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Trigeminal Nerve
Trigeminal Nerve
Contents
Structure
Sensory branches
Function
Muscles
Sensation
Sensory pathways
Summary
Trigeminal nucleus
Spinal trigeminal nucleus
Somatotopic representation
Principal nucleus
Mesencephalic nucleus
Pathways to the thalamus and cortex
Inferior view of the human brain, with cranial
Touch-position sensation nerves labelled
Pain-temperature sensation
Details
Clinical significance
To Ophthalmic nerve
Wallenberg syndrome
Maxillary nerve
Additional images
See also Mandibular nerve
Nerves on the left side of the jaw slightly outnumber the nerves on the right side of the jaw.
Sensory branches
The ophthalmic, maxillary and mandibular branches leave the skull
through three separate foramina: the superior orbital fissure, the
foramen rotundum and the foramen ovale, respectively. The
ophthalmic nerve (V1 ) carries sensory information from the scalp
and forehead, the upper eyelid, the conjunctiva and cornea of the
eye, the nose (including the tip of the nose, except alae nasi), the
nasal mucosa, the frontal sinuses and parts of the meninges (the
dura and blood vessels). The maxillary nerve (V2 ) carries sensory
information from the lower eyelid and cheek, the nares and upper
lip, the upper teeth and gums, the nasal mucosa, the palate and roof
of the pharynx, the maxillary, ethmoid and sphenoid sinuses and
parts of the meninges. The mandibular nerve (V3 ) carries sensory
information from the lower lip, the lower teeth and gums, the chin
and jaw (except the angle of the jaw, which is supplied by C2-C3),
parts of the external ear and parts of the meninges. The mandibular
Dermatome distribution of the nerve carries touch-position and pain-temperature sensations from
trigeminal nerve the mouth. Although it does not carry taste sensation (the chorda
tympani is responsible for taste), one of its branches—the lingual
nerve—carries sensation from the tongue.
The peripheral processes of mesencephalic nucleus of V neurons run in the motor root of the trigeminal
nerve and terminate in the muscle spindles in the muscles of mastication. They are proprioceptive fibers,
conveying information regarding the location of the masticatory muscles. The central processes of
mesencephalic V neurons synapse in the motor nucleus V.
Function
The sensory function of the trigeminal nerve is to provide tactile, proprioceptive, and nociceptive afference
to the face and mouth. Its motor function activates the muscles of mastication, the tensor tympani, tensor
veli palatini, mylohyoid and the anterior belly of the digastric.
The trigeminal nerve carries general somatic afferent fibers (GSA), which innervate the skin of the face via
ophthalmic (V1), maxillary (V2) and mandibular (V3) divisions. The trigeminal nerve also carries special
visceral efferent (SVE) axons, which innervate the muscles of mastication via the mandibular (V3) division.
Muscles
The motor component of the mandibular division (V3) of the trigeminal nerve controls the movement of
eight muscles, including the four muscles of mastication: the masseter, the temporal muscle, and the medial
and lateral pterygoids. The other four muscles are the tensor veli palatini, the mylohyoid, the anterior belly
of the digastric and the tensor tympani. A useful mnemonic for remembering these muscles is "My Tensors
Dig Ants 4 MoM" (Mylohyoid—Tensor Tympani + Tensor Veli Palatini—Digastric (Anterior) – 4 Muscles
of Mastication (Temporalis, Masseter, Medial and Lateral Pterygoids))
With the exception of the tensor tympani, all these muscles are involved in biting, chewing and swallowing
and all have bilateral cortical representation. A unilateral central lesion (for example, a stroke), no matter
how large, is unlikely to produce an observable deficit. Injury to a peripheral nerve can cause paralysis of
muscles on one side of the jaw, with the jaw deviating towards the paralyzed side when it opens. This
direction of the mandible is due to the action of the functioning pterygoids on the opposite side.
Sensation
The two basic types of sensation are touch-position and pain-temperature. Touch-position input comes to
attention immediately, but pain-temperature input reaches the level of consciousness after a delay; when a
person steps on a pin, the awareness of stepping on something is immediate but the pain associated with it
is delayed.
Touch-position information is generally carried by myelinated (fast-conducting) nerve fibers, and pain-
temperature information by unmyelinated (slow-conducting) fibers. The primary sensory receptors for
touch-position (Meissner’s corpuscles, Merkel's receptors, Pacinian corpuscles, Ruffini’s corpuscles, hair
receptors, muscle spindle organs and Golgi tendon organs) are structurally more complex than those for
pain-temperature, which are nerve endings.
Sensation in this context refers to the conscious perception of touch-position and pain-temperature
information, rather than the special senses (smell, sight, taste, hearing and balance) processed by different
cranial nerves and sent to the cerebral cortex through different pathways. The perception of magnetic fields,
electrical fields, low-frequency vibrations and infrared radiation by some nonhuman vertebrates is
processed by their equivalent of the fifth cranial nerve.
Touch in this context refers to the perception of detailed, localized tactile information, such as two-point
discrimination (the difference between touching one point and two closely spaced points) or the difference
between coarse, medium or fine sandpaper. People without touch-position perception can feel the surface of
their bodies and perceive touch in a broad sense, but they lack perceptual detail.
Position, in this context, refers to conscious proprioception. Proprioceptors (muscle spindle and Golgi
tendon organs) provide information about joint position and muscle movement. Although much of this
information is processed at an unconscious level (primarily by the cerebellum and the vestibular nuclei),
some is available at a conscious level.
Touch-position and pain-temperature sensations are processed by different pathways in the central nervous
system. This hard-wired distinction is maintained up to the cerebral cortex. Within the cerebral cortex,
sensations are linked with other cortical areas.
Sensory pathways
Sensory pathways from the periphery to the cortex are separate for touch-position and pain-temperature
sensations. All sensory information is sent to specific nuclei in the thalamus. Thalamic nuclei, in turn, send
information to specific areas in the cerebral cortex. Each pathway consists of three bundles of nerve fibers
connected in series:
The secondary neurons in each pathway decussate (cross the spinal cord or brainstem), because the spinal
cord develops in segments. Decussated fibers later reach and connect these segments with the higher
centers. The optic chiasm is the primary cause of decussation; nasal fibers of the optic nerve cross (so each
cerebral hemisphere receives contralateral—opposite—vision) to keep the interneuronal connections
responsible for processing information short. All sensory and motor pathways converge and diverge to the
contralateral hemisphere.[2]
Although sensory pathways are often depicted as chains of individual neurons connected in series, this is an
oversimplification. Sensory information is processed and modified at each level in the chain by interneurons
and input from other areas of the nervous system. For example, cells in the main trigeminal nucleus (Main
V in the diagram below) receive input from the reticular formation and cerebral cortex. This information
contributes to the final output of the cells in Main V to the thalamus.
Touch-position information from the body is carried to the thalamus by the medial lemniscus, and from the
face by the trigeminal lemniscus (both the anterior and posterior trigeminothalamic tracts). Pain-temperature
information from the body is carried to the thalamus by the spinothalamic tract, and from the face by the
anterior division of the trigeminal lemniscus (also called the anterior trigeminothalamic tract).
Pathways for touch-position and pain-temperature sensations from the face and body merge in the
brainstem, and touch-position and pain-temperature sensory maps of the entire body are projected onto the
thalamus. From the thalamus, touch-position and pain-temperature information is projected onto the
cerebral cortex.
Summary
The complex processing of pain-temperature information in the thalamus and cerebral cortex (as opposed to
the relatively simple, straightforward processing of touch-position information) reflects a phylogenetically
older, more primitive sensory system. The detailed information received from peripheral touch-position
receptors is superimposed on a background of awareness, memory and emotions partially set by peripheral
pain-temperature receptors.
Although thresholds for touch-position perception are relatively easy to measure, those for pain-temperature
perception are difficult to define and measure. "Touch" is an objective sensation, but "pain" is an
individualized sensation which varies among different people and is conditioned by memory and emotion.
Anatomical differences between the pathways for touch-position perception and pain-temperature sensation
help explain why pain, especially chronic pain, is difficult to manage.
Trigeminal nucleus
All sensory information from the face, both touch-position and
pain-temperature, is sent to the trigeminal nucleus. In classical
anatomy most sensory information from the face is carried by the
fifth nerve, but sensation from parts of the mouth, parts of the ear
and parts of the meninges is carried by general somatic afferent
fibers in cranial nerves VII (the facial nerve), IX (the
glossopharyngeal nerve) and X (the vagus nerve).
The spinal trigeminal nucleus represents pain-temperature sensation from the face. Pain-temperature fibers
from peripheral nociceptors are carried in cranial nerves V, VII, IX and X. On entering the brainstem,
sensory fibers are grouped and sent to the spinal trigeminal nucleus. This bundle of incoming fibers can be
identified in cross-sections of the pons and medulla as the spinal tract of the trigeminal nucleus, which
parallels the spinal trigeminal nucleus. The spinal tract of V is analogous to, and continuous with, Lissauer's
tract in the spinal cord.
The spinal trigeminal nucleus contains a pain-temperature sensory map of the face and mouth. From the
spinal trigeminal nucleus, secondary fibers cross the midline and ascend in the trigeminothalamic
(quintothalamic) tract to the contralateral thalamus. Pain-temperature fibers are sent to multiple thalamic
nuclei. The central processing of pain-temperature information differs from the processing of touch-position
information.
Somatotopic representation
Exactly how pain-temperature fibers from the face are distributed to the spinal trigeminal nucleus is
disputed. The present general understanding is that pain-temperature information from all areas of the
human body is represented in the spinal cord and brainstem in an ascending, caudal-to-rostral fashion.
Information from the lower extremities is represented in the lumbar cord, and that from the upper
extremities in the thoracic cord. Information from the neck and the
back of the head is represented in the cervical cord, and that from
the face and mouth in the spinal trigeminal nucleus.
The spinal trigeminal nucleus sends pain-temperature information to the thalamus and sends information to
the mesencephalon and the reticular formation of the brainstem. The latter pathways are analogous to the
spinomesencephalic and spinoreticular tracts of the spinal cord, which send pain-temperature information
from the rest of the body to the same areas. The mesencephalon modulates painful input before it reaches
the level of consciousness. The reticular formation is responsible for the automatic (unconscious)
orientation of the body to painful stimuli. Incidentally, Sulfur-containing compounds found in plants in the
onion family stimulate receptors found in trigeminal ganglia, bypassing the olfactory system.[3]
Principal nucleus
The principal nucleus represents touch-pressure sensation from the face. It is located in the pons, near the
entrance for the fifth nerve. Fibers carrying touch-position information from the face and mouth via cranial
nerves V, VII, IX, and X are sent to this nucleus when they enter the brainstem.
The principal nucleus contains a touch-position sensory map of the face and mouth, just as the spinal
trigeminal nucleus contains a complete pain-temperature map. This nucleus is analogous to the dorsal
column nuclei (the gracile and cuneate nuclei) of the spinal cord, which contain a touch-position map of the
rest of the body.
From the principal nucleus, secondary fibers cross the midline and ascend in the ventral trigeminothalamic
tract to the contralateral thalamus. The ventral trigeminothalamic tract runs parallel to the medial lemniscus,
which carries touch-position information from the rest of the body to the thalamus.
Some sensory information from the teeth and jaws is sent from the principal nucleus to the ipsilateral
thalamus via the small dorsal trigeminal tract. Touch-position information from the teeth and jaws of one
side of the face is represented bilaterally in the thalamus and cortex.
Mesencephalic nucleus
The mesencephalic nucleus is not a true nucleus; it is a sensory ganglion (like the trigeminal ganglion)
embedded in the brainstem and the sole exception to the rule that sensory information passes through
peripheral sensory ganglia before entering the central nervous system. It has been found in all vertebrates
except lampreys and hagfishes. They are the only vertebrates without jaws and have specific cells in their
brainstems. These "internal ganglion" cells were discovered in the late 19th century by medical student
Sigmund Freud.
Two types of sensory fibers have cell bodies in the mesencephalic nucleus: proprioceptor fibers from the
jaw and mechanoreceptor fibers from the teeth. Some of these incoming fibers go to the motor nucleus of
the trigeminal nerve (V), bypassing the pathways for conscious perception. The jaw jerk reflex is an
example; tapping the jaw elicits a reflex closure of the jaw in the same way that tapping the knee elicits a
reflex kick of the lower leg. Other incoming fibers from the teeth and jaws go to the main nucleus of V.
This information is projected bilaterally to the thalamus and available for conscious perception.
Activities such as biting, chewing and swallowing require symmetrical, simultaneous coordination of both
sides of the body. They are automatic activities, requiring little conscious attention and involving a sensory
component (feedback about touch-position) processed at the unconscious level in the mesencephalic
nucleus.
Sensation has been defined as the conscious perception of touch-position and pain-temperature information.
With the exception of smell, all sensory input (touch-position, pain-temperature, sight, taste, hearing and
balance) is sent to the thalamus and then the cortex. The thalamus is anatomically subdivided into nuclei.
Touch-position sensation
Pain-temperature sensation
Pain-temperature information is sent to the VPL (body) and VPM (face) of the thalamus (the same nuclei
which receive touch-position information). From the thalamus, pain-temperature and touch-position
information is projected onto SI.
Unlike touch-position information, however, pain-temperature information is also sent to other thalamic
nuclei and projected onto additional areas of the cerebral cortex. Some pain-temperature fibers are sent to
the medial dorsal thalamic nucleus (MD), which projects to the anterior cingulate cortex. Other fibers are
sent to the ventromedial (VM) nucleus of the thalamus, which projects to the insular cortex. Finally, some
fibers are sent to the intralaminar nucleus (IL) of the thalamus via the reticular formation. The IL projects
diffusely to all parts of the cerebral cortex.
The insular and cingulate cortices are parts of the brain which represent touch-position and pain-
temperature in the context of other simultaneous perceptions (sight, smell, taste, hearing and balance) in the
context of memory and emotional state. Peripheral pain-temperature information is channeled directly to the
brain at a deep level, without prior processing. Touch-position information is handled differently. Diffuse
thalamic projections from the IL and other thalamic nuclei are responsible for a given level of
consciousness, with the thalamus and reticular formation "activating" the brain; peripheral pain-temperature
information also feeds directly into this system.
Clinical significance
Trigeminal neuralgia
Cluster headache
Migraine
Wallenberg syndrome
Wallenberg syndrome (lateral medullary syndrome) is a clinical demonstration of the anatomy of the
trigeminal nerve, summarizing how it processes sensory information. A stroke usually affects only one side
of the body; loss of sensation due to a stroke will be lateralized to the right or the left side of the body. The
only exceptions to this rule are certain spinal-cord lesions and the medullary syndromes, of which
Wallenberg syndrome is the best-known example. In this syndrome, a stroke causes a loss of pain-
temperature sensation from one side of the face and the other side of the body.
This is explained by the anatomy of the brainstem. In the medulla, the ascending spinothalamic tract (which
carries pain-temperature information from the opposite side of the body) is adjacent to the ascending spinal
tract of the trigeminal nerve (which carries pain-temperature information from the same side of the face). A
stroke which cuts off the blood supply to this area (for example, a clot in the posterior inferior cerebellar
artery) destroys both tracts simultaneously. The result is a loss of pain-temperature (but not touch-position)
sensation in a "checkerboard" pattern (ipsilateral face, contralateral body), facilitating diagnosis.
Additional images
Distribution schemes of the trigeminal nerve
See also
Trigeminovascular system
References
1. Pazhaniappan, Nandhaa (15 August 2020). "The Trigeminal Nerve (CN V)" (https://teachme
anatomy.info/head/cranial-nerves/trigeminal-nerve/). TeachMeAnatomy. Retrieved 5 April
2021.
2. Excerpt from Cunningham's Textbook of Anatomy (https://archive.org/details/cunninghamste
xtb00cunn)
3. Lübbert, Matthias; Kyereme, Jessica; Schöbel, Nicole; Beltrán, Leopoldo; Wetzel, Christian
Horst; Hatt, Hanns (October 21, 2013). "Transient Receptor Potential Channels Encode
Volatile Chemicals Sensed by Rat Trigeminal Ganglion Neurons" (https://www.ncbi.nlm.nih.
gov/pmc/articles/PMC3804614). PLOS ONE. 8 (10): e77998.
Bibcode:2013PLoSO...877998L (https://ui.adsabs.harvard.edu/abs/2013PLoSO...877998L).
doi:10.1371/journal.pone.0077998 (https://doi.org/10.1371%2Fjournal.pone.0077998).
PMC 3804614 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804614). PMID 24205061
(https://pubmed.ncbi.nlm.nih.gov/24205061).
4. Kell CA, von Kriegstein K, Rösler A, Kleinschmidt A, Laufs H (2005). "The sensory cortical
representation of the human penis: revisiting somatotopy in the male homunculus" (https://w
ww.ncbi.nlm.nih.gov/pmc/articles/PMC6724806). J. Neurosci. 25 (25): 5984–5987.
doi:10.1523/JNEUROSCI.0712-05.2005 (https://doi.org/10.1523%2FJNEUROSCI.0712-05.
2005). PMC 6724806 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724806).
PMID 15976087 (https://pubmed.ncbi.nlm.nih.gov/15976087).
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Brodal, P. The Central Nervous System. Oxford University Press, 2004.
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External links
Pigeons Detect Magnetic Fields (http://faculty.washington.edu/chudler/pmagnet.html) An
experiment indicating that the trigeminal nerve in Columba livia may be the mechanism
through which "homing pigeons" detect magnetic fields
cranialnerves (http://www.wesnorman.com/cranialnerves.htm) at The Anatomy Lesson by
Wesley Norman (Georgetown University) (V (http://www.wesnorman.com/Images/V.jpg))
Trigeminal nerve anatomy, part 1 (https://www.youtube.com/watch?v=iMT1bHbw6y0#t=22s)
and part 2 (https://www.youtube.com/watch?v=8gqEloRF69U#t=14s) on YouTube
Trigeminal neuralgia (http://www.mountsinai.org/patient-care/health-library/diseases-and-co
nditions/trigeminal-neuralgia)
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