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Trigeminal Nerve
Trigeminal Nerve
Trigeminal Nerve
R
V Root of this nerve travels anteriorly and laterally and reaches
the edge of pyramid of temporal bone.
V At the edge of pyramid it enters a space that extends
anteriorly and inferiorly b/w the layers of duramater,which
widens anteriorly to accommodate semilunar or gasserian
ganglion which is crescent shaped
V Sensory root enters the concave margin and from the
convexity arises the three branches of trigeminal nerve.
V Ophthalmic nerve(V1)
V Maxillary nerve(V2)
V Mandibular nerve(V3)
V It is the first division of trigeminal nerve.
V It splits immediately after reaching the orbit into three main
branches,namely:-
V Nasociliary branch(internal branch)
V Frontal branch(intermediate branch)
V Lacrimal branch(external branch)
V It follows the border of the orbit and
sends a communicating branch
through the ciliary ganglion,which is
sometimes wrongly called as sensory
root of ciliary ganglion.
V It has no relation to do with cells of
ciliary ganglion and its fibres
continue to the eyeball.
V Next,nasociliary nerve gives two or
three long ciliary nerves that run
directly into the eyeball.
V After this nasociliary nerve follows
the upper border of medial rectus of
eye where it gives a branch,ethmoid
nerve,which passes through the
anterior ethmoid foramen into
cranial cavity and passes over the
anterior end of cribriform plate and
passes into the nasal cavity.it is
extradural.
V In the nasal cavity ethmoid nerve divides into medial and
lateral nasal branches.They supply the mucous membrane on
lateral wall and nasal septum.
V External nasal branch runs downward on the inner surface of
nasal bone and turns into skin of nasal bridge through a
small opening.
V Terminal branch of nasociliary nerve is the infratrochlear
nerve.It runs anteriorly and passes below the
trochlea,superior oblique and emerges from the orbit into
skin at inner corner of eye.
V Infratrochlear nerve exchanges fibres with supratrochlear
nerve which is a branch of frontal nerve.
V It is the intermediate and
largest branch of the
ophthalmic nerve.
V It curves around lateral
border of superior rectus
muscle and reaches the
superior surface and then on
the levator of the upper
eyelid.
V It continues b/w the roof of
orbit and levator as
supraorbital nerve which
divides into three
branches,namely:-
V Medial and lateral branches
of supraorbital nerve
V Supratrochlear nerve
V Lateral branch is largest of all and continues anteriorly as
supraorbital nerve and emerges on the skin of forehead
through supraorbital foramen or notch.
V It supplies the greater part of lateral forehead and skin of
scalp upward and backward to vertex.
V Medial branch turns slightly medially from its origin.It
reaches the forehead through frontal notch of superior
orbital rim and supplies medial area of skin of forehead.
V Supratrochlear nerve is the most medial and smallest branch.
V It crosses the trochlea of the superior oblique muscle and
reaches the upper eyelid near inner corner of eye where it
exchanges fibres with the infratrochlear nerve and supplies
the skin of upper lid and nasal root.
V It is the external branch of
ophthalmic nerve
V In its course towards
lacrimal gland ,it receives a
branch from zygomatic
nerve of second division.
V After passing through
lacrimal gland ,the nerve
reaches the upper eyelid
near the outer corner of the
eye and supplies lateral part
of upper eyelid and small
adjacent area of skin.
V It is the second division of Trigeminal nerve.
V It leaves the skull through foramen rotundum and opens into
pterygopalatine fossa.
V Branches of maxillary nerve:-
V Branches in middle cranial fossa
V Middle meningeal nerve
V Terminal branches
V Inferior palpebral
V Lateral nasal
V Superior labial
V It is the external branch of
maxillary nerve and often appears
to be a branch of infraorbital
nerve.
V In the orbit it follows the lateral
edge of orbit floor anteriorly and
laterally.
V It sends a branch to lacrimal gland
upwards.
V After releasing this
branch,zygomatic nerve enters
zygomatico-orbital foramen in
orbital surface of zygomatic bone.
V One branch emerges at anterior or
malar surface of zygomatic bone,
zygomatico-facial nerve and
supplies skin over the height of
cheek.
V Second branch emerges at posterior or temporal surface
of frontal process ,zygomatico-temporal nerve. It supplies
small anterior area of skin in temporal region.
V Pterygopalatine ganglion is attached to its medial side.
V It enters the ganglion after a course of only 2-3mm
V It has only topographic connection with the ganglion.
V It gives posterior superior nasal branch at the level of
ganglion which enters the nasal cavity through
sphenopalatine foramen behind middle nasal concha and
below the body of sphenoid.
V Lateral branches of superior posterior nasal nerve supply
larger posterior part of upper and middle concha.
V Medial branches pass over roof of nasal cavity to the nasal
septum.One of this branch is distinguished by its great
length and diagonal course forward and downward along
nasal septum,it is nasopalatine nerve.
V Nasopalatine nerve suplies branches to septal mucosa and
then passes through incisive canal into oral cavity.
V Immediately after entering incisive canal it exchanges fibres
with anterior superior alveolar nerve and may participate in
innervation of upper central incisor.
V In the incisive canal,right and left palatine nerves approach
each other and enter the oral cavity through unpaired
incisive foramen.
V They supply small anterior area of palatine mucosa behind
the incisor teeth,which is diagramatically bounded by a line
from one canine to the other.
V Main part of pterygopalatine nerve continues below the
ganglion in a downward course through the entire height of
pterygopalatine fossa and then through pterygopalatine
canal.
V Two or three branches leave the palatine nerve in
pterygopalatine canal to enter the nasal cavity.These are
inferior or posterior nasal nerves and supply inferior nasal
concha and middle and inferior nasal meatus
V Before reaching the lower oral end of pterygopalatine
canal,palatine nerve divides into one large and one or two small
branches.
V Larger branch,anterior palatine nerve,enters the oral cavity
through major palatine foramen and turns anteriorly.It soon splits
into numerous branches that spread fanwise.anteriorly,laterally
and medially and supply mucosa of hard palate up to canine line.
V The smaller middle and posterior palatine nerves emerge into oral
cavity through lesser palatine foramen and supply tonsil and soft
palate.
V Posterior superior alveolar nerve(PSA)which arises in
infratemporal fossa before it reaches the maxillary
tuberosity.It runs downwards,anteriorly and laterally to reach
the convex surface(anterior)of maxilla at about center of the
surface.
V At a variable distance PSA divides into two or three branches.
V Sometimes division occurs before the nerve reaches the
maxillary tuberosity,sometimes on posterior surface of
maxilla(most common) and sometimes after it has entered
the posterior superior alveolar foramen
V If the division takes place at the surface of maxilla,alveolar
nerves enter two or three small openings that lead into
narrow posterior superior alveolar canal into posterolateral
wall of sinus.
V In these canals the nerve reaches the base of alveolar
process.
V It is the intermediate branch of maxillary nerve
V It constitutes the course of main trunk anteriorly and slightly
laterally.
V It passes through pterygomaxillary fissure into anteromedial
corner of infratemporal fossa and leaves it through inferior
orbital fissure,through which it enters the orbit.Here it runs
in the infra orbital groove at the orbital floor.
V Anteriorly at some distance from posterior border of
orbit,infraorbital groove is roofed to form infraorbital canal
which leads the nerve to infraorbital fissure.
V After leaving the infraorbital canal it splits into terminal
branches.
V It gives two branches before leaving through infraorbital
foramen.
.
Applied anatomy-
V This nerve gets injured during trauma to the
zygomatico-orbital surface.
V This nerve should be preserved in vestibular maxillary
approach as it is present 7-10 mm inferior to the
infraorbital rim just medial to zygomaticomaxillary
suture
Middle superior alveolar
nerve:-