Dr Hussein Abdel Motelep khalil
Lecturer of oral and maxillofacial Surgery,
Sinai University Kantara
Trigeminal Nerve
Contents
. Introduction
. Nuclei of trigeminal nerve.
. Trigeminal Ganglion.
. Branches of trigeminal nerve (3)
. Ganglions associated with nerve and applied
. Dental innervations
Trigeminal nerve is the largest and thick cranial nerve.
It is a mixed nerve.
Composed of a small motor root and a considerably larger
sensory root.
The sensory root contains 170000 fibres and the motor root
contains 7700 fibres.
Nuclei of trigeminal nerve:-
It has got 4 nuclei : in brain stem
1) Mesencephalic nuclei
2) Main sensory nuclei
3) Motor nuclei
4) Spinal nuclei
Nuclei of trigeminal nerve:-
It has got 4 nuclei : in brain stem
1) Main sensory nuclei (touch, Pressure)
2) Spinal nuclei (pain , temperature)
3) Mesencephalic nuclei (Proprioception Of TMJ when teeth
are not occluded.
4) Motor nuclei (M of mastication, Tensor tempani, T palati,
mylohyoid and Posterior belly of digastric
M of mastication are ( temporalis, medial and lateral pterygoid
masseter muscle
• THE TRIGEMINAL GANGLION :-
Also known as Gasserian ganglion,
or semilunar ganglion, is a
sensory ganglion of the trigeminal
nerve that occupies a cavity
(Meckel's cave) in the dura mater,
covering the trigeminal impression
near the apex of the petrous part of
the temporal bone.
Divisions of trigeminal nerve
• 1- Ophthalmic
• 2- Maxillary
• 3- Mandibular
The Ophthalmic division:-
Superior and smallest division.
Sensory Nerve
Arises from the anteriomedial end of trigeminal ganglion
,2.5cm long.
Passes forward in the lateral wall of the cavernous sinus,
below the oculomotor and trochlear nerves
• Before entering the orbit by the superior orbital fissure it
divides into
Lacrimal Nasociliary Frontal
(smallest) (intermediate) (largest)
Internal External Supra Supra
nasal nasal Trochlear Orbital
Long Infra Posterior
ciliary Trochlear Ethmoidal
The Maxillary Nerve:
• It is intermediate division of trigeminal nerve.
Whole sensory.
• ORIGIN:
It leaves the trigeminal ganglion between the ophthalmic and
mandibular divisions as a flat plexiform band
Passes slightly medial to lateral wall of cavernous sinus
Leaves the cranium through foraman rotandum, which is
located in the greater wing of sphenoid bone.
The Cavernous sinus
• Once outside the cranium, it crosses the uppermost part of the
pterygopalatine fossa, between the pterygoid plates of
sphenoid bone and the palatine bone
As it crosses the pterygopalatine fossa it gives of
branches
sphenopalatine ganglion zygomatic branches
posterior superior alveolar nerve
Maxillary Nerve
Cranial Infraorbital
Cavity
Pterygopalatine
Canal Face
fossa
Middle Anterior
Meningeal Superior Superior
Ganglionic Zygomatic Superior Palpebral Nasal
Alveolar Labial
Posterior Alveolar
Superior
Alveolar
Mandibular Nerve
The mandibular nerve supplies:
• The skin in the temporal region, part of the auricle,
including the external meatus and tympanum (eardrum).
• The lower lip, the lower part of the face.
• The teeth and gums of the mandible.
• The mucosa of the anterior two thirds
of the tongue and the mucosa of the floor of the oral cavity.
• The muscles of mastication.
Mandibular nerve
Passes through foramen
ovale to infratemporal fossa
Here it lies between the
tensor veli palatini (medial)
and the lateral pterygoid.
• As it descends from
the foramen ovale,
the nerve is about 4
cm from the
surface(depth)
• and a little anterior
to the neck of the
mandible.
Mandibular Nerve Branches
( in infratemporal fossa)
From trunk:
1. Meningeal branch
2. Nerve to medial pterygoid muscle
From Anterior Division: M
1. Anterior and posterior Deep temporal nerves
2. Nerve to lateral Pterygoid muscle
3. Nerve to Messeter muscle
4. Buccal nerve ( only sensory nerve)
From Posterior Division:
1. Auriculotemporal nerve
2. Lingual nerve
3. Inferior alveolar nerve
THE MANDIBULAR NERVE
Ganglia Associated to Trigeminal N
• 1.Cilliary ganglion (on ophthalmic )
• 2.Pterygopalatine ganglion (on maxillary)
• 3.Otic ganglion.
• 4. Sub-mandibular ganglion. On mandibular
• parasympathetic ganglia of the head and neck,
are the site of synapse for parasympathetic fibers
and carries other types of nerve fiber that do not
synapse in the ganglion.
1.CILLIARY GANGLION
connected with nasocilliary nerve by ganglionic
branches in orbit,
located just behind the eye in the posterior orbit. It is
1–2 mm in diameter.
The ganglion contains postganglionic parasympathetic
neurons. These neurons supply the pupillary sphincter
muscle, which constricts the pupil, and the ciliary
muscle which contracts to make the lens more convex.
Both of these muscles are involuntary since they are
controlled by the parasympathetic division of
the autonomic nervous system.
1.ciliary ganglion
2.sensory root
3.parasympathetic root (double)
4.short ciliary nerves
5.nerve to the inferior oblique muscle.
,
Directions: An anterior Po posterior, In inferior, Su superior
ciliary body control lens for accommodation
2.PTERYGO-PALATINE
GANGLION:
The pterygopalatine ganglion (aka Meckel's
ganglion, nasal ganglion, or sphenopalatine ganglion)
is a parasympathetic ganglion found in
the pterygopalatine fossa. It is largely innervated by
the greater petrosal nerve (a branch of the facial
nerve); and its axons project to the lacrimal glands and
nasal mucosa.
The flow of blood to the nasal mucosa, in particular
the venous plexus of the conchae, is regulated by the
pterygopalatine ganglion and heats or cools the air in
the nose
Branches of Pterygo-palatine ganglion
3. OTIC GANGLION:
• The Otic ganglion is a small parasympathetic
ganglion located immediately below the foramen
ovale in the infra-temporal fossa and on the medial
surface of the mandibular nerve.
• It is functionally associated with the glosso-
pharyngeal nerve and innervates the parotid gland for
salivation.
4.SUBMANDIBULAR GANGLION
• The submandibular ganglion is small and fusiform in
shape.
• It is situated above the deep portion of
the submandibular gland, on the hyoglossus muscle,
near the posterior border of the mylohyoid muscle.
• The ganglion 'hangs' by two nerve filaments from the
lower border of the lingual nerve (itself a branch of
the mandibular nerve).
• Through the posterior of these it receives a branch
from the chorda tympani (facial n) nerve which runs in
the sheath of the lingual nerve.
Sub-mandibular ganglion fibers
• Sympathetic fibers from the external carotid plexus, via
the facial artery and its branches. These do not synapse
in this ganglion.
• Preganglionic parasympathetic fibers from the superior
salivatory nucleus of the Pons, via the chorda
tympani and lingual nerve, which synapse at this
ganglion.
• Postganglionic parasympathetic fibers to the oral
mucosa and the submandibular and sublingual salivary
glands. They are secretomotor to these glands. Some
of the postganglionic fibers reach the sublingual gland
after they re-enter the lingual nerve.
Dental innervations
Dental innervations
