11.

Trace your Trigeminal nerve and discuss its anatomy and functions

Trigeminal Nerve (CRANIAL NERVE V)

The trigeminal nerve is the largest cranial nerve. It supplies
sensations to the face, mucous membranes, and other
structures of the head. It is the motor nerve for the muscles of
mastication and contains proprioceptive fibers. 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 crescent-shaped trigeminal ganglion, which lies
within a pouch of dura mater called the trigeminal or Meckel
cave. The ophthalmic, maxillary, and mandibular nerves arise
from the anterior border of the ganglion. The ophthalmic nerve
(V1) contains only sensory fibers and leaves the skull through
the superior orbital fissure to enter the orbital cavity. The maxillary nerve (V2) also contains only
sensory fibers and leaves the skull through the foramen rotundum. The mandibular nerve (V3) contains
both sensory and motor fibers and leaves the skull through the foramen ovale.

Nuclei
The trigeminal nerve has four nuclei: (1) the main sensory
nucleus, (2) the spinal nucleus, (3) the mesencephalic nucleus,
and (4) the motor nucleus.

The sensory nucleus, located in the pons, is quite extensive. It

receives ordinary sensations from the main 3 branches of the
trigeminal. The ophthalmic division is in the lower part of the
nucleus, and the mandibular branch is in the upper part. The
large rostral head is the main sensory nucleus. The caudal
tapered part is the spinal tract, which is continuous with
substantia gelatinosa of Rolando in the spinal cord. The spinal
tract is the sensory nucleus, primarily for pain and
temperature. The main sensory nucleus serves mostly for
discrimination sense.

The motor nucleus is ventromedial to the sensory nucleus. It lies near the lateral angle of the fourth
ventricle in the rostral part of the pons. The mesencephalic nucleus is in the midbrain and receives
proprioceptive fibers from all muscles of mastication.
Connections
The main sensory nucleus receives its afferents (as the sensory root) from the semilunar ganglion
through the lateral part of the pons ventral surface. Its axons cross to the other side, ascending to the
thalamic nuclei to relay in the postcentral cerebral cortex. The descending sensory fibers from the
semilunar ganglion course through the pons and medulla in the spinal tract of CN V to end in the nuclei
of this tract (as far as the second cervical segment).

The axons of these nuclei cross to the opposite side,

ascending in the spinothalamic tract, to relay in the
thalamic nuclei; from there, they end in the cerebral
cortex. The sensory nucleus of CN V is connected to
other motor nuclei of the pons and medulla. In
addition, the descending sensory spinal tract receives
somatic sensory fibers from CNs VII, IX, and X.

The proprioceptive fibers of CN V arise from the

muscles of mastication and the extraocular muscles.
They terminate in the mesencephalic nucleus. This
nucleus has connections to the motor nucleus of CN V.

The motor nucleus of CN V receives cortical fibers for

voluntary control of the muscles of mastication. These
fibers are mostly crossed. It also receives input from
the mesencephalic and sensory nuclei. The axons
emerge anterior to the sensory root from the lateral
surface of the pons. This motor root joins the semilunar
ganglion together with the sensory root.

The semilunar (gasserian or trigeminal) ganglion is the great sensory ganglion of CN V. It contains the
sensory cell bodies of the 3 branches of the trigeminal nerve (the ophthalmic, mandibular, and maxillary
divisions). The ophthalmic and maxillary nerves are purely sensory. The mandibular nerve has sensory
and motor functions.

The gasserian ganglion lies in a depression on the petrous apex, within a dural fold called the
Meckel cave. The sensory roots of the 3 branches of CN V are received anteriorly. They then pass from
the posterior aspect of the ganglion to the pons. The motor root passes under the ganglion to join the
sensory division of the mandibular nerve and exits the skull through foramen ovale. The carotid plexus
contributes sympathetic fibers to the gasserian ganglion.
 Branches of the Trigeminal Nerve
The ophthalmic, maxillary, and mandibular
branches of the trigeminal nerve leave the skull
through 3 separate foramina: the superior orbital
fissure, the foramen rotundum, and the foramen
ovale, respectively.

Ophthalmic Nerve (V1)

The ophthalmic nerve is purely sensory. It arises
from the convex surface of the gasserian ganglion,
in the dura it runs forward in the lateral wall of the
cavernous sinus in the middle cranial fossa and
divides into three branches, the lacrimal, frontal,
and nasociliary nerves, which enter the orbital
cavity through the superior orbital fissure.

The ophthalmic nerve carries sensory information

from the scalp and forehead, the upper eyelid, the
conjunctiva and cornea of the eye, the
nose (including the tip of the nose,
except alae nasi), the nasal mucosa,
the frontal sinuses, and parts of the
meninges (the dura and blood
vessels).

The ophthalmic nerve receives

sympathetic filaments from the
cavernous sinus and communicating
branches from CN III and IV.
Branches
The lacrimal nerve runs forward on
the upper border of the lateral rectus muscle. It is joined by the zygomaticotemporal branch of the
maxillary nerve, which contains the parasympathetic secretomotor fibers to the lacrimal gland. The
lacrimal nerve then enters the lacrimal gland and gives branches to the conjunctiva and the skin of the
upper eyelid. It supplies the lacrimal gland, conjunctiva, and upper lid. In the orbit, it receives a
communication from the zygomatic branch of the maxillary nerve.

The frontal nerve runs forward on the upper surface of the levator palpebrae superioris muscle and
divides into the supraorbital and supratrochlear nerves. These nerves leave the orbital cavity and
supply the frontal air sinus and the skin of the forehead and the scalp.

The nasociliary nerve crosses the optic nerve, runs forward on the upper border of the medial rectus
muscle, and continues as the anterior ethmoid nerve through the anterior ethmoidal foramen to enter
the cranial cavity. It then descends through a slit at the side of the crista galli to enter the nasal cavity. It
gives off two internal nasal branches and it then supplies the skin of the tip of the nose with the
external nasal nerve. Its branches include the following:
■ Sensory fibers to the ciliary ganglion
■ Long ciliary nerves that contain sympathetic fibers to the dilator pupillae muscle and sensory fibers to
the cornea
■ Infratrochlear nerve that supplies the skin of the eyelids
■ Posterior ethmoidal nerve that is sensory to the ethmoid and sphenoid sinuses

Maxillary Nerve (V2)

The maxillary nerve arises from the
trigeminal ganglion in the middle cranial
fossa. It passes forward in the lateral wall of
the cavernous sinus and leaves the skull
through the foramen rotundum and crosses
the pterygopalatine fossa to enter the orbit
through the inferior orbital fissure. It then
continues as the infraorbital nerve in the
infraorbital groove, and it emerges on the
face through the infraorbital foramen. It
gives sensory fibers to the skin of the face
and the side of the nose. The maxillary nerve carries sensory information from the lower eyelid and
cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the
pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninge
Branches
■ Meningeal branches
■ Zygomatic branch, which divides into the zygomaticotemporal and the zygomaticofacial nerves that
supply the skin of the face. The zygomaticotemporal branch gives parasympathetic secretomotor
fibers to the lacrimal gland via the lacrimal nerve.
■ Ganglionic branches, which are two short nerves that suspend the pterygopalatine ganglion in the
pterygopalatine fossa. They contain sensory fibers that have passed through the ganglion from the
nose, the palate, and the pharynx. They also contain postganglionic parasympathetic fibers that are
going to the lacrimal gland.
■ Posterior superior alveolar nerve, which supplies the maxillary sinus as well as the upper molar teeth
and adjoining parts of the gum and the cheek
■ Middle superior alveolar nerve, which supplies the maxillary sinus as well as the upper premolar
teeth, the gums, and the cheek
■ Anterior superior alveolar nerve, which supplies the maxillary sinus as well as the upper canine and
the incisor teeth
Pterygopalatine Ganglion
The pterygopalatine ganglion is a parasympathetic ganglion, which is suspended from the maxillary
nerve in the pterygopalatine fossa. It is secretomotor to the lacrimal and nasal glands.
Branches
■ Orbital branches, which enter the orbit through the inferior orbital fissure
■ Greater and lesser palatine nerves, which supply the palate, the tonsil, and the nasal cavity
■ Pharyngeal branch, which supplies the roof of the nasopharynx

Mandibular Nerve (V3)

The mandibular nerve is both motor
and sensory. The sensory root leaves
the trigeminal ganglion and passes out
of the skull through the foramen ovale
to enter the infratemporal fossa. The
motor root of the trigeminal nerve also
leaves the skull through the foramen
ovale and joins the sensory root to form
the trunk of the mandibular nerve, and
then divides into a small anterior and a
large posterior division.

The mandibular nerve carries sensory

information from the lower lip, the
lower teeth, gums, the chin and jaw (except the angle of the mandible, which is supplied by C2-C3),
parts of the external ear, and parts of the meninges. The mandibular nerve carries touch/position and
pain/temperature sensations from the mouth. It does not carry taste sensation (the chorda tympani is
responsible for taste), but one of its branches, the lingual nerve, carries multiple types of nerve fibers
that do not originate in the mandibular nerve.
Branches from the Main Trunk of the Mandibular Nerve
■ Meningeal branch
■ Nerve to the medial pterygoid muscle, which supplies not only the medial pterygoid, but also the
tensor veli palatini muscle.
Branches from the Anterior Division of the Mandibular Nerve
■ Masseteric nerve to the masseter muscle
■ Deep temporal nerves to the temporalis muscle
■ Nerve to the lateral pterygoid muscle
■ Buccal nerve to the skin and the mucous membrane of the cheek. The buccal nerve does not supply
the buccinator muscle (which is supplied by the facial nerve), and it is the only sensory branch of the
anterior division of the mandibular nerve.
Branches from the Posterior Division of the Mandibular Nerve
■ Auriculotemporal nerve, which supplies the skin of the auricle, the external auditory meatus, the
temporomandibular joint, and the scalp. This nerve also conveys postganglionic parasympathetic
secretomotor fibers from the otic ganglion to the parotid salivary gland.
■ Lingual nerve, which descends in front of the inferior alveolar nerve and enters the mouth. It then
runs forward on the side of the tongue and crosses the submandibular duct. In its course, it is joined
by the chorda tympani nerve, and it supplies the mucous membrane of the anterior two thirds of the
tongue and the floor of the mouth. It also gives off preganglionic parasympathetic secretomotor
fibers to the submandibular ganglion.
■ Inferior alveolar nerve, which enters the mandibular canal to supply the teeth of the lower jaw and
emerges through the mental foramen (mental nerve) to supply the skin of the chin. Before entering
 the canal, it gives off the mylohyoid nerve, which supplies the mylohyoid muscle and the anterior
belly of the digastric muscle.
■ Communicating branch, which frequently runs from the inferior alveolar nerve to the lingual nerve
The branches of the posterior division of the mandibular nerve are sensory (except the nerve to the
mylohyoid muscle).
Otic Ganglion
The otic ganglion is a parasympathetic ganglion that is located medial to the mandibular nerve just
below the skull, and it is adherent to the nerve to the medial pterygoid muscle. The preganglionic fibers
originate in the glossopharyngeal nerve, and they reach the ganglion via the lesser petrosal nerve . The
postganglionic secretomotor fibers reach the parotid salivary gland via the auriculotemporal nerve.

Submandibular Ganglion
The submandibular ganglion is a parasympathetic ganglion that lies deep to the submandibular salivary
gland and is attached to the lingual nerve by small nerves. Preganglionic parasympathetic fibers reach
the ganglion from the facial nerve via the chorda tympani and the lingual nerves. Postganglionic
secretomotor fibers pass to the submandibular and the sublingual salivary glands.

The trigeminal nerve is thus the main sensory nerve of the head and innervates the muscles of
mastication. It also tenses the soft palate and the tympanic membrane.

Ophthalmic Nerve Branches and Distribution

Nerve Branches Distribution

• Upper lid, frontalis muscle,

• Supraorbital nerve scalp
Frontal nerve
• Supratrochlear nerve • Conjunctiva, upper lid,
forehead

Receives branch from the zygomatic nerve Lacrimal gland, conjunctiva,

Lacrimal nerve
of the maxillary upper lid

• Frontal, anterior, ethmoid

sinuses
• Anterior ethmoid nerve
• Anterior septum, nasal wall
Nasociliary • Branches to ciliary ganglion
• Cornea, iris, ciliary body
nerve • Posterior ethmoid nerve
• Posterior ethmoid
• 2-3 long ciliary nerves
sphenoid sinuses
• Eye

Maxillary Nerve Branches and Distribution.

Nerve Branches Distribution

Middle meningeal
  Dura
nerve

• Lacrimal gland
• Zygomatico-temporal
Zygomatic nerve • Forehead
• Zygomatico-facial
• Cheek

• 2 branches unite
• Nasal cavity, pharynx, palate
sphenopalatine ganglion and
• Soft and hard palate
Pterygopalatine maxillary nerve
• Superior, middle turbinate,
nerve • Greater palatine nerve
septum
• Posterior superior nasal nerve
• Nasopharynx
• Pharyngeal

• Gums, posterior cheek, teeth

Posterior superior • Middle, anterior, superior
(canine, incisors, premolar), nasal
alveolar nerve alveolar, and nasal nerves
floor

Mandibular Nerve Branches and Distribution

Nerve Branches Distribution

Recurrent
  Dura
meningeal

Medial pterygoid, tensor veli palatini,

Medial pterygoid  
tensor tympani muscles

Masseter muscle, temporomandibular

Masseteric  
joint

Deep temporal
  Temporalis muscle
(x2)

Lateral pterygoid   Lateral pterygoid muscle

• Temporal nerve (upper) Skin of cheek, mucous membrane of

Buccal
• Buccinator nerve (lower) mouth, and gingiva
 • Communication with
facial nerve, and otic Parasympathetic and sympathetic supply
Auriculotemporal ganglion, to the parotid gland, after relay in the otic
• Articular nerve ganglion
• Parotid gland

Communicates with CN VII Taste sensations to the anterior third of

Lingual
via chorda tympani tongue

• Mylohyoid
Mylohyoid, anterior, belly of digastric,
• Dental
Inferior alveolar molars, premolars, canine, incisors lower
• Incisive
lip, and chin
• Mental

Reference:
Medscape: Trigeminal Nerve Anatomy, retrieved from
https://emedicine.medscape.com/article/1873373-overview#a1

Snell Clinical Anatomy by Regions 9th edition

 5. Subsites of the oral cavity

The oral cavity extends from the

vermilion border of the lip pos
terosuperiorly to the hard palate-soft
palate junction, postero inferiorly to
the circumvallate papillae (linea
terminalis), and posterolaterally to
the anterior tonsillar pillars. It is
divided into seven specific subsites:
1) the lips, 2) dentoalveolar ridges,
3) oral tongue, 4) retromolar
trigone, 5) floor of mouth, 6) buccal
mucosa, and 7) hard palate.

ORAL CAVITY SUBSITES

Lips. The anterior boundary of the oral cavity

starts at the vermilion border, which
demarcates the transition from the facial skin
to the internal mucosa. The underlying
musculature is made up of many different
muscle groups with varying locations of
insertion. The lip muscles insert onto the
modiolus, which is an area that is lateral and superior to the oral commissure where the facial muscles come
together and is held together by a fibrous band. The muscles of the lip include the orbicularis oris, buccinators,
levator anguli oris, depressor anguli oris, zygomaticus major and risorius muscles.

Motor function of the muscles of the lip is provided by the facial nerve, primarily the buccal and marginal
mandibular branches. The trigeminal nerve is responsible for sensation from the lip with afferent fibers of the
infraorbital nerve (from the second division of the trigeminal nerve [cranial nerve V2]) from the upper lip and
afferent fibers of the mandibular nerve (from the third division of the trigeminal nerve [cranial nerve V3]) from the
lower lip.

The blood supply to the lip originates from the facial artery, a branch of the external carotid artery. The facial
artery branches into a superior and inferior labial artery; these branches run deep to the orbicularis oris muscle
and anastomose with the labial arteries of the opposite side. Lymphatic drainage from both the upper and lower
lips is primarily to the ipsilateral sub-mandibular lymph nodes. There is occasional contralateral drainage from the
central part of the upper lip, and the central aspect of the lower lip additionally drains directly to the submental
lymph nodes. The submental lymph node basin drains to the submandibular lymph nodes, which subsequently
drain to the deep jugular lymph nodes.

Alveolar Ridges. The alveolar process of the maxilla is formed by the palatine processes of the maxilla anteriorly
and the horizontal process of the palatine bones posteriorly. The mandible also has an alveolar process on its
superior aspect. Both the maxillary and mandibular alveolar processes support the dentition. Deciduous teeth
begin eruption around six to eight months; eruption is completed by 24 months with a total of 20 deciduous teeth.
Deciduous teeth are generally shed and replaced by permanent dentition between the ages of six through 12
years. The permanent dentition numbers a total of 32 teeth. There are two central incisors, two lateral incisors,
two canines, two first and second premolars, and two first, second and third molars. The permanent teeth are
labeled starting with the right maxillary third molar and ending with the right mandibular third molar from number
1 to number 32.
The inferior alveolar nerve, a branch of the mandibular nerve, innervates the alveolar process of the mandible. The
maxillary nerve provides innervation to the teeth of the maxilla via the posterior and anterior superior alveolar
nerves. The greater palatine nerve supplies the lingual aspect of the alveolus posterior to the premaxilla (the area
anterior to the incisive canals), and the nasopalatine nerve supplies the lingual gingiva of the premaxilla.

The blood supply to the alveolar processes of both the maxilla and mandible are the superior and inferior alveolar
arteries, respectively. The primary lymph drainage from the alveolar ridges is to the submandibular lymph nodes
which ultimately drain to the deep jugular lymph nodes.

Oral Tongue. The anterior two-thirds of the tongue is within the oral cavity, while the posterior one-third,
comprised mainly of the lingual tonsils, is within the oropharynx. This separation is demarcated by the sulcus
terminalis, an inverted v-shape groove at the anterior aspect of the circumvallate papillae. At the apex of the
sulcus terminalis is the foramen cecum, which is the origin of the thyroglossal duct. The anterior two-thirds of the
tongue is considered the mobile tongue, comprised of both intrinsic and extrinsic musculature. The intrinsic
musculature includes the superior and inferior longitudinal, transverse and vertical muscles. The tongue is divided
into two halves by the median fibrous septum. These intrinsic muscles function to change the shape of the tongue
during speech and swallowing. The extrinsic musculature includes the genioglossus, hyoglossus, and
stylopharyngeus muscles. These extrinsic muscles act to move the tongue anteriorly, posteriorly, upward, and
downward. The genioglossus functions to protrude and retract the tongue as well as depress its tip. The
palatoglossus muscles, although primarily responsible for palatal function, act to elevate the tongue as well as
depress the soft palate, playing a role in the transition from the oral phase to the pharyngeal phase of swallowing.

Motor innervation of the tongue is almost exclusively through the hypoglossal nerve (CN XII), which innervates all
of the extrinsic and intrinsic musculature except for the palatoglossus muscles. The hypoglossal nerve enters the
tongue on the lateral surface of the genioglossus muscle and anastomoses with fibers from the lingual nerve.
When one of the hypoglossal nerves is injured, the tongue deviates to the side of the injury on protrusion. The
palatoglossus muscles are innervated by branches from the pharyngeal plexus.

Sensory innervation of the tongue can be separated into general sensation and taste. General sensation of the
anterior two-thirds of the tongue is carried by afferent fibers from the mandibular division of the trigeminal nerve
in the form of the lingual nerve. Taste sensation from the anterior two thirds of the tongue is carried by afferent
fibers of the seventh cranial nerve via the chorda tympani. Both general sensation and taste from the posterior
one-third of the tongue are carried by afferent fibers of the glossopharyngeal nerve.

The main arterial supply to the tongue is from the lingual artery, a branch of the external carotid artery. The main
components of the tongue’s venous drainage are the lingual veins, which drain into the internal jugular vein.
Lymphatic drainage of the tongue can be somewhat unpredictable. In general lymph from the anterior two-thirds
of the tongue drains into the marginal and central lymphatic vessels within the tongue; these vessels then drain
into the submental and submandibular lymph nodes. The remainder of the tongue or middle one-third of the
tongue drains primarily into the submandibular lymph nodes and subsequently to the upper deep jugular lymph
nodes. The posterior one-third of the tongue can drain directly into the upper deep jugular lymph nodes.

Retromolar Trigone. The retromolar trigone is bounded by the distal surface of the third or last remaining
mandibular and maxillary molars anteriorly, and the ramus of the mandible to the coronoid posteriorly, with its
apex at the maxillary tuberosity. The lateral aspect of this space is contiguous with the gingivobucccal sulcus, and
the medial aspect is the anterior tonsillar pillar.

Sensory innervation is carried by afferent nerve fibers of both the glossopharyngeal nerve and the lesser palatine
nerve.

Blood supply to the retromolar trigone is the tonsillar and ascending palatine branches of the facial artery. Venous
drainage is through the tonsillar fossa to the pharyngeal plexus. The lymphatic drainage is primarily to the upper
deep jugular lymph node chain, with some drainage to the retropharyngeal lymph nodes.
Floor of Mouth. The floor of mouth is primarily formed by the paired mylohyoid muscles. These muscles arise from
the medial surface of the mandible and extend toward the midline where they insert with muscle fibers from the
opposite side. The posterior most aspect of the mylohyoid muscle inserts onto the hyoid bone. The anterior belly
of the paired digastric muscles bound the floor of mouth inferiorly. The geniohyoid muscles arise from the mental
spine of the internal surface of the mandible and insert onto the hyoid bone, lateral to the midline. A majority of
the submandibular gland lies below the mylohyoid musculature; a small part of the submandibular gland curves
around the posterior aspect of the mylohyoid muscle and lies above it along with the sublingual gland, the lingual
and hypoglossal nerves, and the tongue musculature. The hilum of the submandibular gland drains via the bilateral
Wharton ducts on either side of the frenulum on the ...frenulum on the floor of mouth Covering these structures is
a layer of superficial fascia. Between this fascia and mylohyoid musculature is a potential space; the development
of an abscess within this potential space is known as Ludwig angina.

Sensation from the floor of the mouth is carried by afferent nerve fibers of the lingual nerve. The motor function of
the mylohyoid musculature and the anterior belly of the digastrics muscle is provided by the mandibular branch of
the trigeminal nerve. The motor innervation to the posterior belly of the digastric muscles is provided by the facial
nerve.

The main blood supply to the floor of mouth is provided from the lingual artery. The venous drainage is provided
by the lingual vein. The floor of mouth contains a high concentration of lymphatic vessels that drain the tongue,
floor of mouth and mandibular gingival.3 The majority of these lymphatics drain into both ipsilateral and
contralateral submandibular lymph nodes. There is a few small lymph vessels at the anterior aspect of the floor of
mouth that drain directly to the sub-mental lymph nodes.

Buccal Mucosa. The buccal mucosa is the lateral wall of the oral vestibule, and the buccinators muscle is the lateral
muscular wall that assists with oral competence. Within the buccal mucosa, opposite the second maxillary molars,
are the bilateral Stensen ducts which drain the parotid glands.

Sensation from the buccal mucosa is carried by afferent nerve fibers of the buccal branch of the maxillary nerve.
The buccinators muscles receive their motor innervation from the facial nerve.

The blood supply to the buccal mucosa is from the facial and transverse facial arteries. Lymphatic drainage from
the buccal mucosa is to the submental and submandibular lymph nodes which ultimately drain to the upper deep
jugular lymph nodes.

Hard Palate. The hard palate separates the oral and nasal cavities.
It is a bony plate formed by the alveolar and palatine processes of
the maxilla and palatine bones. The alveolar process of the maxilla
articulates with the horizontal or palatine process of the maxilla
medially at the second and third molars. There is a longitudinal
suture that fuses the horizontal lamina medially. Occasionally bony
ridges or bulges develop at this suture line known as torus
palatinus. In young people, there is a suture between what was
once the premaxillary part of the maxilla and the maxillary
palatine processes. The junction between these two sutures is
marked by the incisive foramen which separates the primary
palate anteriorly from the secondary palate posteriorly. The
incisive foramen transmits the nasopalatine nerve and the
terminal branch of the sphenopalatine artery. Other openings
within the hard palate include the greater and lesser palatine
foramina. The greater palatine foramen is located at the lateral
border of the palate approximately at the level of the upper third
molar and transmits the greater (anterior) palatine nerve and the
greater palatine artery. The lesser palatine foramina are posterior to the greater palatine foramina at the edge of
the hard palate and transmit the lesser palatine nerves and arteries. The hard palate is covered by a layer of
mucosa that is firmly adherent to the underlying periosteum; this mucosa contains numerous minor salivary
glands.

Sensory innervation from the secondary palate is carried by afferent nerve fibers of the greater palatine nerve. The
sensory innervation to the primary palate is the nasopalatine nerve, a branch of the maxillary nerve.

The arterial and venous supply to the hard palate is from the greater palatine artery and vein. There is limited
lymphatic drainage from the hard palate, principally to the upper deep jugular lymph nodes and occasionally to the
retropharyngeal nodes.

Reference: Ballenger's Otorhinolaryngology: Head and Neck Surgery