Innervation of the face

and mouth
Prof St-John Crean
BDS MBBS FDSRCS FFGDP(UK)
FRCS FRCS(OMFS) PhD
 Aims and objectives
 Aims
 Illustrate the nerves responsible for sensation and motor
supply of face and mouth
 Special autonomic function of oral/facial structures
 Objectives
 Develop applied knowledge of the nerves responsible for
innervation of facial and oral tissues
 TRIGEMINAL NERVE
Central Connections

• The cell bodies of most trigeminal sensory neurons are

located in the trigeminal ganglion, which lies in a
recess of dura matter on the apex of petrous temporal
bone (the cell bodies of proprioceptive fibers are
located in the midbrain).

• A bundle of central processes from the ganglion cells

passes into the lateral aspect of pons where they
contact the main ( common sensation) & spinal (pain
& temperature) sensory nuclei.
 TRIGEMINAL NERVE
Central Connections

• The motor fibers originate from neurons in a motor

nucleus adjacent to the main sensory nucleus in the
floor of 4th ventricle.

• However, recent evidence suggests that

proprioceptive information from the teeth also pass to
the principal sensory nucleus.
Parasympatheic ganglia of the head and
neck
 Associated with the trigeminal nerve
 Parasympathetic fibres come from another
cranial nerve
 Three types of fibres
 Sympathetic (pass straight through)
 Somatic motor / sensory (pass straight
through)
 Parasympathetic (synapse)
 TRIGEMINAL NERVE (V)

Nerve Opening passage Classification

from skull
Ophthalmic Superior orbital Sensory
division (V1) fissure
Maxillary division Foramen Sensory
(V2) Rotundum
Mandibular Foramen Ovale Mixed
division (V3)
 OPTHALMIC DIVISION (V1)
• Contains only sensory fibers.

• Passes anteriorly from the ganglion along the lateral

wall of cavernous sinus & divides in to Frontal,
Lacrimal & Nasociliary branches which enter the
orbit through superior orbital fissure.

• Supplies the ;
 Upper face including scalp, eyelids, cornea,
 Paranasal sinuses.
Cavernous sinus
Ophthalmic nerve
Ciliary ganglion
 MAXILLARY DIVISION (V2)
• Contains only sensory fibers.

• Nerve emerges in to the

pterygopalatine fossa through
the F.Rotundum of the
sphenoid bone.

• It’s subsequent branches can be

subdivided into branches from ;
 The main trunk &
 Branches from the
pterygopalatine ganglion.
Maxillary nerve (V2)
Pterygopalatine ganglion
 MAXILLARY DIVISION (V2)
• Supplies the ;
 Maxillary teeth & the
supporting structures,
 The palate,
 The maxillary air sinus,
 Much of the nasal
cavity, &
 The skin overlying the
middle part of the face.
 MANDIBULAR DIVISION (V3)
• Largest division of trigeminal
nerve & only division that
contains motor as well as sensory
fibers.

• Emerges into infratemporal fossa

through foramen ovale.

• It lies deep to the lateral pterygoid

muscle, where it gives off all its
branches dividing into ;
 Anterior (mainly motor) &
 Posterior (mainly sensory)
trunks.
Mandibular nerve V3
Mandibular nerve (V3)
Otic ganglion
 MANDIBULAR DIVISION (V3)
• Proximal to posterior division, it gives off the ;
 Meningeal branch: passes back into the middle
cranial fossa through Foramen Spinosum.

 The nerve to medial pterygoid: through the Otic

Ganglion (without synapsing) &, after supplying the
muscle, continues on to supply the tensor veli palatini
& tensor tympani muscles.
 MANDIBULAR DIVISION (V3)
• Sensory fibers supply ;
 Mandibular teeth & their
supporting structures,
 Mucosa of the ant.2/3rd of
tongue,
 Floor of mouth,
 Skin of lower part of face,
& 
 Parts of temple & auricle.
• Motor fibers supply ;
 Muscles of mastication,
 Mylohyoid,
 Anterior belly of
digastric,
 Tensor veli palatini, &
Tensor tympani
muscles.
 TRIGEMINAL NEURALGIA
• A distressing condition characterized by brief
paroxysms of sharp, piercing pain in the territory of
one or two divisions of trigeminal nerve (not usually
ophthalmic division).

• Frequently the paroxysms can be provoked by

touching a specific area of skin “trigger area” or by
eating or talking.

• Little is known of its cause.

 FACIAL NERVE (VII)
• VII contains motor, sensory & secretomotor
(preganglionic parasympathetic) fibers.

• The motor & secretomotor neurons lie in pons of

brainstem.

• Cell bodies of the sensory fibers form the geniculate

ganglion in the petrous temporal bone.
 FACIAL NERVE (VII)

• VII supplies ;
 Stapedius,
 The muscles of facial expression,
 Taste to the anterior 2/3rd of the tongue, &
 Secretomotor fibers to the lacrimal gland, nose, palate
& salivary glands in the floor of the mouth.
 FACIAL NERVE WITHIN THE
SKULL
• Facial nerve leaves the brain near
the cerebellum & passes laterally
into the internal acoustic meatus.

• Runs through the meatus to the

medial wall of middle ear, where
it is enlarged by the geniculate
ganglion.

• On reaching the posterior wall the

nerve makes a right-angled bend,
passes downwards & exits skull
through stylomastoid foramen.
FACIAL NERVE WITHIN THE
SKULL
• In the middle ear facial nerve gives off ;
 Greater petrosal branch: carries parasympathetic
fibers to the pterygopalatine ganglion.

 In the posterior wall of the middle ear the VII

supplies stapedius & gives off the chorda tympani.

 The Chorda tympani: which joins the lingual nerve

& is distributed with it. ( submandibular ganglion)
Submandibular ganglion
 EXTRACRANIAL COURSE OF
FACIAL NERVE
• VII leaves the stylomastoid foramen &
supplies ;
 Stylohyoid,
 Posterior belly of digastric &
 Occipital belly of occipitofrontalis.
 EXTRACRANIAL COURSE OF
FACIAL NERVE
• VII then enters parotid gland & divides in to the
following terminal branches,
• temporal,
• zygomatic,
• buccal,
• mandibular
• cervical.
• They spread out in a fan-like pattern on the side of
the face & supply the muscles of facial expression,
including buccinator & platysma
EXTRACRANIAL COURSE &
DISTRIBUTION OF VII
 FACIAL NERVE (VII)
• CLINICAL CONSIDERATION:

 The cervical branch, which supplies muscles that

control the angle of the mouth, loops down over the
sub-mandibular region below the angle of the jaw.

 Surgery (e.g. biopsy of lymph nodes) in this region

must preserve this branch carefully.
 FACIAL NERVE (BELL’S) PALSY
• Facial nerve can be damaged by swelling in the facial
canal, which is probably caused by a viral infection.

• The condition usually regresses spontaneously, but on

occasion it may be necessary to decompress the nerve
within the canal.
Submandibular gland
mucocele
stones
 anatomy
 Use patients as revision
 Read up as go along
 Clinical applications

 Thank you
 REFERENCES
• Trigeminal Nerve anatomy: illustrated using
examples of abnormalities. Kamel HA,Toland

• The trigeminal nerve. Shankland WE 2nd.

• The trigeminal nerve.

Go JL, Kim PE, Zee CS.

 Anastomoses between the cervical branch of the facial nerve and

the transverse cervical cutaneous nerve.
Domet MA, Connor NP, Heisey DM, Hartig GK.

• Oral anatomy, Histology & Embryology,3th Ed. B.K.B. Berkowitz,

G.R. Holland, B.J. Moxham