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The Trigeminal
Trigeminal nerve anatomy
| Question | Answer |
|---|---|
| The trigeminal nerve is the nerve of the ____ branchial arch. | First |
| What are the two bundles it splits off into? Where does it emerge from? | Emerges from the side of the pons (brainstem) and separates into large sensory root and the small motor root |
| The two roots enter the ____ cave (aka ___ ___) in the dura mater | trigeminal; Meckel's cave |
| What ganglion contains the sensory neuron cell bodies? | The trigeminal ganglion |
| What are the three main divisions of the trigeminal nerve? What types of fibers do each of them carry? | Opthalmic (purely sensory); maxillary (purely sensory); and mandibular (sensory and motor--all of its motor fibers are here) |
| Does the trigeminal nerve have any parasympathetics? | Not of its own, but it carries some from cranial nerves III, VII, and IX |
| What fissure does the opthalmic (V1) branch pass through? | The superior orbital fissure |
| What is the most superior branch of V1? Where is it located? | The frontal branch; most superior branch in the orbit |
| What two branches does the frontal give off? | The supratrochlear branch and the supraorbital branch |
| What does the supratrochlear branch of V1's frontal nerve do? | smaller, more medial branch; runs superior to trochlea of superior oblique; supplies the scalp as far as the vertex of the skull and also sends branches to the upper eyelid |
| What does the supraorbital branch of V1's frontal nerve do? | larger, lateral branch; passes through the supraorbital notch or foramen; supplies the scalo as far as the vertex of the skull and sends branches to the upper eyelid |
| What structures pass through the cavernous sinus? | Middle: pituatary; laterally from superior to inferior: CNIII, CNIV, (more medial) internal carotid artery, (right below ICA)CN VI, laterally: V1, V2 |
| Where does the lacrimal nerve branch of V1 pass through? What does it innervate? Where does it get its postganglionic parasympathetics? | Along the upper edge of the lateral rectus eye muscle; passes through the lacrimal gland, giving it sensory twigs and ends in palpebral branches of upper eyelid; from pterygopalatine ganglion via the zygomatic branch of the maxillary nerve (V2) |
| Describe the path of the nasocilliary nerve | Proceeds anteromedially between superior rectus and the optic nerve following the course of the opthalmic artery |
| What are the four branches given off by the nasocilliar nerve? | The long ciliary, posterior ethmoidal, anterior ethmoidal, infratrochlear |
| What does the long ciliary nerve do? | Sends sensory fibers to the eyeball (notably, the cornea); postganglionic sympathetic fibers to the dilator of the pupil and the vasculature of the eye |
| What does the posterior ethmoidal nerve do? | Enters the posterior ethmoidal foramen; sends sensory fibers to the sphenoidal air sinuses and posterior ethmoidal air cells |
| Describe the path of the anterior ethmoidal nerve. | Ant. ethmoidal foramen (sensory fibers to middle and anterior ethmoidal air cells); cranial cavity at side of cribiform plate (sensory fibers to meninges); nasal cavity through nasal slit (sensory fib. to ant. part of nasal septum and ant. lateral walls); |
| What types of fibers does the anterior ethmoidal nerve have? | Sense (no smell) |
| What does the infratrochlear nerve do? Path and innervation | Passes forward beneath the trochlea; sensory to the side of the nose and the medial corner of the upper eyelid |
| Immediately after the nasocilliary nerve enters the orbit, it is connected to the ____ ganglion by a small twig called the ____ root of the ___ ganglion. | cilliary; sensory |
| What are the three roots of the ciliary ganglion? | Sensory root (connects to nasociliary nerve), sympathetic root (for postganglionic sympathetics), the motor (parasympathetic) root with preganglionic parasympathetics that synapse in ganglion |
| Describe the path of the maxillary division of the opthalmic branch of CN V as it begins | Enters lateral wall of cavernous sinus; passes through foramen rotundum to enter pterygopalatine fossa |
| Within the pterygopalatine fossa, the maxillary division is connected to the _____ ganglion and the ___ of the ___ ___ for exchange of fibers. | pterygopalatine ganglion; nerve of the pterygoid canal |
| What fibers does the pterygopalatine ganglion provide? | Postganglionic parasympathetics |
| What two nerves comprise the nerve of the pterygoid canal? | Greater petrosal nerve-taste and preganglionic parasympathetic fibers (from facial nerve); Deep petrosal nerve-postganglionic sympathetic fibers (from internal carotid plexus) |
| What happens after CN V2 receives branches in the pterygopalatine fossa? | Proceeds through the inferior orbital fissure to the floor of the orbit becoming the infraorbital nerve; it passes along the infraorbital groove, canal, and foramen; finally emerges on face |
| * Describe the path of the greater and lesser palatine nerve | Descend through palatine canals and emerge on the greater and lesser palatine foramina to reach the hard and soft palates of the mouth |
| * What types of fibers are carried by the greater and lesser palatine nerves? Where do the fibers come from? | General sensory fibers from V2; postgang. paras. from pterygopalatine ganglion; taste fibers from greater petrosal branch of facial nerver (taste buds for roof of mouth); postgang. sympathetics from deep petrosal nerve |
| Describe the path of the upper posterior nasal nasopalatine nerves | Pass into nasal cavity via sphenopalatine foramen; |
| Describe the path of the lower posterior nasal nerves | Originate from the greater palatine nerve as it descends in greater palatine canal; pass through small bony foramina to enter nasal cavity |
| What structure do the posterior nasal branches supply? | Posterior part of the nasal septum and posterior walls of the nasal cavity |
| The nasopalatine nerve proceeds antero-inferiorly through the ___ ___ and enters the mouth through the ___ ___ behind the upper incisor teeth to supply a small anterior portion of the hard palate. They lack what fibers? | nasal septum; incisive foramen; no taste |
| What fibers are carried by the posterior nasal branches and nasopalatine nerves? | General sensory (from V2), postganglionic parasympathetics (frm pterygopalatine ganglion), and postganglionic sympathetics from deep petrosal nerve |
| Where does the pharyngeal branch of the maxillary division of CN V pass through to leave the pterygopalatine fossa? | Passes posteriorly from pterygopalatine ganglion, leaves pterygopalatine fossa through palatovaginal (pharyngeal) canal |
| What structures does the pharyngeal branch supply? | Mucosa and glands of the nasopharynx |
| What branches are carried by the pharyngeal branch of CN V? | general sensory fibers from V2, postganglionic parasympathetics from pterygopalatine ganglion, and postganglionic sympathetics from deep petrossal nerve |
| What are the branches arising from the main trunk of the maxillary nerve and the infraorbital nerve (that is, everything in V2 after passing pterygopalatine fossa) | Orbital branches, zygomatic branch, the superior alveolar nerves (post., middle, ant.); and infraorbital nerve |
| Describe the path of the orbital branches of the maxillary nerve. What do they supply? | Pass through inferior orbital fissure; contribute to supply orbital wall; contribute to the supply of the ethmoidal, sphenoidal, and frontal air sinuses |
| What nerve supplies the ethmoidal, sphenoidal, and frontal air sinuses? | Orbital branches of V2 |
| Where does the zygomatic branch of the maxillary nerve arise from? | Arise from the maxillary nerve within the pterygopalatine fossa; passes into orbit and splits into zygomaticofacial and zygomaticotemporal branches (sensory to zygomatic and temporal regions of the face) |
| Describe the path of the parasympathetic fibers in the zygomatic nerve | Receives postganglionic parasympathetics from pterygopalatine ganglion which are handed over to the lacrimal nerve of V1 |
| Posterior superior alveolar nerve: path, structures supplied | From main trunk of maxillary nerve (while in pterygopalatine fossa); supplies mucous membrane of maxillary sinuses and upper molar teeth |
| Middle superior alveolar nerve: path, structures supplied | Arises from infraorbital nerve within the infraorbital groove/canal; supplies mucous membrane of the maxillary sinuses and upper premolar teeth |
| Anterior superior alveolar nerve: path, | Arises from infraorbital nerve in anterior part of the infraorbital canal; supplies mucous membrane of maxillary sinuses and upper three anterior teeth |
| posterior, middle, and anterior superior alveolar nerves intermingle forming a ____ ___ before innervating the teeth | dental plexus |
| What are the fiber types for the superior alveolar nerves? | General sensory V2; postganglionic parasympathetic from pterygopalatine gang.; postganglionic sympathetics from deep petrosal nerve |
| What structures are supplied by the infraorbital nerve? | lower eyelid, side of the nose, upper lip, front of the cheeck, and nasal vestibule |
| What division of the trigeminal nerve receives all of the motor fibers of the trigeminal? | The mandibular division |
| Where does the mandibular division exit from? What does it enter? | Through foramen ovale to enter the infratemporal fossa |
| What does the mandibular division connect to in the infratemporal fossa? | The otic ganglion |
| * What structures are supplied by the motor branches of the trigeminal? | muscles of mastication; mylohyoid and anterior belly of the digastric muscle; tensor of the palate; tensor tympani |
| The motor branches of the mylohyoid and anterior belly of the digastric are carried by what nerve? | The inferior alveolar branch; leaves it just before it enters the inferior alveolar foramen |
| What are the branches of the main trunk of V3? | Meningeal branch, medial pterygoid nerve |
| What does the meningeal branch of V3 supply? How does it get there? What does it travel with? | The dura of the middle cranial fossa and mastoid air cells; enters through foramen spinosum with middle meningeal artery |
| What does the medial pterygoid nerve of V3 supply? How does it get there? What does it travel with? What types of fibers does it carry? | Enters deep surface of medial pterygoid muscle and supplies it; gives off two branches: nerve to the tensor tympani and nerve to the tensor palate (both are motor) |
| What are the branches of the anterior division of the madibular division of CN V? | The masseteric, deep temporal, lateral pterygoid, and long buccal nerves |
| What does the masseteric muscle supply? | Passes through the mandibular notch to supply the masseter muscle; gives sensory twig to the temporomandibular joint |
| What do the temporal nerves supply? | Supply temporalis muscle (motor); gives off twig to the temporomandibular joint |
| What does the lateral pterygoid nerve supply? | Lateral pterygoid muscle (motor) |
| What three nerves provide somatic sensory twigs to the temporomandibular joint? | Masseteric nerve, deep temporal nerve, and the auricotemporal nerves |
| Where is the long buccal nerve (path)? What does it supply? | Passes laterally between heads of the lateral pterygoid muscle; descends over buccinator muscle; supplies mucous membrane of the cheek and gums (molar area) and skin of overlying cheek |
| What are the branches of the posterior division of V3? | Mainly sensory except for mylohyoid nerve: auricotemporal, inferior alveolar, lingual |
| Describe the path of the auricotemporal nerve | Runs posteriorly and splits around middle meningeal artery; reforms and runs through parotid gland to be distributed to external ear and scalp over temporal region |
| What ganglion does the auricotempoeral nerve receive parastympathetics from? | Receives postganglionic parasympathetics from otic ganglion |
| Describe the origin of the auricotemporal parasympathetic fibers | Glossopharyngeal nerve-->tympanic branch-->lesser petrossal nerve-->otic ganglion-->auricotemporal nerve-->parotid |
| What is the MAIN sensory supply to the temporomandibular joing? | Branches of the auricotemporal nerve |
| What structures are supplied by the auricotemporal nerve branches? | temporomandibular joint, parotid gland, external auditory meatus, tympanic membrane, anterior portion of the external ear, skin covering temporal fossa |
| What types of fibers does the inferior alveolar nerve have? | General sensory and motor fibers |
| Describe the path of the inferior alveolar nerve | Enters mandibular foramen (after giving off nerve to mylohyoid) |
| Main trunk of the inferior alveolar nerve supplies what structures? | Molar and premolar teeth |
| What are the two terminal branches of the inferior alveolar teeth? What do they supply? | mental nerve: passes out mental foramen to supply skin of lower lip and chin, mucous membrane of lower lip, gigiva of buccal side of mandibular incisor, canine, and premolar teeth; incisive nerve: lower canine and incisior teeth |
| What does the mylohyoid branch supply? | mylohyoid muscle and anterior belly of the digastric |
| What fibers does the lingual nerve have? | Contains general sensory fibers (for anterior 2/3 of tongue, lingual gingiva, and floor of mouth) |
| What branch of the facial nerve joins it? What does it contain? | Chorda tympani: pre-ganglionic parasympathetics, taste fibers for taste buds of anterior 2/3 of tongue (fungiform papillae) |
| Describe the course of the chorda tympani | leaves facial nerve while it runs through facial canal; runs along lateral wall of tympanic cavity-->emerges through petrotympanic fissure to join lingual nerve |
| What is the course of the lingual nerve? What structures is it associated with? | Related to the third molar tooth and can be be damaged during extraction of the tooth; crosses floor of mouth close to submandibular duct |
| Describe the origin of the lingual nerve parasympathetic fibers | Pregang. paras. of chorda tympani depart from lingual nerve in region of submandibular ganglion; synapse with parasympathetic neurons in submandibular ganglion (connected to lingual nerve) |
| What structures receive parasympathetic fibers from the lingual nerve? | submandibular gland, sublingual and lingual salivary glands |
| What are symptoms associated with trigeminal nerve lesion | loss of facial sensation, deviation of jaw towards side of lesion, trigeminal neuralgia. Trigeminal neuralgia on maxillary division most common; referred pain to other branches |
Created by:
karkis77
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