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Trigeminal nerve(V)

It has three divisions


1.ophthalmic(V1)
2.maxillary(V2)
3.mandibular(V3)
The first two are purely sensory
Mandibular is a mixed nerve.
Its motor nucleus is in the pons
which supplies the muscles derived from I arch

Functional components
GSA
SVE(to masticatory muscles)
Nuclei: the principal sensory nucleus is
in the pons
Which sends extensions into
midbrain(mesencephalic nucleus of V)
and
into spinal cord through medulla(spinal
nucleus and tract of V)
1.mesencephalic nucleus of V
2.pontine nucleus
3.motor nucleus,
4.spinal nucleus and tract
It is the sensory nerve of the face
and

Nerve of the I arch


The trigeminal nerve functions in
sensing facial touch,
pain and temperature,
as well as controlling muscles of
mastication
Superficial attachment of Vnerve
Foramina of exit
Ophthalmic nerve (superior orbital fissure)
Maxillary nerve(foramen rotundum)
Mandibular nerve(foramen ovale)
FORAMINA OF EXIT

V1

V2

V3
Testing the trigeminal nerve

Facial sensation and chewing

Sensation in areas of the face is tested


by using
a pin and a wisp of cotton. (ophthalmic)
Testing the trigeminal nerve

The blink reflex is tested by


touching the cornea of the eye
with a cotton wisp.(ophthalmic)
Testing the trigeminal nerve

Strength and movement of muscles of


mastication are tested(V3)
by asking the person to clench the teeth
and open the jaw against resistance.
Two disorders that affect the trigeminal nerve
and ganglion are
herpes zoster (= shingles)
trigeminal neuralgia (= tic douloureux).
Both cause pain.
Usually one of the three divisions is involved.
Facial nerve(VII)(nerve of II arch)

Motor nerve of the face


Nerve of second arch
Carries taste from the anterior 2/3 of the tongue
Carries secretomotor fibers to submandibular and
sublingual salivary glands, lacrimal gland,
glands of the nose,palate.
Functional components:

1.SVE (to the muscles of second arch)


2.SVA (taste)
3.GVE (parasympathetic fibers),
4.SA(small area of pinna)
Nuclei

1.Motor nucleus is in the pons.


Taste goes to
2.nucleus of tractus solitarius in the medulla
From the small area of the pinna sensations go to
3.Spinal nucleus of trigeminal nerve.
4.Parasympathetic nucleus is called
superior salivatory nucleus.
Facial nerve at ponto medullary junction
It leaves the cranial cavity(!)
through the internal acoustic meatus
enters the petrous temporal.
Petrous temporal(Lt)
exits the skull through
the stylomastoid foramen
then enters the parotid gland
Here it divides into its terminal branches
which spread out
To supply the muscles of facial
expression.
Stylomastoid foramen
Clinical aspects
Upper Motor Neuron (UMN)
Lesion

Results from damage to


neuronal cell bodies in the
cortex or their axons that
project to the motor nucleus of
CN VII.
With an UMN lesion,
voluntary control of only the
lower muscles of facial
expression on the contralateral
side to the lesion will be lost.
Voluntary control of muscles of
the forehead will be spared
due to the bilateral innervation
of the the upper muscles of
facial expression.
Upper half of face is spared
Bilateral representation
How shall I know UMN or LMN lesion?

•Atrophy of muscles of lower


portion of the face on affected
side*

•No eyebrow droop*


!!

•Intact folds on forehead*


Only in UMN
Bell’s palsy
 Lower Motor Neuron (LMN) Lesion

Results from damage to the motor nucleus of


CN VII or its axons.

A LMN lesion results in the paralysis of all


muscles of facial expression (including those
of the forehead) ipsilateral to the lesion.
Bell’s palsy
Facial nerve testing

VII Facial Facial The ability to move


expression the face is tested by
and taste in asking the person to
the front smile, to open the
two thirds mouth and show the
of the teeth, and to close
tongue the eyes tightly. Taste
is tested using
substances that are
sweet (sugar), sour
(lemon juice), salty
(salt), and bitter
(aspirin, quinine, or
aloes).
Vestibulo cochlear nerve(VIII)
 Purely sensory
 Has cochlear part(hearing) and
vestibular part(for balance)
Vestibular part begins from the
semicircular canals and vestibule of the
internal ear.
Cochlear part from the organ of corti in the
internal ear.
the nerve then travels through
the internal auditory meatus
with the facial nerve.
*enters the brain stem at the junction of
the pons and medulla
lateral to the facial nerve.
The auditory part ends in a sensory nucleus called the
cochlear nucleus.
which is located at the junction of the pons and medulla.
The Vestibular part of the eight nerve ends
in the Vestibular nuclear complex
located in the floor of the fourth ventricle.
Testing the VIII nerve

VIII Acousti Hearing and Hearing is tested with


c balance a tuning fork. Balance
is tested by asking the
person to walk a
straight line.
Damage to the Vestibular nucleus leads
to:
vertigo (violent spinning sensation)
(often with initial vomiting)
dizziness, and difficulties with
balance, vision, or hearing may
result.
Sometimes the symptoms can be so
severe
that they affect the ability to sit up,
stand, or walk.

There may also be tinnitus (ringing or noises in


the ear) and/or hearing loss.