TRIGEMINAL

NERVE

WAHEED KHAN
FINAL YEAR (BDS)
 TRIGEMINAL NERVE:
• It’s the 5th cranial nerve
• Largest of the 12 cranial nerves
• Has small motor root and a large sensory root
• a/c to name it has 3 main divisions:

1. Opthalmic nerve V1

2. Maxillary nerve V2

3. Mandibular nerve V3
 MOTOR ROOT
Originate from motor nucleus located in pons and
medulla oblongata

Fibers then run toward the foramen ovale

Leaves the middle cranial fossa (along with sensory root of

V3)

Just leaving the skull motor root unites with sensory root of
V3 and form a single nerve trunk
MOTOR FIBER INNERVATES
• Motor fibers of CN5 supply following muscles
1. Masticatory muscles
2. Mylohyoid
3. Ant belly of digastric
4. Tensor tympani
5. Tensor veli palatini
 SENSORY ROOT
Sensory root fibers located in the trigeminal ganglion
(2 ganglion innervating each side of face.. Located in the meckels cavity on ant surface of petrous
part of temporal bone)

Give 3 divisions

Opthalmic V1 Maxillary V2 Mandibular V3

travels anterior in travels ant. N downward travels directly downward
Lateral wall of c.sinus to toward foramen rotundum exist skull via foramen ovale
medial part SOF n leaves n leaves the skull along with motor root of
the skull n enters the orbit TN .. Both roots then unite
n forms a single nerve trunk
 OPTHTALMIC DIVISION
• It’s the 1st branch of trigeminal nerve
• Purely sensory
• Smallest division
• Leaves cranium n enter orbit via Superior Orbital Fissure

INNERVATES:
1. Eyeball
2. Conjunctiva
3. Lacrimal gland
4. Parts of mucous membrane of nose and paranasal sinus
5. Skin of forehead
6. Eyelid
7. nose

• After passing through SOF it gives 3 branches

BRANCHES
Nasocillary nerve frontal nerve lacrimal nerve
 DIVISION OF
OPTHTALMIC NERVE:
NASOCILLIARY NERVE
Travel along medial border of orbital roof give of 6 branches

1.Internal nasal nerve (MM of ant.part of nasal septum + lateral wall of

nasal cavity)
2:ext. nasal nerve (apex + ala of nose)
3: short cilliary nerve (eyeball)
4: long cilliary nerve (iris + cornea)
5:infratroclear nerve (skin of lacrimal sac+ Lacrimal caruncle
6:post. Ethmoidal nerve ( ethmoid + sphenoid sinus)
 DIVISION OF OPTHTALMIC
NERVE:
FRONTAL NERVE
• Travels ant. In orbit
• Largest branch of V1
BRANCHES

SUPRAORBITAL SUPRATROCLEAR
1: Supply conjunctiva 1: upper eyelid
2: Skin of medial aspect of upper eyelid 2: scalp upto parietal bone
3: Skin over lower+mesial 3:lambdoidal suture
aspect of forehead
 DIVISION OF
OPTHTALMIC NERVE:
LACRIMAL NERVE
• Smallest branch of V1
• Supply
1. Lateral part of upper eyelid + small adjacent area of skin.
2. Lacrimal gland
•
MAXILLARY
Arises from the middle of trigeminal ganglion
DIVISION
• Purely sensory nerve
Innervates
1. Skin
a) middle portion of face b) side of nose
c) lower eylid d) upper lip
2. Mucous membrane
a) nasopharynx b) maxillary sinus
c) soft n hard palate d) tonsil
3. Maxillary teeth and periodontal tissues
 BRANCHES OF
MAXILLARY DIVISION
• It gives branches in 4 areas.

1. Cranium
2. pterygopalatine fossa
3. infraorbital canal
4. face
BRANCHES OF MAXILLARY
DIVISION IN CRANIUM

Innervates
the dura
the mater
middle
meningeal
In cranium nerve
maxillary
give off a
small branch
 BRANCHES OF MAXILLARY
DIVISION IN
PTERYGOPALATINE FOSSA
• pterygopalatine fossa it gives off following branches:

1: Zygomatic nerve
a) Zygomaticotemporal b) zygomaticofacial

2: pterygopalatine nerve
a)Orbital branches
b) nasal branches(nasopalatine )
c)palatine branches(greater and lesser palatine)
d)pharyngeal branches

3:posterior superior alveolar Nerve

 BRANCHES OF MAXILLARY
DIVISION IN
PTERYGOPALATINE FOSSA
• Innervation
1. Zygomatic: types:

Zygomatcotemporal Zygomaticofacial
Skin at the side of forehead skin at the prominence of
cheek
 BRANCHES OF MAXILLARY DIVISION IN

PTERYGOPALATINE FOSSA
INNERVATION OF PTERYGOPALATINE NERVES
NASAL BRANCH
PALATINE
ORBITAL BRANCH PHARYNGEAL
BRANCHES
(NASOPALATINE)

Periosteum of orbit greater: decends into PP Small branch

run DW & FW reach nasal
canal to GP foramen &
cavity give branches to ant
Enters in hardpalate
part of nasal septum & floor
Located distal to 2nd molar
of nose
• innervates palatal ST + Innervates nasopharynx
bone upto 1st premolar .
Then communites with
then enter into the incisive terminal branch of NP
canal through incivive
foramen enters in oral
cavity
Innervates the palatal
lesserpalatine. Emerge from
mucosa of premaxillary
LP foramen .
area canine and incisors
• innervates: MM of soft
palate + tonsillar region
 BRANCHES OF MAXILLARY DIVISION IN
PTERYGOPALATINE FOSSA
POSTERIOR SUPERIOR ALVEOLAR NERVE
Decencends from main trunk of V2 in pterygopalatine fossa. Before entering infraorbital canal
give 2 branches of PSA

1st branch 2 nd branch

Passes DW reach post surface of maxilla other branch enter PSA canal travels down the
Remain ext. to bone. Contiune Dw post wall of maxillary sinus
Innervates: buccal gingiva in maxillary Innervates maxillary sinus
molar region Cont. DW innervates
1: Alveoli
2: PDL
3: Pulpal tissue of 3rd 2nd 1st molar
( With exception of mesiobuccal root of
1st molar which is innervated by MSA in 28% cases.)
BRANCHES OF MAXILLARY DIVISION IN INFRA ORBITAL CANAL
Within the infraorbital groove & canal the V2 is known as infraorbital nerve.
Gives 2 branches

ANTERIOR
MIDDLE SUPERIOR
SUPERIOR
ALVEOLAR NERVE
ALVEOLAR NERVE
●
Arise from post portion of infraoribal Canal to ●
larger branch
the ant portion of IO foramen
●
Innervates: 1st n 2nd premolar, MB root of 1st
●
exist infraorital foramen, decends
molar +PDL, buccal ST + bone of PM Region with the ant.wall of max. sinus
●
Nerve is absent in 30-54% of individual ●
innervates:pulp of incisors and
●
Then these areas are innervated by ASA or
PSA nerve. canine+PDL, buccal ST, bone of
these teeth

ASA and MSA communicate give small nasal branch and innervates
ant part of nasal cavity
 BRANCHES OF MAXILLARY DIVISION IN
FACE
Infra orbital nerve emerge from infra orbital foramen .. Give
ERIOR PALPEBRAL
EXTERNALSUPERIOR
NASAL
3 terminal branches.
LABI

Innervates : skin On Innervates: skin ,mucous

Membrane ,upper lip
Innervates Skin Lateral Aspect Of nose
Of lower eyelid
 MANDIBULAR DIVISION
• Largest branch of trigeminal nerve
Mixed nerve with 2 roots

large sensory root small motor root

Arise from inferior angle of arise from motor cells in
trigeminal ganglion pons &medulla

• Two roots emerge separately from foramen ovale . Outside the skull unite
to form a main trunk..
• Only upto 2-3 mm it is undivided than divide into small anterior & large
posterior divisons.
 DIVISION OF
MANDIBULAR NERVE
Give branches in 3 areas

Undivided nerve divided nerve

meningeal branch medial pt nerve anterior nerve posterior nerve

Innervate dura medial pt muscle motor innervation sensory
Mattar give small branches small sensory innervation
that innervates tensor veli innervation small motor
palatine n tensor tympani innervation
 ANTERIOR DIVISION
Provide motor innervation to muscle of mastication and sensory innervation to
buccal MM of mandibular molar n MM of cheek
Branches run forward under lateral pterygoid muscles gives several branches

Buccal nerve

deep temporal nerve masseter N lateral pt N

Innervates the respective muscles.

Buccal nerve: also called buccinator or long buccal nerve.

Innervates: give sensory innervation to buccal gingiva of mandibular molars +
muccobuccal fold of that region.
 • POSTERIOR DIVISION
Primarily sensory innervation. Small motor innervation
Decends downward and medial to lateral pterygoid muscle.
Auriculotemporal nerve

Lingual Nerve
Transverse Upper part Of parotid gland
Inferior alveolar Ne
lies b/w ramus & medial
pterygoid muscle, anterior to
Innervates
Skin over tragus
IAN.
Ext auditory meatus
Tympanic membrane
Post portion of tmj
Has parallel path

largest Branch Lateroposterior To lingual nerve And Enters mandibular canal at level of Mandibular

then give
foramen. Travels upto Mental foramen

Terminal branches:
mental N

Innervates: Anterior 2/3 of

rd
efore entering canal
incisive N ..B

tongue, MM of floor of mouth

give branch of
lingual Gingiva of mandible
mylohyoid nerve
 Posterior divison cont.
INNERVATON OF IAN
• Mandibular teeth
• Motor innervation to mylohoid muscle and ant. Belly of
digastric.Sensory innervation to skin on inf and ant surface of mental
protuberance. Accersary pulpal innervation to mandibular molars
usually to mesial root of lower 6 in some individuals.(Mylohyoid
nerve)
• innervates pulp of 1st PM, canines and incisors (Incisive nerve)
• skin of chin , skin & MM of lower lip (Mental nerve)
Mandibular teeth nerve
supply
 INTERIOR ALVEOLAR NERVE
BLOCK
• NERVE ANESTHETIZED;
o Inferior alveolar nerve
o Incisive nerve
o Mental nerve
o Lingual nerve

• AREAS
o Mandibular teeth to the midline
o Body of the mandible, inferior portion of the ramus
o Buccal mucoperiosteum, mucus membrane anterior to mental foramen (mental nerve)
o Anterior two third of the tongue and the floor of the oral cavity ( lingual nerve)
o Lingual soft tissue and periosteum
• INDICATIONS
o Multiple teeth procedure
o For buccal soft tissue procedure
o For lingual soft tissue procedure

• CONTRAINDICATIONS
o Inflammation of the area
o handicapped patient
o Children

• ADVANTAGES
o One injection, large area anesthesia

• DISADVANTAGES
o Inadequate
o Trauma (self inflicted)
TECHNIQUE
• Target area: mandibular foramen

Anatomical landmarks:
• coronoid notch
• Pterygoandibular raphe
• Occlusal plane for mandibular posteriors

Direct technique:
• Palpate and identify injection site
• Advance needle from contralateral side premolars horizontally 1cm above the occlual
plane
• Needle goes in 2-2.5cm, hit bone, retract needle 1mm, aspirate, inject slowly.
• SUBJECTIVE SIGN
• Tingling or numbness of lower lip (anesthesia of mental nerve)
• Tingling or numbness of tongue( anesthesia of lingual nerve)

• OBJECTIVE SIGN
• No pain on inserting the dental probe

• SAFETY FEATURE
• Preventing over insertion of needle

• PRECAUTIONS
• Donot deposit local anesthesia if bone is not contacted
• Avoid pain by not contacting the bone too forecfully