OMFS lec1

2. Sensory
innervations of
maxillofacial
region
Dr/ Hamed ad

3. PAIN
• Pain is an unpleasant sensory
and emotional experience
associated with tissue damage

4. GENERAL PAIN PATHWAY
 Pain impulses starts from pain
receptors (Nociceptors)
 Then impulses propagate
through a neuron to spinal
column of the other side
 Then impulses ascend through
special tracts to thalamus then
to cerebral cortex

6. CRANIAL NERVES &SPINAL
NERVES
Cranial nerves are nerves that
emerge directly from the brain
which are 12 pairs of cranial
nerves.
 spinal nerves are nerves that
emerge from segments of the
spinal cord.

7. CRANIAL NERVES
1- olfactory n.
2-optic n
3- occulmotor n.
4- trochlear n.
5- trigeminal
n.
7- facial n.
8-vestibulocholear
n,
9-glosspharangeal
n.
10-vagus n.
11-accessory n.

8. TRIGEMINAL NERVE
It the largest cranial nerves,
mixed in function due to it
composed of small motor root
and large sensory root

9. Trigeminal nerve
The motor root
originated from
motor nucleus
within the pons and
medulla oblongata
and supply 8 facial
muscels

10. TRIGEMINAL NERVE
The sensory root fibers
consist of the central
processes of ganglion
cells located in the
trigeminal (semilunar or
gasserien) ganglion(1 x 2
cm).

11. THE TRIGEMINAL NERVE
The Semilunar Ganglion
(Gasserian ganglion) occupies a
cavity (Meckles Cavity) in the
dura mater near the apex of the
petrous part of the temporal
bone.
It is somewhat crescent in shape,
with its convexity directed
forward: medially.

12. ophthalmic
Foramen rotandum
Foramen oval
T G
PETROUS BON
Superior orbital fissure
Meckles Cavity

13. THE TRIGEMINAL NERVE
From its convex border,
which is directed
forward and lateral
ward, three large nerves
proceed: the
ophthalmic, maxillary,
and mandibular.

14.  The motor root originated
from motor nucleus within the
pons and medulla oblongata
and supply 8 facial muscels

15. Ophthalmic
division (V1)

16. OPHTHALMIC DIVISION(V1)
 It the first branch of the trigeminal
nerve.
 it is exclusively sensory and is
the smalllest of the three division.
 It leaves the cranium and enter
the orbit through superior orbital
fissure.
 The nerve trunk is approximately
2.5cm in length

19. OPHTHALMIC DIVISION
 Before it leave the
fissure the nerve trunk
divided into three
branches:
 1- Nasociliary nerve
 2-Frontal nerve:
 3- lacrimal nerve

20. Ophthalmic division
Branches of nasociliary nerve:
2- Posterior ethmoidal nerve
3- Anterior ethmoidal nerve:
A- Internal nasal nerve
B- External nasal nerve
4- Infra-trochlear nerve
5- Long & short ciliary nerve

21. Function of ophthalmic nerve
1. Sensory supply the eye ball.
2. conjunctiva.
3. lacrimal gland.
4. Sensory supply part of the mucous
membrane of para-nasal sinuses.
5. Sensory supply of skin of the
forehead, eye lids and nose.

22. Maxillary
division(V2)
Exclusively sensory and intermediate in
size

28. MAXILLARY DIVISION COURSE
It is intermediate, both in position and size. The nerve
pass through four regions and give off branches in
each.
It leaves the skull through the foramen rotundum.

29. Maxillary division course
It then crosses the
pterygopalatine fossa and
enters the orbit through
the inferior orbital fissure.

30. MAXILLARY DIVISION COURSE
It traverses the infraorbital
groove and canal in the
floor of the orbit, and
appears upon the face at
the infraorbital foramen

31. MAXILLARY DIVISION
BRANCHES
Maxillary nerve give off branches
in four regions
1- Cranium;
2- Pterygopalatine fossa
3- Orbit
4- face

32. FIRST REGION
A- BRANCH IN THE CRANIUM
Middle meningeal nerve:
it accompanies the middle
meningeal artery and
supplies the dura mater.

33. Second region
b- branches in the pterygo-
palatine fossa
1-The Zygomatic Nerve.
2-The Pterygo- or (spheno)- palatine
Branches and four subdivisions nerves .
3-The posterior superior alveolar nerve
(PSAN).

34. 1- THE ZYGOMATIC NERVE.
1. Zygomaticotemporal (to the skin of
the side of the forehead)
2. Zygomaticofacial (supplies the skin
on the prominence of the cheek )

35. 2 - The Pterygo(spheno)palatine
Branches:
a- Orbital branch for orbital
peri-ostium
b - Nasal branches:
1. -Long sphenopalatine
(Nasopalatine).
2. Short sphenopalatinenasal
branches

36. c- Palatine branches:
1. Greater palatine nerve
2. lesser palatine nerve
D- The pharyngeal nerve: It
supplies the nasal part of the
pharynx
The Pterygo(spheno)palatine Branches:

37. SECOND REGION
BRANCHES
 3- The posterior
superior alveolar nerve
(PSA):
 It supplies the lining membrane of
the maxillary sinus and buccal
mucosa, supporting structures and
pulps of upper molars teeth except
the MB root of upper first molar.

38. Needle at the target area for a posterior superior alveolar (PSA) nerve
block.

39. C -BRANCHES IN THE INFRA-ORBITAL
CANAL
1- Middle Superior Alveolar
Branch present nearly in 28%
of cases. It is given off from
the infraorbital nerve in the
posterior part of the
infraorbital canal, and runs
downward and forward in a
canal in the lateral wall of the

40.  Middle Superior Alveolar
nerve supply the buccal
mucosa, supporting
structures and pulps of
upper premolar teeth &
pulp of mesiobuccal root
of first molar (28 %)

41. THIRD REGION
C -BRANCHES IN THE INFRAORBITAL CANAL
2- The Anterior Superior Alveolar
nerve is given off from the
infraorbital nerve just before its
exit from the infraorbital
foramen; it descends in a canal
in the anterior wall of the
maxillary sinus. it supply the
labial mucosa mucosa, supporting
structures and pulps of upper
incisors and canines.

42. ORBITAL FLOOR

43. Fourth region
D- branches for the face
Terminal branches of
the infraorbital
nerve divides into:
1. The Inferior Palpebral nerve.
2. The lateral nasal nerve.
3. The Superior Labial nerve.

44. 1-The Inferior Palpebral Branch. It supplies
the skin and conjunctiva of the lower
eyelid,
2-The lateral nasal branch.
It supplies the skin of the side of the nose.
3-The Superior Labial Branches.
It supplies the skin & mucous membrane of
the upper lip.

45. INNERVATION OF MAXILLARY TEETH
Upper molar teeth
1. Pulp, P.L, bone and bucaal mucosa supplied by
PSA (except MB root of first molar by MSA)
2. Palatal Mucosa supplied by Greater palatine

46. INNERVATION OF MAXILLARY TEETH
 Upper premolar teeth
1. Pulp, PL, bone and bucaal mucosa
supplied by MSA
2. Palatal mucosa supplied by greater
palatine n.

47. INNERVATION OF MAXILLARY TEETH
Upper anterior teeth
1.Pulp, PL, bone, and bucaal mucosa
supplied by ASA
2.Palatal mucosa supplied by
Nasopalatine

49. SUMMERY
Upper molar teeth
1. Pulp, bone, PL, bucaal mucosa
supplied by PSA (except MB root
of first molar by MSA)
2. Palatal Mucosa supplied by
Greater palatine

50. SUMMERY
Upper premolar teeth
1. Pulp, bone, PL, bucaal mucosa
supplied by MSA
2. Palatal Mucosa supplied by
greater palatine

51. SUMMERY
Upper anterior teeth
1. Pulp, bone, PL, bucaal mucosa
supplied by ASA
2. Palatal Mucosa supplied by
Nasopalatine

52. FUNCTION OF MAXILLARY NERVE
Supply the:
a- the skin of:
1- Lower eye lid
2- Midle portion of the face
3- Side of the nose
4- Upper lip

53. Sensory supply of the face

54. FUNCTION OF MAXILLARY NERVE
b- Mucous membrane of:
1- Nasopharynx
2- Maxillary sinuses
3- Soft palate
4- Tonsil
5- Hard palate

55. Distribution of the
maxillary division (V2).
1, Posterior superior
alveolar branches;
2, infraorbital nerve;
3, maxillarynerve;
4, foramen rotundum;
5, greater palatine
nerve;
6,nasopalatine nerve.

56. MANDIBULAR
NERVE(V3)
 It the largest branch of Trigeminal
nerve
 It is mixed nerve composed of (large
sensory root and small motor root)

58. Mandibular nerve
course
The two roots united and
emerge through foramen
oval from the cranium to
the infera-temporal fossa

59. Mandibular nerve
course
The two roots (sensory and
motor) form trunk of about 2-
3mm before it divided into
small anterior division and
large posterior division.

62. MANDIBULAR
NERVE
BRANCHES
1- Branches of the main trunk
A- The Nervus Spinosus
B- The medial Pterygoid Nerve

63. The Nervus Spinosus which
re-enters (recurrent) the
skull through the foramen
spinosum with the middle
meningeal artery and
supplies the dura mater.
The medial Pterygoid Nerve
which supplies the medial
pterygoid muscle

65. MANDIBULAR
NERVE
 2- Branches of anterior
division
(one sensory and three motor n.)
 supplies the muscles of mastication and the
skin and mucous membrane of the cheek
 Its motor branches are the masseteric for
masseter M, deep temporal for temporalis M,

66. MANDIBULAR
NERVE
Sensory nerve of ant. division:
long buccal nerve (buccal or buccinator nerveBranches
of the anterior division:
• Continues to travel in antero antero-lateral direction .
At level of the mandibular 3 3rd rd molar, branches exit
through the buccinator and provide innervation to the skin
of the cheek
• Branches also stay within the retromandibular triangle
providing sensory innervation to the buccal gingiva of the
mandibular molars and buccal
vestibule

67. MANDIBULAR
NERVE
 3- branches of posterior
division(three sensories and one
motor)
 Sensory neves:
 (auriculotemporal n
 lingual n
 inferior alveolar nerve.

68. 3- BRANCHES OF
POSTERIOR DIVISION
A- Auriculotemporal nerve
Transverses the upper part of the
parotid gland and posterior portion
of the zygomatic arch
Branches:
Communicates with facial nerve to
provide sensory innervation to the
skin over areas of the zygomatic,
buccal, and mandibular
Communicates with the otic ganglion
for sensory, secretory, and
vasomotor fibers to the parotid

69. Auriculotemporal: • Branches:
– Anterior auricular auricular
- skin over helix and tragus
– External auditory meatus meatus
- skin over meatus and
tympanic membrane
– Articular Articular
- posterior TMJ
– Superficial temporal temporal
- skin over temporal region

70. LINGUAL NERVE
Lingual nerve is one of
the terminal branches
of the posterior
division of the
mandibular nerve.
It is sensory to the
anterior 2/3rd of the
tongue and to the

71. Course and Relations of the Lingual
Nerve
It begins 1cm below the skull runs
between the lateral and the medial
pterygoids m. and about 2cm below
the skull it is joined by the Chorda
Tympani nerve.
Emerging at the lower border of the
lateral pterygoid m., the nerve runs
downwards and forwards between
the ramus of the mandible and the
medial pterygoid m.

72. Next it lies in direct contact with the
mandible, medial to the third molar
between the origins of the superior
constrictor and the mylohyoid
muscles.
The Lingual Nerve might lying just
beneath the mucous membrane
lingual to lower third molar.
It leaves the gums, runs over the
hyoglossus deep to the mylohyoid
and round the submandibular duct
dividing into terminal branches.

73.  It supplies the mucous membrane of the
anterior two-thirds of the tongue.
 The chorda tympani joins the lingual Nerve
for taste sensation of the tongue

74. INFERIOR ALVEOLAR NERVE
Inferior Alveolar Nerve is the
largest terminal branch of the
posterior division of the
mandibular nerve. It runs
vertically downwards lateral to
the medial pterygoid and to the
sphenomandibular ligament. It
enters the mandibular foramen
and runs in the mandibular
canal accompanied by the
inferior alveolar artery.

75. Terminal branches of
inferior alveolar
nerve:
1- The incisive branch
is continued inward
within the bone, and
supplies the canine
and incisor teeth.

76.  2- The mental nerve
 The mental nerve emerges
at the mental foramen. It
supplies the skin and
mucous membrane of the
lower lip
 Some fibers supply the
mucous membrane of the
gingiva of the labial
surface of the mandible

77. The MYLOHYOID BRANCH
contains all motor fibers of
the posterior division. It arises
just before the inferior
alveolar nerve enters the
mandibular foramen, pierces
the sphenomandibular
ligament with the mylohyoid
artery and supplies the
mylohyoid muscle and the
anterior belly of the digastric.
While running in the
mandibular canal the inferior
alveolar nerve gives branches

80. INNERVATIONS OF
MANDIBULAR TEETH
Lower molar teeth
1. Pulp, PL and bone supplied by
inferior alveolar nerve.
2. Bucaal mucosa supplied by Long
buccal.
3. Lingual mucosa by lingual nerve

81. INNERVATION OF
MANDIBULAR TEETH Lower premolar teeth
1. Pulp, PL and bone,supplied by inferior alveolar nerve.
2. Buccal mucosa by mental nerve and may be Cutaneous coli (from
cervical plexus).
3. Lingual mucosa supplied by lingual nerve.

82. INNERVATION OF
MANDIBULAR TEETH
 Lower anterior teeth
1. Pulp, PL and bone, are supplied by
incisive nerve
2. Bucaal mucosa is supplied by mental
nerve
3. Lingual mucosa by lingual nerve

83. FUNCTION OF
MANDIBULAR NERVE
the sensory root supply :
a- skin of the temporal region

84. MANDIBULAR
NERVE
auricle
ex. Auditory
meatus
cheek
lower lip
chin region

85. FUNCTION OF MANDIBULAR
NERVE
b- mucous m. of:
cheek Ant. 23 of the tongue
c- mandibular teeth and its
supporting structures

86. FUNCTION OF MANDIBULAR
NERVE
d- bone the mandible
e-TMJ
f- parotid g

87. the motor fibers of the trigeminal nerve supply the
following muscles
1. Masseter muscle
2. temporalis muscle
3. medial prtygoid muscle
4. lateral prygoid muscle
5. mylohoid muscles
6. anterior belly of digastric muscle
7. Tensor tympani muscle
8. Tesor paltini muscle

88. Sensory supply of the fa

89. Lateral view of head, neck and face