V N.

trigeminalis
Nuclei
1. Main sensory nucleus (nucleus principalis): located in posterior part of pons lateral to motor nucleus (continuous with spinal nucleus)
2. Spinal nucleus: extend inferiorly to MO and upper part of spinal cord up to C2
3. Mesencephalic nucleus: lateral part of gray matter around cerebral aqueduct, extent inferiorly to pons as nucleus principalis
4. Motor nucleus: located in pons medial to main sensory nucleus

General pathway Sensory pathway

Motor pathway
- There is also sympathetic influence from plexus caroticus (vasculomotor, secretory, and trophic fibers)
- Branches of a trigeminal nerve anastomose with facial, glossopharyngeal and vagus nerves and contain sympathetic fibers.
Signs of lesions
1. Lesions of 1 branch of n. trigemini:
- Hyposthesias or hypersthesias, loss of reflex (e.g. loss of corneal reflex due to disturbances of n. opthalmicus)
- Isolated lesions usually observed as pain (epileptiform neuralgia), painful point include: foramen supraorbitalis, foramen infraorbitalis, and foramen
mentale.
- Disturbances of diaphoresis (vasculomotor phenomena) especially in retinal area due to presence of sympathetic fibers
- Neuralgia quinti major (special form of epileptiform neuralgia): severe pain, paroxysmal attack (occur mainly due to advanced age)
2. Lesions of Gasseri ganglion, nucleus or nerve root: hyposthesias of all V1-V3
- Etiolgy: Herpes zoster of face (Gasseri lesion)
- Lesions of root: disturbances of all type of sensation (deep and superficial) on face, intense pain
- Lesion of nucleus: pain less intense and dissociation disturbance of sensation in face (loss of superficial but intact deep sensation)
3. Partial lesions of nucleus produces segmentary annular zones of hyposthesias
a. Lesion of oral part: hyposthesias in are of nose and mouth
b. Lesion of caudal part: striae of hyposthesias up to zones of upper cervical segment
4. Lesions of motor fibers of n.mandibularis, its root or nucleus:
- Ipsilateral paralysis of muscles of mastication
- Atrophy of muscles of mastication
- Jaw is displaced to side of paralyzed muscles
5. Central paralysis (corticonuclear pathway lesions)
- In unilateral lesion disturbances do not manifest due to bilateral cortical innervation
- Feature of bilateral lesions:
a. Cramps of m. masseter bilaterally
b. Topical spastic stricture (trismus) [tetanus, meningitis, rabies, also occur at trigeminal neuralgia, subcortical and cortical hyperkinesias)