As the rnandibular nervf, treav*s the f*ramen cvele, it lies cn th* tearssr veli palatini

l:rusele arud is eovered latcrally by the upp€r Saead *f t?ae lateral pterygcid na::s*le
fslishtlv anteri*r tc the :reek of the mandihlr'\

rlrl * LITI-IEf
l?nfttT!rll.}l
Main trunk
' Meningeal branch (nervus spinasus)
" Jn{erve to medial pterygoid

A *-.r.^,-: ^-. +------ l--

ri.lrlEt lUl lt tltln-;
Masseteric nerve
Deep temporatr nerves
\Tor- ra *n ln*onn I
I t \,I v t, L\J rCLLvr rrr l-'
^#o^.^^il
Lvr J 6\r rLi

Buccal nerve

Fna*ar"i6r"
-l t it l'.i,! tal.l.
*r.rrmlz"
9r tltl-alre

Auriculotemporal ncrve
Lingual nerve
Inferiar alve+lar nerve

1. 'I'he meningeal branch (nervus spinosus):

it is 'd'rel)urrfftri tr€rve' as ii runs irack intu Lirc rniddie uraniai fus$a Lirluugh iire
forametr spinasurn. Tt sppplies the dura nrater lining the midrlle anr,l anterior cranial
fossae and the rnucosa of the mastoid antrum and mastoid air cells.

2.
The nerve to the medial pterygoid muscle:
This enters the deep surface of the muscle and also gives slender branches that pass
uninterrupteei through tirc ofic gangiior to suppiy the lensor tyrnpani anci tensor veii
palatini museles.

3.
Tire nrassclsri$ nurve
This is usually the first braneh of the anteriar trunk of the mandibular newe, It passes
above the upper border of the lateral pterygoid rnuscle (aecompanying the posterior
J-.=.-- +-i-.4,4.^-.'^! "-".-.-=.-\ *..= J +1".-".- .^..,44n ^- +l^^ ,ra^..--l:1^"-l ^a^1- /t^+--.^^,^ +1.- J-,1 ^".
Lrc{rir tctupLrliat lt€rvcj airLi uie,li i-t"u$$.ss ilitt iliaiiGiti'riiAi'iiG[Cii tneiw*een liie C0iifiyiai
and coronoid prscesses) to be distributed inta fhe massetsr musele. It also gives an
artieuiar branch to the temporomandibular joint

4.
The deep temporal nerves
These n€rves also pass above the lateral pterygaid musele. Antcriar middle and
nnc'f.=""i1-rr-.loot"
y:us*v3iur *\rvl/ fsrtrtrrlrol
uvr}.i.y\rivar trar.qreq
rrvt tv* j-n:.tiJ i.iv r.pr.nrrtrlnoA
??,r-qt/ k,o
"Lvv!r6_i."ii&.1r'.i.i.

z-
/ 5" The ncrl/e to the later*l pterygaicl musele
Tlrig
:]itu ariqe gen"ar*fetrr
:'!--ra\,/ +!iauv
:r:!!J u$t}.*t!.+e*nJ nr" $1fi1/ rrln
.a{i. t:rq{"J +q,i,ii
--xritlr
Vi;.i,*i flre
tij.;* hrrr'.r.al rrer"rr*
Vi-.i:*nr_;i:i ii'*-: rt! l'refrrr.e er-lfr=r'inrr *l"re
ij+-'-(r-.L.:d i'nni.,viti:*; r{r=e!r
L.!.i€ LiLLi,;

surfaee of the latcral ptcrygoid muse le"

6. The hueeal t'rary+h of th* rnandihular pervfi

This is the only sensory branch of the anterior trunk. It contact the medial surface of
the temporaiis ntllscie. It tiren ciears the ramus of the maniiibie to iie on the iaterai
surfape of ffre huccinator rrruscte in the clleek. At fhis pnint^ it is close tn the
retrornolar fossa of thc mandible.
it now gives branehes to tire skin of the cheek before piercing tire buccinator to
suppl3r its lining mueosa, the buccal sulcus and the buccal gingiva related to the
rnandibular molar and premolar teeth. It may also cany secretomator fibres to minor
saiivary giancls in the b'uccai mlrcosa. Tire bucr;ai branch of tire rnanciib'uiar nerve may
anastomose with the buccal branches of the facial nerve.

7 . Tire auri,;ulutuurpural rterve

This is the first branch of the posterior trunk of the manclibular nerve. It is essentially
sensory but it also distributes autonomic fibers to the parotid gland derived frorn the
-+l^ *^"^-ll^"^ T* --^,,^ll-, -- +.*.^ ,.^.^+- /^.^.^."^-. nCO/ ^'f ^^^^.-\ +l-^+ ^^^:.,-1.- *l-*
utIU BauBuurr. It ubui:ilL! ^..:^^^
aLrbtrb 4s L\^rr.J rrrrrts \dFPruA. i J /u rJI ua5E5 ) LItaL t'rruirLis Lrlg
middle rneningeal artery and unite behind the artery. The nerve then runs backwards
under the lateral pterygoid muscle to lie beneath the mandibular condyle (between the
^-J +1-r^
^^-Jt.l^ rw cr.llt't
v\.rrrLrJ Lrrv -^L^-^*^*Ji1-ttl^-
ilynwtlurircliNliuLiicli li.-^'*^'.*\
rr6.iriivriLit.
On entering the parotid region, it turns to emerge superficially between the
temporomandibular joint and the external acoustic meafus. From the upper surface of
fhe nnrnfir{ fSrrtlr\.It
Lrrv tillivlru r-!nnr! fhe.atrr"icrr.!nferll.lnrc.!
rrrv iriLlrL1jt.iiiita/iii|J\riii^
poni4
Livi 1v liiivVii\t,l nn fha
esnanr.la t-ii +iiv cirlo
Jiii{' nf +ho ii-lli-;
ho- .{ llrifh fho
'L;i iiiu ii'ilii iiiv

superficial temporal vessels, passing over the posterior part of the zygomatic arch. It
gives several branches along its course:

o Ganglionic branches which eommunicate with the otic ganglion.

3 Artieular branches which enter the posterior part of the temporomandibular
ini*rf
J.1"rrl.t
o Parotid branches whieh convey parasympathetic seeretornotor fibers and
syrnpathetic fibers to the parotid gland; these fibres ar€ related to the otic
.'"nn rtlittrr Qoncnr.rr fil"o".c, fr.r* +ho nrrrinrrlnfor.rrnn""ol r)o't.\ra c,rrr-r-1. r Liiv
t1na girfii\i
Era.tr.i5rrvrr. \JvalrvrJ riuvru riijiii iiit riurlvLar\rLvirr}Jvrur rivr Y i/ !}sPiriJ ^l-rtr{
(with the exception of the capsule, which is innervated by the great auricular
nerve).
sY r-lrtcr hr"grrnheq /rrqltolhr frrrrr\..rhi.h .,lrr-"*lrr fha *r.r'rro .r*.r{ .,*rcr n-f fl..o h^li-
=
;; ru'-i;
.A-.rritv\lrui
? -lUi

;; ;;;il;;;,-;;;' ";;# ;-;#i'#;J,il'#;;:;;t;'

surtbce af the tympanic membrane.
a, Q1r1.o"'fir-''i+l fotr.*..t*ol t-/!.r+al\/l1vLr ttrl.i.h
lvrrr]tj \-/rir.l" h*o-.'1*,-c, rrra
- L'u}Jvrllvrt+l !! Irrvlr srv r-rrfrr*16.-llc\
vr-rlrlltlvvur-7 n6r\7aci orr^"-ltri-* *^r.f
llvr .r vrf ULryl"rJ rlrj5 yui L L;r
*l"o
^f Lilv
skin of the ternple .

3
t_

I" The tringual nsrve"

It is cssentiattry a senssry rt#trv€ but, f*llcwing uni*n with the eharda tympani braneX:
*f the fa*ial nf,rn/e, it als* e cntains i]sres:ry*pathetie fibres. I:ritielly, fh* nerl"/* li*s cn
the tensor veli palatini muselc deep to the lateral pterygaid muscle. Herc, thc ehcrda
tympani nerve {whieh has entered the intratemporal fbssa via the petratyrnpani*
fiss,:re .'::1
ancl - rnassnd *ver th* snin* *f the snh*n*ie! hone) !oins the nosteri*r sr:rfbee ctf
the lingual nerve.
'between tire ratnus ct
The iinguai nsrve eurves iiownwarcis anci forwarcis in the spaee
t!,p n+l1dfhlg a1{ tlre ryqdla! ple1ygold qru5qle (ptgryrgnrnandihular space), At this
level, it lies anterior to, and slightly deeper than, the inferior alveolar nerve. The
iinguai nerve then ieaves the infratemporai fossa, passing iiownwarcis ancl forwarcis to
lie elose to the lingual alveolar plate of the mandibular third molar. Befare curving
forwards into the tongue, the nerve is found above the origin of the mytohyoid
nruscie arrei iaterai to ihe hyogiossus rnuscie.
The elose relationship of the lingual nerve to the third molar tooth makes the nerve
susceptible to darnage during rernoval of the tooth. In addition, in aborit one in seven
{rasus) iirr lingual ncrve is auiuaiiy iucn'red atjuve iirc iiirguai bony pla're ilr 'rire 'tirirri
molar region and is liable to darnage during surgery.
The lingual nerve supplies the mucosa covering the anterior two-thirds of the dorsum
.-f 41.,- 4---r-.=--,.- *!..- 41*^.'^f,1!.-.- --.J +!-..- 1:t^''-"-^1
CIt tiie r^.---,*
^f +1-^ t0iiglie' +l^.*.
tne -..-.*+.-^t ^=,-"f-^^ iii
Venii:ai Sui,iae€ tne t$ngue, ii1- IiOUi- ,Oi tii€ riiurllri'.-.--::*1= $rtLt Lrt€ rlrr$urxL
gingivae of the mandibular teeth.

'Fl.^ ^L^-J^ *rmenni

iiic iiiiuiiiA fftrt^'.- \ri
iyiiipaiii
iiOi.:i3 ^f +f,.^ f^..i.-'l .1n.,.r14
LiiU iaiviaii LiiiYuiiiiig .ryif!-
riUiVU fr-nrrr-'!!in- Lriu !i*-"^1
wilii th1- ^^-'1^
rrir$tlo.r ilv-r ?v .trv n{'
::r'.^ \[

two types: sensoty and parasympathetic. The sensory fibers are associated with taste
for the anterior two-thirds of the dorsum of the tongue. The parasympathetic fibers
- r-a
Ai r.,,.A.rarlrrlin'ir'
it iji CgiXfi6iiv-iii'v filror.o
iivvi; th-qt
i.ii{ii x..ace fn
i,v +ho q',rhrrrenr{ihrr!,e!' c'.qrro!ion Pnef$pn*li+nir-
iiir./ DL.liiitiL+ii\ti\ti,'itli i 1,-i.ttrrulbuufr?
i,tr;D; $itri-iifiiririi..
fibers are distributed to the submandibular and sublingual salivary glands.
9. The inferior alveolar nerve
This is the largest branch of the rnandibular divisicn cf the trigerninal nerve. It is the
third branch of the posterior trunk of the rnandibular nerve. Although it is essentially
a sensory nsrve, it also camies motor tibers which are given off as the rnylohyoid
ilFryp, Insle ed, the m3rlolr,vold !l*t've cclrltaips all the motcrr fibcr's sf fhe Fosterinr tnrnk
of the rnandibular nerve. The inferior alveolar nerve descends deep to the lateral
pterygoici muscie, posterior to tire iinguai nerve in the pterygoici hiatus" Here, it is
*rosseel h.v fftq nraxillary arterlr. On ernerging at the infericr border of the rnrlscle, it
pass€s between the sphenornandibular ligarnent and the ramus of the mandible to
enter tire rnanriibuiar ioramen. it is aceompanieei in its eollrse by inrerior aiveoiar
blaod vessels"
The mylahyoid nerve is given off just before the mandibular forarnen" It pierees the
spirenomandibuiar iigaurent anci ruils irr a grrlov* ltire myioiryoicl gruov*) wirich iies
imrnediately below tlee mandibutrar foramen" The mylohvoid nerve supplies the
mylah3zoid inusclc and the anterior belly of thc digastric. The mylahyaid nerv€ may

k
 alsc e*ntain senssry fiber"s that supply the skin of the ehin and l:reclial parfs *f the
/ submandibrilar triangtr* in the s*pralaycieX r*gian"

The main distribution cf thc inferiar alvcolar nerv€ is to the n'randibular teeftrt and
their suppo$ing strucf,ures, there being molar and ineisive branehes. 'Ihe mental nerve
is a +utin*c,r-r* branch that supplies thr skin *f the *hin and the lc,trer lip It
ariscs within the mandible in the premolar region, but soon exits onto the face via the
mentai foramsn

THE OTIC GAbIGLIO]'{:

Tiris parasympatiretic gangiion iies irnmeriixeiy beiow the foramen ovaie on the
medial surface of the main trunk of the mandibular nerve. It is oonoerned primarily
with supplying the parctid gland. Like other parasympathetic ganglia in the head,
three rypes of fibers are associaieci 'wiih ii: parasyrnpathetic, sympaiireiie anei s€nsory
fibers. However, only tho parasympathetic fibers synapse in the ganglion. The
preganglionic parasympathetic fibers originate fronn the inferior salivatory nucleus in
iiie brains'rein. Tire .fibers pa$s uut in titv glossupiraryngeai nerv€2 appuarirrg as iire
lesser (superficial) petrosal nerve from the tympanic plexus in the rniddle ear eavity.
The lesser petrosal nerve reaches the otic ganglion by a complex
+_!_..^.-=_l_ +7-.^ ..-^+.=^--_ .^^..+ ^f +l_ ^ +^,^.^ et-^ l^^-^". .-^+,.-_^l
._ T)^^^:"._^
LIJUI,5U. r clsbrlr$ trir\JuBll rrre PUtruus p(rtr rjt LIrg LtrrfiPLrrCrrI L^"-^
[rlJlrF, trl{t rFsbur PIJLILtb(rr
nerve comes to lie in the floor of the rniddle cranial fossa. Here, it is lateral to the
greater (superficial) petrosal branch of the faeial nerve. The lesser petrcsal nerve
-l*ff--t^r-h^rnl +L-^rr^tr, 4n i^it. +L.^
tr^tr-ll-,
LloLrt[IlJ a**nro i] +L^
\rirLwt Litw rr-rl.t rrL\r.IrrPwr crr f^-^-
lv\}rjc] Lttr \-/r-16rr +L^
tlrw f^*-*^-
r\rl trllrvrr ^tr^l^
\r'v cltv Lw J\^Ir ^4i^
Llrv \JLlv
ganglion. On occasion, the lesser petrosal nerve passes through the sphencpetrosal
fissure. The sympathetic root of the otic ganglion is derived from postganglionic
flkar"<l
riu\/rr frn*-yr
ll\->rtt fh*
Lriv .rt^o*inr
r-?sfJvtrvl, nonri.'oI
v\'.t rllvwr. .rqt"-lir'rtr
sHl.tt5rrvar.

They are said to reach the otic ganglion from the plexus on the middle meningeal
artery. Other descriptions have it that the sympathetic root arises fiom the deep
netrn,qat ner\/e or rLirect!'r fi'cm the ister:ral carotirl nlexus" The ssnserrr rnot is derirterl
iJ
*wr t--*\ t s3!rJ iiul!! 3ii* *:v*:!i*i t*!vti*
I/ ^$raatf
. ri!* *!irp*rJ ruvv !u +v^!,. **

fiom the auriculotemporal nerve. The postganglionic parasympathetic fibers (with

sympathetic and s€nsory oomponents) reach the parotid gland by way of the
aurieulot*rnrorat
- -'-ll - nervs. Paras\4rnathetic
J --'l' fibers mav also innervate th* r-"ninor sativarv
' -'-- '-- J

glands in the cheek, passing with the buccal branch of the mandibular norve"
The innervation of tensor veii paiatini anci tensor tympani is eieriveci from tire nerve to
the rnedial pterligoicl tty * hraneh tlrat nasses through the otie ganglion"

Ciinieai signitieance :
Lesions of mandibular divisicn of trigeminal nerve will czuse unilateral
paralysis af muscles of mastication followed by atrophy; results in a sunken-in
appearanes aiong raffrus of rnandibie anqi a'nq:ve tire zygomaii* areh"

5
 r
\

Lr!auiil=r,,
nafue

Anterior
diuision of
* .- J;L,,t..
lI tatrqr$ui#
netve [V3]

*nstrt
palatini
and
trhorda tgmpani netue

.4uriculoternporal nertlg

Ma*illarg erterg

Medialnteruqoid
neru* and muscle [*ut]

frlerue tn mglohgoid muEcle

Fterugoid hamului lnferior alr,eolgr nerue emetging
a--- J:L--l-- a----
rr\ !!:3 1!t irrlrrrrrtr4! t! ri &r.\*rr --
---

f" "'x

d
 maflC**&r rdFr;*
teci#r **lipelx!irri
sF;Hd€ irr*r:iry*# ai*r3
xzi,t akxn#*c&i{Hflt1*

*hyi::*,,! prta***e

n€*ha ni3
r.rs*.!d #gryS,*i*

lix#sal **r,pe

**& ['Ffl"iF*.{ii

r:*i3kl ptery,g*id

kx*ir*lc.t
r*""f* r?:l *l**c'kr *.*n** lilpa,1ff{rraii;B

uryh6rluryry+us
gir*e**plxxryngc *l,re naa

*'4*i i*rr' ::,: fi xtia€uA

tn#* u::gc*lii**r
,:S*$c'*sLn
ge;:i*h:'ei'J
inf* dg si'se*{*r'il* i-** xt*tu@fu
,ed*artrx
$sr*hmgk!ryold
*n:l*t^*iil{ Kao**** raf*hyfi*
nq

Trigemi*al qar4lir:n ,,Jl,i**ffi

'*il-Genrcrtffi
P*l*ti R* r*rve$ '/I
H
[ , ,['of*T*t1onff
',fEA
,-rF$ial €
Fter g,goBalati n* grElion
W.,r*rv*,.:
t{a*lib*!*r n*rve [?31

*h*r** t4mp*ni

Lirqe**l a*rv*

:3u*rn* Hi $ Hl*r g*rql ir:*

{ +3
 L*{r# #ar{
Nac"-,r*

t/z{#z*{ f+t*w?ar
?1*a":*

*^*,,t**{'fdis$#rc=i
"[**t*
{i{1*ue'2 74w"'s*

g*2
 '/
t
I

,/
-7/ t/
'/

/
l
tl

li

t.
I

* *| : <:zV ;-;l,t'y ie'lili;i*

--'-* a"lrifiliCt{,i':iir*:At f; f lrl*

"-,.- llir;:rtl* i./rtill-l€'+ 5:;:':.r,5 l:4r:! pJ,1]

t,.:r,i:Lii: -ifi:ri:3i i'$t'"s

,rr*ir::;.;fti +:erd

; r. i';:: 1u] "r tii)'i i'tr ul;sr rJ

1.."' -,.-.."j,rd" '.1."- -

lr,. i.i(]l it,, :., :.; :z

5,-:r:iai *-.*r-';* l!,Jl ! !

L*;-l rir:il i.? iriia.i,,"l lr{ti',rri

\.
*g*ltihe,*tir: ii*r!'*, *J, i".--^-
,"-'-
i,4;i.a+l,,try**t.".ifitJ.i,. jl

Gi*s;;*ijh*il
L,i *l :;li d;rll :ll g it+"1r.,'* f,r1 ! -.. -- -.-, --i r:4r'f* ii{i
eiil+ i,1*ii-6;i*rr
:titr
l;;;:t;:S*ii t.:";
Ar;tic]*l*ttlinpitriil ii{i{t;} ---*- \*
_..i1.

l, 11"46:3i ii{:J {;i: .,,

ed r?t J'*,i\
1.
'"' 'lfr?ef u'i;Ai

1: *] fr a:: iC l-ilf il tiiar-l

W:ii
i.:-,i- -.. L-,?r !! -i -.!
'''.r:.' ! ;lLi, :t.l-' I

giji r!ilct:

-ir; ir iil al i : ?-rij

:
ir
lli:?rij

1
 €

Ipr-*n
I+:vS:3r4+:Y
N"p {
v .**fft
?' t4
'L&G
lqtt
3-**l -J

THE MANUBULAR I{ERVE

Maxill*ry
bran*h tV*}

i.,...,t', ,

't;
, r;,{
Sup*ri*r
.- r-
- ^-*. i
{*iVUUtdt
f"l*rve
Msndit]*:lar
*ran*f:
JrciltLlr 1v;|i
{Vg} , ,/
? -/{.1 ILrrinnr rgl
rsirrtar

/-1
I
f}*fv*
lnf*rir:r I
'''',
,
af v**l*r
fi*rv&

This is the largest division of the trigeminal nerve and is the onl-rl one to contain
motor as well as sensory fibers. Developmentally, it is the nerve of the first branchial
areh anci is thr"rs responsibie for suppiying structures tieriveri frorn ii.

Its Sensory fibers supply

l. Lltu rrlarluruurar
_1 +!- ._- -!:1=._!_._ r_ -rl_ _,= _t +'!_ _:._ _=
leetil aliu .-ri.- ._ _L.___ _L-
lilei{ sulrportiitB structures,
2" the mucosa of the anteriorfwo-thirds of the tongue and the flcor of the rnouth.
3. the skin of the lower pafi of the face (including the lower lip) and parts of the
4^,*-.^^-"^t ."^ *:^-^ ^--J ^,..":^1^
rsrrrpur{rr lu3iiuii ariii iiul iui€.

Its motor fibers supply

t
r. t}"r+
Lljlv €rrr. 111rrn^lo- \ri
l\rLrr riiuiirvi\/i) ^f *^.*i^-fi^-
iiiri;iti\raltiiiii
2.the rnylohyoid, anterior belty of digastric,
3. tensor veli palatini and tensor tympani muscles.
The mandibular nerve is formed in the infi'atemporal fossa by the unian of the
sensory and tnotor racts immediately atler they leave the skull at the forarnen o'rale.
Within the fbralrlen o.rale, the rnat+r raot (or rcc'ts) lie posteromedially to th* sensary
root and these raats are ascompanied by emisssry veins, the lesser petrosal nerve
and the &ccessory meningeat artery.