Trigeminal Nerve

D.Nimer D.Rania Gabr

D.Safaa D.Elsherbiny
 Objectives
• List the trigeminal nerve nuclei and their
location
• Follow up the course of trigeminal nerve
from its point of central connections to
exit and down to its target areas.
• Describe the sensory and motor
components of the trigeminal nerve.
 Trigeminal nerve
Type: mixed nerve formed of a large sensory root and a small motor root. The
largest cranial nerve
:Origin
Sensory root: arise from the trigeminal ganglion ( Gasserian , semilunar .1
.ganglion)
:a. The peripheral branches form the 3 divisions of the trigeminal nerve
.ophthalmic, maxillary and mandibular
b. The central branches form the sensory root of the trigeminal nerve.

.Motor root: from the motor nucleus in the pons. It joins the mandibular nerve .2
Fibers:
1. General somatic
afferent:
Carrying general
sensations from face.
2. Special visceral
efferent:
Supplying muscles
developed from the
1st pharyngeal
arch, (8
muscles).
Nuclei:
4 nuclei (motor and 3 sensory)
1. One motor nucleus: in the
lateral part of the pontine
tegmentum (mid pons).
2. Three sensory nuclei:
a. Mesencephalic nucleus: in
the midbrain, for proprioception
from the face.
b. Main sensory nucleus: in the
pons, for discriminative touch
from the face.
c. Spinal trigeminal nucleus: in
the medulla, for pain and
temperature sensations from the
face.
 Trigeminal Nerve
Emerges from the middle
of the ventral surface of
the pons
Divisions:
1. Ophthalmic.
2. Maxillary.
3. Mandibular.
 Axons of cells of
motor nucleus join
only the mandibular
division.
 Pure Sensory

Pure Sensory

C2,3
Great
.auricular N

Mixed Nerve

Areas of Distribution of Trigeminal Nerve in the Face

 Trigeminal Ganglion
)Gasserian ganglion(

 Site:
 Occupies a depression
in the middle cranial
fossa.
 Importance: Contains
cell bodies:
1. Whose dendrites carry
sensations from the
face.
2. Whose axons form the
sensory root of
trigeminal nerve.
 Ophthalmic nerve
(Pure Sensory)
Type: purely sensory nerve.
Origin: It arises from the trigeminal
ganglion.
Course:
 It passes in the lateral wall of the
cavernous sinus and divides into 3
branches that enter the orbit through
the “superior orbital fissure”.
Branches:
1. Frontal: supplies skin of face &
scalp.
2. Lacrimal: supplies skin of face &
lacrimal gland.
3. Nasociliary: supplies skin of face,
nasal cavity & eyeball.
 Maxillary nerve
(Pure Sensory)
Type: purely sensory nerve.
Origin: It arises from the trigeminal ganglion.
Course:
It passes in the lateral wall of the cavernous sinus → passes through foramen
rotundum → enters the pterygopalatine fossa → passes through the inferior
orbital fissue to continue as the infraorbital nerve → passes through the
infraorbital groove, infraorbital canal and the infraorbital foramen.
 Maxillary nerve

Supplies the:
1. Upper teeth, gums &
maxillary air sinus:
(posterior, middle &
anterior superior
alveolar nerves).

2. Face:
(zygomaticofacial ,zygomatic
otemporal & infraorbital
nerves).

Branches
Maxillary nerve block (Dentists)
 Mandibular nerve
(Mixed)
Type: mixed nerve.
Origin: It arises by two roots,
motor and sensory:
1. Motor root (small):
from the motor nucleus of the
trigeminal nerve in the pons.
2. Sensory root (large):
from the trigeminal ganglion.

Course:
The 2 roots pass through foramen
ovale → unite below foramen
ovale to form a short mandibular
nerve trunk → divides into
anterior and posterior divisions.
 Mandibular nerve
• SENSORY BRANCHES:
1. Lingual:
General sensations from anterior 2/3
the of tongue.
2. Buccal: Face(cheek on upper jaw)
3. Auriculotemporal:
auricle, temple, parotid gland & TMJ.
4. Inferior alveolar:
Lower teeth, gums & face.

• MOTOR BRANCHES:
1.Four muscles of mastication:
Masseter, Temporalis, Medial And
Lateral Pterygoid.
2. Other 4:
Anterior belly of Digastric, Mylohyoid,
Tensor Palati and Tensor Tympani.
Clinical Anatomy
Paralysis of lateral
pterygoid muscles
causes the jaw to
deviate towards the
paralysed side on
opening the mouth as
a result of action of
normal muscle.
 Trigeminal Neuralgia
• Compression, degeneration or
inflammation of the 5th cranial nerve
may result in a condition called
trigeminal neuralgia or tic douloureux.
• This condition is characterized by
recurring episodes of intense stabbing ,
excoriating pain radiating from the
angle of the jaw along a branches of
the trigeminal nerve.
• Usually involves maxillary &
mandibular nerves, rarely in the
ophthalmic division.
 Trigeminal block
A trigeminal nerve block is
an injection of medication
e.g carbamazepine, that
helps relieve facial pain.
It’s used to treat:
1-Trigeminal neuralgia
2- Herpes zoster infection
(or “shingles”) affecting
the face
3- Other atypical facial
pain syndromes
Inferior alveolar block (Dentists)