Trigeminal nerve

• It arise from the pons and it has two roots :

1. Major sensory root : for pain, temperature, touch
and proprioception
2. Small Motor root

• The two roots meet on trigeminal ganglion , this

ganglion covered by dura and found inside a space
called mickle's cave and it supplied by accessory
meningeal artery .

• Trigeminal nerve give three branches :

1. Ophthalmic : enter the superior orbital fissure
to go to the eye
2. Maxillary : pass through foramen rotundum to
enter ptrygopalatine fossa, then go to the eye
passing through inferior orbital fissure
3. Mandibular : passing through foramen ovale to
enter the infra temporal fossa .

• The motor part of the trigeminal nerve go

with mandibular, and Ophthalmic and maxillary
branches are purely sensory .
 #1. Mandibular Devision :

• Passing through foramen ovale to enter the

Infratemporal Fossa
• From the main trunk it gives one sensory
and one motor.
• The meningeal branch ( nervus spinosus )
re-enters the middle cranial fossa via the foramen
spinosum, or the foramen ovale, supplying
the meninges of the middle cranial fossa, and
the mastoid air cells.
• Nerve to medial ptrygoid which supply :-
1. Medial ptrygoid
2. Tensor tympani : which tense the tympanic
membrane of the ear
3. Tensor palati or palatini : it's tense the soft
palate and it's important for swallowing.

• After that the Mandibular nerve devided within

the Infratemporal Fossa into :
1. Anterior devision : it's mainly motor and little
of it is sensory .
2. Posterior devision : it's mainly sensory and
little of it is motor.
#1. Anterior devision :-
• The motor part supply the remaining muscles
of mastication which include ; Lateral ptrygoid ,
Masseter & Temporalis
• The sensory part of the anterior devision in form
of a nerve called Buccal Nerve supply :
1. Buccal mucosa
2. Buccal skin
3. Buccinator as proprioception .

#2. Posterior devision :-

• The give the following branches:
1. Lingual Nerve :
• supply general sensation to the anterior two
thirds of the tongue

2. Inferior Alveolar Nerve :

• Enter the mandibular foramen going to the
alveolar arch supply the teeth from below , and it
terminated by mental nerve that supply the skin
• This inferior alveolar nerve lie midway
between the anterior and posterior borders
of the mandibular ramus at the level of
pterygomandibular raphe this is important for
nerve block in dentistry to extract the teeth
• The inferior alveolar nerve runs with its vessels in
the mandibular canal. It supplies the three molar
and two premolar teeth. Then it divides into the
mental nerve and the incisive nerve . The latter
nerve supplies the canine and both incisors .

• Complecation of this block :-

1. numbness in the lower lip occur because you
blocked the inferior alveolar nerve and all it's
branches including the the mental nerve which
become anesthetized and cause this numbness
2. One of complications of inferior alveolar nerve
block is damage of ptrygoid venous plexus in the
infratemporal fossa causing ptrygoid hematoma
which usually tend to conserve
3. The most danger is damage to the lingal nerve .

3. auriclutemporal nerve :
• derived by two roots from the posterior division;
they embrace the middle meningeal artery
• The auricular part innervates the skin of the up-
per part of auricle , the external acoustic meatus
and the outer surface of the tympanic membrane.
• The temporal part is distributed to the skin
of the temple area and parotid gland. The
auriculotemporal nerve supply the parotid
gland with postganglionic parasympathetic
 secretomotor fibres from the otic ganglion

• The motor part of the posterior devision of the

mandibular nerve is nerve to mylohyoid that arise
from the inferior alveolar nerve before it enter
the mandibular foramen and run in the mylohyoid
groove going to supply:
1. Mylohyoid muscle
2. Anterior belly of digastric

Note :-
• In addition to taste sensation ( which is a general
sensation ) , we also need a secretomotor
sensation ,but secretomotor is strong sensation ,
found only in cranial nevers number 1973 .

★ Otic ganglion :
• lies between the tensor palati and the mandibular
nerve, just below the foramen ovale
• It is a relay station for parasympathetic
secretomotor fibres to the parotid gland

• Parasympathetic root : From the inferior salivary

nucleus by the glossopharyngeal nerve, its
tympanic branch, the tympanic plexus and the
lesser petrosal nerve.
• Sympathetic root : From the superior cervical
ganglion by fibres running with the middle
meningeal artery.
• Sensory root : From the auriculotemporal nerve
with cell bodies in the trigeminal ganglion.
• Branches : To the parotid gland via filaments of
the auriculotemporal nerve.

★ Submandibular gangilon :-
• The submandibular, sublingual and tongue salivary
glands are supplied by lingual nerve which take
the secretomotor innervation from the facial via
branch called chorda tympani .
• this nerve arise from the facial nerve while it's
course through the ear and in it's own canale .

• Parasympathetic root : From the superior

salivary nucleus by the nervus intermedius
part of the facial nerve, the chorda tympani
and the lingual nerve.
• Sympathetic root : From the superior cervical
ganglion by fibres running with the facial artery.
• Sensory root : From a branch of the lingual nerve,
with cell bodies in the trigeminal ganglion.
• Branches : To the submandibular and sublingual
glands via branches of the lingual nerve. .
 Clinical notes :-

• The lingual nerve gives :

1. General sensation : pain , temperature, touch .
2. Taste sensation for the anterior two thirds
of the tongue
3. Secretomotor innervation .

• During nerve block in extraction of the teeth a

suregon damage the lingual nerve , this damage
may be anterior (proximal) or posterior (distal) to
the connection with the chorda tympani .

• If the damage is behind to the connection the pa-

tient will lose the General sensation , but threre
will be intact taste sensation and secretions .
• If the damage in front of the connection the
patient will lose all the sensation .

•--------------------------------------------------•

#2. Maxillary nerve :-

• It's mainly sensory nerve

• First , it give a meningeal branch to the front of
the middle cranial fossa
• Then It enters ptrygopalatine fossa through
foramen rotundum of the greater wing of
sphenoid bone and give the following branches in
the ptrygopalatine fossa :-
1. Zygomatic nerve ( later on gives
Zygomaticotemporal and Zygomaticofacial )
2. Posterior superior alveolar nerves

• In the fossa the maxillary nerve is connected

to the pterygopalatine ganglion by two
branches that carry fibres going both to and
from the ganglion.

• Then it emerge from the ptrygopalatine fossa

through the inferior orbital fissure to enter the
eye , then it go through infraorbital canal and
emerge from the eye through infraorbital foramen
as infra orbital nerve
• Within the infraorbital canal it gives middle and
anterior superior alveolar nerves

• The infra Orbital nerve supply :-

1. Lower eyelid
2. Ala of the nose (side of the nose)
3. Upper lip

★ Ptrygopalatine ganglion :-
• relay station between the superior salivary
nucleus in the pons and the lacrimal gland and
mucous and serous glands of the nose , palate
and paranasal sinuses.
• It is the ganglion of hay fever ‘running
nose and eyes’

• Parasympathetic root : From the superior salivary

nucleus by the nervus intermedius part of the
facial nerve, the greater petrosal nerve and the
nerve of the pterygoid canal.
• Sympathetic root : From the superior cervical
ganglion by the internal carotid plexus, the
deep petrosal nerve and the nerve of the
pterygoid canal.
• Sensory root : From branches of the maxillary
nerve, with cell bodies in the trigeminal ganglion.
• Branches :
1. To the lacrimal gland via the zygomatic and
lacrimal nerves,
2. To mucous glands in the nose, and palate via
maxillary nerve branches.
• Ptrygopalatine ganglion Give it's own branches
that emerge through the connecting foramina
as following :
1. Nasal (sphenopalatine) nerves : emerge through
the sphenopalatine foramen . From these nerves
a branch called nasopalatine nerve descend to
the palate passing through incisive foramen
2. Never to the ptrygiod canal
3. Pharyngeal nerves : go through palatovaginal
foramen to the pharynx
4. Greater and lesser palatine nerves : that pass
through greater and lesser palatine foramen

Note :-
• Sympathetic fibers to the head and neck come
from sympathetic trunk that go with arteries.
• Ptrygopalatine ganglion called ganglion of
hay fever or rhinitis.
• Patient with flu will have Congestion and pain
in the nose, palate and posterior pharynx (areas
supplied by branches of this ganglion).

•--------------------------------------------------•
 # 3. Ophthalmic nerve :-
• Give the following branches :-

1. Frontal nerve : that ascend as supraorbital

and supratrochlear
2. Lacrimal nerve : to lacrimal gland
3. Nasocilliary nerve : give the following
branches :-
• 1. Anterior ethmoidal
• 2. posterior ethmoidal
• 3. Infratrochlear
• 4. Long ciliary nerves to dilator pupili muscles

Note :-
• External nasal is a branch of the anterior
ethmoidal
• Lacrimal gland supplied by lacrimal nerve which is
has no secretomotor function so it's take from the
facial nerve as following:
• Greater petrosal nerve relay on the
ptrygopalatine ganglion & Branches of the
ptrygopalatine ganglion run with main trunk of
the maxillary nerve ,
• the maxillary has zygomaticotemporal branch that
 coonect with the lacrimal nerve and provide the
parasympathetic secretomotor fibers .
• The facial nerve in it's course in the ear give :-
1. The chorda tympani nerve
2. The Greater petrosal nerve
3. Nerve to stapedius

• structures that pass through foramen ovale :-

1. Mandibular nerve
2. Lesser petrosal nerve
3. Accessory meninge artery
4. Emissary vein from ptrygoid venous plexus
Last modified: Sep 12, 2018