TRIGEMINAL NERVES

Anatomy

by Dr. Nadira. A

www.similima.com 1
www.similima.com 2
 The trigeminal nerve is the largest cranial
nerve and contains both sensory and motor
fibres.
 They are the chief sensory nerves for the
face and head, receiving impulses of pain,
temperature and touch.
 The motors fibres stimulate the muscles of
mastication.

www.similima.com 3
TRIGEMINAL NERVE NUCLEI
 There are four trigeminal nuclei: one motor and
three sensory
 The motor nucleus of CNV is in the superior part of
the pons, deep to the floor of the 4th ventricle.
 The mesencephalic nucleus of CNV is lateral to
the cerebral aqueduct.
 The principal sensory nucleus is in the dorsolateral
area of the pontine tegmentum at the level of entry
of the sensory fibres.
 The spinal nucleus of CNV is in the inferior part of
the pons and throughout the medulla

www.similima.com 4
www.similima.com 5
SENSORY COMPONENTS OF
TRIGEMINAL NERVE
 The sensations of pain, temperature, touch and
pressure from the skin of the face and mucous
membrane travel along axons whose cell bodies are
situated in the semilunar or trigeminal sensory
ganglion.
 The central process of these cells form the large
sensory root of the trigeminal nerve.
 About half the fibres divide into ascending and
descending branches when they enter the pons, the
remainder ascend or descend without division

www.similima.com 6
 The ascending branches terminate in the main
sensory nucleus and the descending branches
terminate in the spinal nucleus.
 The sensations of touch and pressure are conveyed
by nerve fibres that terminate in the main sensory
nucleus. The sensation of pain and temperature
pass to the spinal nucleus.
 The sensory fibres from the ophthalmic division of
the trigeminal nerve terminate in the inferior part of
the spinal nucleus, fibres from the maxillary division
terminate in the middle of the spinal nucleus and
fibres from the mandibular division end in the
superior part of the spinal nucleus.

www.similima.com 7
 Propioceptive impulses from the muscles of
mastication and from the facial and extraoccular
muscles are carried by fibres in the sensory root of
the trigeminal nerve.
 The axons of the neurons in the main sensory and
spinal nuclei now cross the median plane and
ascend as the trigeminal lemniscus to terminate on
the nerve cells of the ventral posteromedial nucleus
of the thalamus.
 The axons of these cells travel through the internal
capsule to the postcentral gyrus ( area 3, 2 and 1 )
of the cerebral cortex.

www.similima.com 8
Motor component of the trigeminal
nerve
 The motor nucleus receives corticonuclear
fibres from both cerebral hemispheres.
 It also receives fibres from the reticular
formation , the red nucleus, the tectum, and
the medial longitudinal fasciculus.
 It also receives fibres from the
mesencephalic nucleus to form a
monosynaptic reflex arc.

www.similima.com 9
 The cells of the motor nucleus give rise to the
axons that form the motor root.
 The motor nucleus supplies the muscles of
mastication, the tensor tympani, the tensor
veli palatini, the myelohyoid and the anterior
belly of the digastric muscle.

www.similima.com 10
COURSE OF THE TRIGEMINAL
NERVE
 The trigeminal nerve leaves the anterior aspect of the pons as a
small motor root and a large sensory root.
 The nerve passes forward out of the posterior cranial fossa and
rests on the upper surface of the apex of the petrous part of the
temporal bone in the middle cranial fossa.
 The large sensory root now expands to form the cresent shaped
trigeminal ganglion, which lies within a pouch of dura mater
called the trigeminal or Meckel’s cave.
 The ophthalmic, maxillary and the mandibular nerves arises
from the anterior border of the ganglion.

www.similima.com 11
www.similima.com 12
 The ophthalmic nerve contains only sensory
fibres and leaves the skull through the
superior orbital fissure to enter the orbital
cavity.
 The maxillary nerve also contains only
sensory fibres and leaves the skull through
foramen rotundum.
 The mandibular nerve contains both sensory
and motor fibers and leaves the skull through
the foramen ovale.
www.similima.com 13
Divisions and branches of
trigeminal nerve
 There are three main branches of the
trigeminal nerves.
 Ophthalmic nerve – sensory only
 Maxillary nerve – sensory only
 Mandibular nerve – sensory and motor

www.similima.com 14
www.similima.com 15
Ophthalmic nerve

 A sensory nerve passes through the superior

orbital fissure and supplies the eyeball,
conjunctiva, lachrymal gland and sac, nasal
mucosa, frontal sinus, frontal sinus, external
nose, upper eyelid, forehead and scalp.

www.similima.com 16
Branches
 Tentorial nerve
 Lachrymal nerve
 Frontal nerve – supraorbital nerve
 - supratrochlear nerve
 Nasociliary nerve
 Short ciliary nerves
 Long ciliary nerves
 Infratrochlear nerve
 Anterior and posterior ethmoidal nerves.
www.similima.com 17
www.similima.com 18
 Maxillary nerve
 A sensory nerve passes through the foramen rotundum. It
supplies
the cheeks, upper gums, upper teeth and lower eyelids.

Branches
 Meningeal branch
 Zygomatic nerve
 Posterior superior alveolar branches
 Infraorbital nerve
 Greater palatine nerves
 Lesses palatine nerve
 Lesser palatine nerves
 Posterior superior lateral nasal branches
 Nasopalatine nerve
 Pharyngeal nerve www.similima.com 19
Mandibular nerve
 Largest of the three divisions and has a
motor nerve and sensory nerve. It passes
through the foramen ovale.
 Meningeal branch
 Buccal nerve
 General sensory nerves
 Auriculotemporal nerve
 Lingual nerve
 Inferior alveolar nerve

www.similima.com 20
Branchial branches to muscles
 Masseter

 Temporal

 Medial and lateral pterygoids

 Tensor veli palatine

 Mylohyoid

 Anterior belly of digastric

 Tensor tympani

www.similima.com 21
Applied aspects

www.similima.com 22
Trigeminal nerve injury
 The nerve may be injured by trauma,
tumours, aneurysms, or meningeal infection.
Occasionally it may be involved in
poliomyelitis and generalized polyneuropathy,
a disease involving several nerves. The
sensory and motor nuclei in the pons and
medulla may be destroyed by intramedullary
tumours or vascular lesions. An isolated
lesion of the spinal trigeminal tract also may
occur with multiple sclerosis.

www.similima.com 23
 Injury to the CN V causes;
 Paralysis of the muscles of mastication with
deviation of the mandible (lower jaw) toward the
side of lesion.
 Loss of inability to appreciate soft tactile, thermal, or
painful sensations in the face.
 Loss of corneal reflex and the sneezing reflex.
 Common causes of facial numbness are dental
trauma, herpes zoster, cranial trauma, head and
neck tumours, intracranial tumours, and idiopathic
trigeminal neuropathy.

www.similima.com 24
Trigeminal neuralgia
 Trigeminal neuralgia or tic douloureux is the
principal disease affecting the sensory root of
CN V. It is characterized by attacks of
excruciating pain in the area of distribution of
the maxillary or mandibular divisions or both.
The maxillary nerve is most frequently
involved. The paroxysms of excruciating pain
in the area of its distribution are often set off
by touching the most sensitive area. Usually
the cause of the neuralgia is undetectable.

www.similima.com 25
 Thank you

www.similima.com 26