the anterior
wall of the maxillary sinus (Canalis sinuosus)wall of the maxillary sinus (Canalis sinuosus) , and divides into branches, and divides into branches
whichwhich supply the incisor and canine teeth.supply the incisor and canine teeth. It communicates with theIt communicates with the
middle superior alveolar branchmiddle superior alveolar branch , and gives off a, and gives off a nasal branchnasal branch, which passes, which passes
through a minute canal in the lateral wall of the inferior meatus, andthrough a minute canal in the lateral wall of the inferior meatus, and supplies thesupplies the
mucous membrane of the anterior part of the inferior meatus and themucous membrane of the anterior part of the inferior meatus and the
floor of the nasal cavityfloor of the nasal cavity , communicating with the nasal branches from the, communicating with the nasal branches from the
sphenopalatine ganglion.sphenopalatine ganglion.

 Branches on face:Branches on face:
 Inferior Palpebral NerveInferior Palpebral Nerve ascend behind the Orbicularis oculi. Theyascend behind the Orbicularis oculi. They
supply the skin and conjunctiva of the lower eyelidsupply the skin and conjunctiva of the lower eyelid , joining at the, joining at the
lateral angle of the orbit with the facial and zygomaticofacial nerves.lateral angle of the orbit with the facial and zygomaticofacial nerves.
 External Nasal NerveExternal Nasal Nerve supply the skin of the side of the nosesupply the skin of the side of the nose
and of the nasal septumand of the nasal septum , and join with the terminal twigs of the, and join with the terminal twigs of the
nasociliary nerve.nasociliary nerve.
 Superior Labial NerveSuperior Labial Nerve - the largest and most numerous - distributed to- the largest and most numerous - distributed to
thethe skin of the upper lip, the mucous membrane of the mouth,skin of the upper lip, the mucous membrane of the mouth,
and labial glands.and labial glands.

SphenopalatineSphenopalatine
(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 andsituated 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 ofnucleus of facial nerve>>Nervous intermedius of Facial nerveFacial nerve>>>>Greater petrosalGreater petrosal
nervenerve>>>> Nerve of Petrygoid canalNerve of Petrygoid canal >>>>Pterygopalatine ganglion: RelayPterygopalatine ganglion: Relay
stationstation>>>>Postganglionic fibresPostganglionic fibres: Enter: Enter Maxillary nerveMaxillary nerve>>>>ZygomaticZygomatic
branchbranch>>>>Zygomaticotemoral nerveZygomaticotemoral nerve>>communicate with Lacrimal>>communicate with Lacrimal
nerve>>nerve>>Lacrimal gland. Postganglionic branches from ganglion alsoLacrimal 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 superiorposterior superior
nasalnasal, and, and pharyngealpharyngeal..
 Orbital branchesOrbital branches enter the orbit by the inferior orbital fissure, and supply theenter the orbit by the inferior orbital fissure, and supply the
periosteum in orbit, the mucous membrane of theperiosteum in orbit, the mucous membrane of the posterior ethmoidal andposterior ethmoidal and
sphenoidal sinusessphenoidal sinuses..
 PalatinePalatine nerves are distributed to thenerves 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 distributedbranches are distributed to the septum and lateralto 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 andsphenopalatine foramen and supply the mucous membrane covering the superior and
middle nasal conchæ, the lining of the posterior ethmoidal cells, and the posterior partmiddle nasal conchæ, the lining of the posterior ethmoidal cells, and the posterior part
of the septum.of the septum. One branch, longer and larger than the others, is namedOne branch, longer and larger than the others, is named
the nasopalatine nerve.the nasopalatine nerve.
 Pharyngeal nervePharyngeal nerve is a small branch arising from the posterior part of the ganglion.is a small branch arising from the posterior part of the ganglion.
It passes through the pharyngeal canal andIt passes through the pharyngeal canal and supplysupply to the mucous membrane of theto the mucous 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 blocksFor 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 forrequired. The indications for complete maxillary nerve block are few for
example procedures requiring anesthesia of multiple teeth and surroundingexample procedures requiring anesthesia of multiple teeth and surrounding
areas.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, caninePremolar, canine
and incisor teeth. It combines both Anterior superior Alveolar and Middleand 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 V2MAXILLARY 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 aIt begins - middle of semilunar ganglion as a
flattened plexiform band, passing horizontallyflattened plexiform band, passing horizontally
forward - leaves the skull ,forward - leaves the skull , foramen rotundum.foramen rotundum.
 Then crosses - pterygopalatine fossa - enters theThen crosses - pterygopalatine fossa - enters the
orbit through the inferior orbital fissure - itorbit through the inferior orbital fissure - it
traverses the infraorbital groove and canal in thetraverses 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 forameninfraorbital foramen
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In the cranium Middle Meningeal Nerve
In the Pterygopalatine
fossa
Zygomatic
Sphenopalatine
Posterior Superior
Alveolar
In the Infraorbital Canal Anterior Superior
Alveolar
Middle Superior Alveolar
On the Face Inferior Palpebral
External Nasal
Superior Labial
Branches of
Maxillary
Nerve

Maxillary divison(v2)Maxillary divison(v2)
From middle of the gaserion ganglion it travelsFrom middle of the gaserion ganglion it travels
anteriorly & downwordsanteriorly & downwords
Branche Within cranium –Branche Within cranium –Middle minengial nerveMiddle minengial nerve
Run along with middle minengialRun along with middle minengial
artery, sensory innervation to duraartery, sensory innervation to dura
matter.matter.
Exit cranium from foramen rotundumExit cranium from foramen rotundum
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Within pterigopalatine fossaWithin pterigopalatine fossa
ZygomaticZygomatic pterygopalatine nervepterygopalatine nerve
inferior.orbital fissureinferior.orbital fissure pterygopalatine ganglionpterygopalatine ganglion
Zygomatico temporal zygomatico facialZygomatico temporal zygomatico facial
Skin of forehead to skin of cheekSkin of forehead to skin of cheek
OrbitalOrbital nasal/nasopalatinenasal/nasopalatine palatinepalatine pharyngealpharyngeal
Periosteum roof of nasal cavity,Periosteum roof of nasal cavity, greater palatine nervegreater palatine nerve pharyngial canalpharyngial canal
of orbit mucous memb.&ant. Partof orbit mucous memb.&ant. Part g.p.forameng.p.foramen supplies to nasalsupplies to nasal
of nasal septum,of nasal septum, runs muco periosteum & part of pharynxruns muco periosteum & part of pharynx
incisive canalincisive canal hard palatehard palate
incisive foramenincisive foramen supplies soft tissues ant. tosupplies soft tissues ant. to
rt.&lt. nasopalatine nervert.&lt. nasopalatine nerve 11stst
PMPM
supplies hard palate -1 to 3supplies 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 &
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Post. Superior alveolar nervePost. Superior alveolar nerve
11stst
trunktrunk 22ndnd
trunktrunk
External to boneExternal to bone inters into maxillainters into maxilla
Buccal gingivaBuccal gingiva sensory innervation tosensory innervation to
In maxillary molarsIn maxillary molars sinus, alveolus, pulp ofsinus, alveolus, pulp of
maxillarymaxillary
molars(molars(exceptionexception -mesio-mesio
buccal root of 1buccal root of 1stst
molars)molars)
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In infra orbital canalIn infra orbital canal
MSA nerveMSA nerve ASA nerveASA nerve
11stst
& 2& 2ndnd
PM regionPM region supplies antariorsupplies antarior
wall ofwall of
Mesiobuccal root of 1Mesiobuccal root of 1stst
MM 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 then
Psa & AsaPsa & Asa
Provides its supplies).Provides its supplies).
4747

In the faceIn the face
Inferior pulpaberal external nasal sup. LabialInferior pulpaberal external nasal sup. Labial
Skin of lower eyelid skin of lateral skin,mucousSkin of lower eyelid skin of lateral skin,mucous
aspect of noseaspect of nose
memb.,uppermemb.,upper
lip.lip.
4848

MAXILLARY NERVE BRANCHESMAXILLARY NERVE BRANCHES
A. ZygoticaticotemporalA. Zygoticaticotemporal
B. ZygomaticofacialB. Zygomaticofacial
C. Post. Sup. AlveolarC. Post. Sup. Alveolar
D. NasopalatineD. Nasopalatine
E. Greater PalatineE. Greater Palatine
F. Lesser PalatineF. Lesser Palatine
G. Mid. & Ant. AlveolarG. Mid. & Ant. Alveolar
H. InfraorbitalH. Infraorbital
4949

Mandibular NerveMandibular Nerve

 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 theThe skin in the temporal region, part of the
auricle, including the external meatus andauricle, including the external meatus and
tympanum.tympanum.
 The lower lip, the lower part of the faceThe lower lip, the lower part of the face
 The muscles of mastication.The muscles of mastication.
 The mucosa of the anterior two-thirds, (presulcalThe mucosa of the anterior two-thirds, (presulcal
part) of the tongue and the mucosa of the floorpart) of the tongue and the mucosa of the floor
of the oral cavity.of the oral cavity.

Mandibular nerve:Mandibular nerve:
Origin and courseOrigin and course
 A branch of trigeminal (VA branch of trigeminal (V
cranial) nerve. It Hascranial) nerve. It Has
 A Large Sensory root:A Large Sensory root:
Arises from lateral part ofArises from lateral part of
trigeminal ganglia intrigeminal ganglia in
middle cranial fossamiddle cranial fossa
 A small motor rootA small motor root ::
which passes under thewhich passes under the
ganglion to unite with theganglion to unite with the
sensory root just outsidesensory root just outside
the skull.the skull.
Mandibular nerveTrigeminal gangliaTrigeminal ganglia

Motor root
Mandibular nerveMandibular nerve

 Passes through foramenPasses through foramen
ovale to infratemporalovale to infratemporal
fossafossa
 Here it lies between theHere it lies between the
tensor veli palatinitensor veli palatini
(medial) and the lateral(medial) and the lateral
pterygoid.pterygoid.

 Just beyond thisJust beyond this
junction a meningealjunction a meningeal
branch and thebranch and the
nerve to the medialnerve to the medial
pterygoid leaves thepterygoid leaves the
medial side of themedial side of the
nerve.nerve.
 The nerve thenThe nerve then
divides into a smalldivides into a small
anterior and largeanterior and large
posterior trunk.posterior trunk.

As it descendsAs it descends
from thefrom the
foramenforamen
ovale, theovale, the
nerve is aboutnerve is about
4 cm from the4 cm from the
surface and asurface and a
little anterior tolittle anterior to
the neck of thethe neck of the
mandible.mandible.

(( in infratemporal fossain infratemporal fossa))
Branches:Branches:
From trunk:From trunk:
1.1. Meningeal branchMeningeal branch
2.2. Nerve to medial pterygoidNerve to medial pterygoid
musclemuscle
From Anterior Division:From Anterior Division:
1.1. Anterior and posterior DeepAnterior and posterior Deep
temporal nervestemporal nerves
2.2. Nerve to lateral PterygoidNerve to lateral Pterygoid
musclemuscle
3.3. Nerve to Messetor muscleNerve to Messetor muscle
4.4. Buccal nerve ( only sensoryBuccal nerve ( only sensory
nerve)nerve)
From Posterior Division:From Posterior Division:
1.1. Auriculotemporal nerveAuriculotemporal nerve
2.2. Lingual nerveLingual nerve
3.3. Inferior alveolar nerveInferior 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)

Branches:Branches:
 From trunk:From trunk:
1.1. Meningeal branchMeningeal branch
2.2. Nerve to medial pterygoidNerve to medial pterygoid
musclemuscle
 From Anterior Division:From Anterior Division:
1.1. Anterior and posteriorAnterior and posterior
Deep temporal nervesDeep temporal nerves
2.2. Nerve to lateral PterygoidNerve to lateral Pterygoid
musclemuscle
3.3. Nerve to Messetor muscleNerve to Messetor muscle
4.4. Buccal nerve ( onlyBuccal nerve ( only
sensory nerve)sensory nerve)
 From Posterior Division:From Posterior Division:
1.1. Auriculotemporal nerveAuriculotemporal nerve
2.2. Lingual nerveLingual nerve
3.3. Inferior alveolar nerveInferior alveolar nerve

Mandibullar division v3Mandibullar division v3
OriginOrigin motor rootmotor root sensory rootsensory root
motor nucleus of ponsmotor nucleus of pons gasserion gangliongasserion ganglion
& medulla oblongata& medulla oblongata
Foramen ovaleForamen ovale
Branches from undivided nerve:Branches from undivided nerve:
Nervus spinosumNervus spinosum medial pterygoidmedial pterygoid
enters along middle minengialenters along middle minengial medial pterygoidmedial pterygoid
artery through foramenartery through foramen musclemuscle
spinosumspinosum small branches to tensorsmall branches to tensor
to supply dura matter,mastoid air cells. velli palatini, tensorto supply dura matter,mastoid air cells. velli palatini, tensor rr
tympani.tympani.
Runs under the lateral pterygoid musclesRuns under the lateral pterygoid muscles
6262

Branches From antarior division:Branches From antarior division:
Buccal/long buccal n. masseteric deep temporal lateral pterygoidBuccal/long buccal n. masseteric deep temporal lateral pterygoid
Sensory supply to mucousSensory supply to mucous
Memb. Of cheek &buccalMemb. Of cheek &buccal
part of mand. Molars.part of mand. Molars.
Passes between the twoPasses between the two
heads of lateral pterygoidheads of lateral pterygoid motor supply to related musclesmotor supply to related muscles
At the level of occlusal planeAt the level of occlusal plane
Between 2Between 2ndnd
&3&3rdrd
molar itmolar it
crosses ant.crosses ant.
Border of the ramus &Border of the ramus &
enters into cheekenters into cheek
through buccinator muscles.through buccinator muscles.
6363

Branches from posterior division:Branches from posterior division:
Auriculo temporal lingual nerveAuriculo temporal lingual nerve inferior alveolar nerveinferior alveolar nerve
Sensory supply to medial to IAN& lateralSensory 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 onlateral pterygoid,runs on
external auditoryexternal auditory medial surface of ramusmedial surface of ramus
meatus,TMJ,meatus,TMJ, in pterygomandibular space. Along with inf. alveolarin pterygomandibular space. Along with inf. alveolar
Temporal region. sensory supply to ant. 2/3Temporal region. sensory supply to ant. 2/3rdrd
artery & vein.artery & vein.
of the tongue, mucous memb. Supplies mandi. molarsof the tongue, mucous memb. Supplies mandi. molars
of floor of the mouth,lingual before entering mentalof floor of the mouth,lingual before entering mental
aspect of the gingiva foramen it divides intoaspect of the gingiva foramen it divides into
mylohyoid nerve.mylohyoid nerve.
in mental foramenin mental foramen
incisive nerve mental nerveincisive nerve mental nerve
mandi. Incisors & PM’s chin & lowermandi. Incisors & PM’s chin & lower
lips.lips.
6464

MANDIBULAR NERVEMANDIBULAR NERVE
BRANCHES (posterior division)BRANCHES (posterior division)
A. AuriculotemporalA. Auriculotemporal
B. LingualB. Lingual
C. Inferior AlveolarC. Inferior Alveolar
D. N. to theD. N. to the
MylohyoidMylohyoid
E. MentalE. Mental
F. BuccalF. Buccal
6565

Applied Anatomy-Lingual nerveApplied Anatomy-Lingual nerve
The lingual nerve is at great risk duringThe lingual nerve is at great risk during
surgical removal of (impacted) lower thirdsurgical removal of (impacted) lower third
molars. After such operations up to 10% ofmolars. After such operations up to 10% of
patients may have symptoms, which arepatients may have symptoms, which are
usually temporary, of nerve damage. Theusually temporary, of nerve damage. The
nerve is also at risk during operations tonerve is also at risk during operations to
remove the submandibular salivary gland,remove the submandibular salivary gland,
during which the duct must be dissectedduring which the duct must be dissected
from the lingual nerve.from the lingual nerve.

Inferior alveolar nerve blockInferior alveolar nerve block
 The surface marking of the inferior alveolar nerve from the inside ofThe surface marking of the inferior alveolar nerve from the inside of
the oral cavity is important in giving nerve blocks.the oral cavity is important in giving nerve blocks.
 The mandibular foramen lies midway between the anterior andThe mandibular foramen lies midway between the anterior and
posterior borders of the ascending ramus of the mandible about 1posterior borders of the ascending ramus of the mandible about 1
cm above the occlusal surfaces of the lower teeth.cm above the occlusal surfaces of the lower teeth.
 With either technique the buccal and lingual nerves can be blockedWith either technique the buccal and lingual nerves can be blocked
en passant.en passant.
 The inferior dental nerve may be damaged during the extraction ofThe inferior dental nerve may be damaged during the extraction of
an impacted lower third molar tooth. The roots of such teeth arean impacted lower third molar tooth. The roots of such teeth are
commonly grooved and, very rarely, perforated by the nerve.commonly grooved and, very rarely, perforated by the nerve.
 It is also frequently damaged in fractures of the posterior tooth-It is also frequently damaged in fractures of the posterior tooth-
bearing part of the mandible.bearing part of the mandible.

Mental nerve blockMental nerve block
Incisive nerve blockIncisive nerve block
Gow-Gates Technique of MandibularGow-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 theA filament to the
Tensor tympani.Tensor tympani.
Tensor veli palatini.Tensor veli palatini.
7171

SUBMAXILLARY GANGLION:SUBMAXILLARY GANGLION:
 Small size & fusiform in shape.Small size & fusiform in shape.
 Situated above the deep portion of the submaxillarySituated 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 ductSupply - mucous membrane of the mouth and the duct
of the submaxillary gland.of the submaxillary gland.
7373

TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA
7474

TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA
INTRODUCTION: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 frequentlyThe condition is the most frequently
occurring of all the nerve painoccurring 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 fewThis pain can last from a few
seconds to a few minutes.seconds to a few minutes.
7575

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