The document summarizes the trigeminal nerve (CN V), which is the largest and most complex of the cranial nerves. It has both sensory and motor components. The trigeminal nerve has three major divisions - the ophthalmic, maxillary, and mandibular nerves. Each division innervates different regions of the face and performs various sensory and motor functions. The document describes the anatomy and branches of each division in detail. It also discusses some relevant clinical conditions like trigeminal neuralgia and herpes zoster ophthalmicus.

1. TRIGEMINAL NERVE
1

2. NERVE: PHYSIOLOGY
COMPONENTS OF NERVE
PHYSIOLOGY OF NERVE CONDUCTION
 CRANIAL NERVES
TRIGEMINAL NERVE:
INTRODUCTION
OPTHALMIC NERVE
MAXILLARY NERVE
MANDIBULAR NERVE
 TRIGEMINAL NEURALGIA
APPLIED ASPECT
2

3. NERVE:
NEURON – NERVE CELL
3

4. COMPONENTS OF THE NERVE
4

5. PHYSIOLOGY OF NERVE CONDUCTION:
. 5

6. NERVOUS SYSTEM
GUYTON AND HALL, TEXTBOOK OF MEDICAL PHYSIOLOGY, 11TH EDITION 6

7. CRANIAL NERVES:
7

8. CRIBRIFORM PLATE OLFACTORY NERVE(I)
OPTIC FORAMEN OPTIC NERVE (II)
SUPERIOR ORBITAL FISSURE OCCULOMOTOR (III)
TROCHLEAR (V)
ABDUCENS (VI)
OPTHALMIC DIV OF TRIGEMINAL (V1)
FORAMEN ROTANDUM MAXILLARY DIV OF TRIGEMINAL (V2)
FORAMEN OVALE MANDIBULAR DIV OF TRIGEMINAL (V3)
INTERNAL AUDITORYCANAL FACIAL (VII)
VESTIBULOCOCHLEAR (VIII)
JUGULAR FORAMEN GLOSSOPHARYNGEAL (IX)
VAGUS (X)
ACCESSORY (XI)
HYPOGLOSSAL CANAL HYPOGLOSSAL (XII)
EXIT OF THE CRANIAL NERVES:
8
SNELL’S ANATOMY, 7TH EDITION, RICHARD S. SNELL.

9. 9
TRIGEMINAL NERVE – WHY?
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL.

10. INTRODUCTION
 largest cranial nerve
 Fifth cranial nerve.
 Mixed nerve ( sensory and motor )
 Sensory to – Skin of face
 Motor to –
Mucosa of cranial viscera
Except base of tongue and pharynx
Muscles of Mastication
Tensor ville palatini,Tensor tympany
Anterior belly of digastric
Mylohyoid
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL.

11. SENSORY ROOT
Face, Scalp, Teeth, Gingiva, Oral, Nasal, Cavities,
Para nasal sinus, Conjunctiva and Cornea
Pain, temp, light touch touch, pressure proprioception
Trigeminal gang. Bypasses trigem gang.
sensory root.
Spinal Principal sensory Mesencephalic
CNS
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL.

12. Tensor tympani
Tensor palatini
Muscles of mastication
Masseter
Lateral & Medial Pterygoids
Temporalis
CNS
MOTOR NUCLEUS
MOTOR ROOT
MANDIBULAR NERVE
MOTOR ROOT
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL.

13. DIVISIONS OF TRIGEMINAL NERVE
1. Ophthalmic nerve
2. Maxillary nerve
3. Mandibular nerve
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL.

14. OPTHALMIC NERVE
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 14

15. OPTHALMIC NERVE
 Superior division of the V nerve
 Entirely Sensory
 Has 3 branches. All 3 of them pass through the sup. orbital
fissure into the orbit. They are;
1.Lacrimal nerve
2.Frontal nerve
3.Nasocilliary nerve
SNELL’S ANATOMY, 7TH EDITION,
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16. 16
COURSE
 Emerges from trigeminal
ganglion
 Lateral wall cavernous sinus
 3 branches in ant part of
cavernous sinus
 lacrimal, nasocilliary, frontal
 Superior orbital fissure
 Orbit
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RICHARD S. SNELL.

17. BRANCHES:
1. Lacrimal nerve: Smallest
Sensory
Supplies : lacrimal gland & the conjuntiva , skin of
the upper eyelid.
17
SNELL’S ANATOMY, 7TH EDITION, RICHARD S. SNELL.

18. 2) Frontal nerve: largest branch
It enters the orbit through the superior orbital fissure divides into 2 branches.
i. The supra orbital branch: It is larger ,arises from the orbit through the
supraorbital foramen.
Supplies : skin of the forehead & scalp
mucous membrane of the frontal sinus
ii. The supra trochlear branch: It is smaller & from the orbit above the trochlea.
Supplies : skin of the upper eyelid
lower part of the forehead.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 18

19. 3) Nasocilliary nerve: It enters the orbit through middle of superior
orbital fissure and ends in anterior ethmoidal foramen
Branches:
i. Communicating branch to cilliary ganglion: sensory .
ii. Long ciliary nerve: Iris & Cornea.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 19

20. iii. Posterior ethmoidal nerve: mucous membrane lining of the
Post. Etmoidal & Sphenoidal paranasal sinus.
iv. Anterior ethmoidal nerve: Ant.ethmoidal & frontal
paranasal air cells.
In the upper part of the nasal cavity, further divides :
1) Internal nasal branches: medial and lateral mucosa of nose.
2) External nasal branches: lower border of the nasal bone.
v.Infra trochlear nerve: medial end of eyelid , conjunctiva, lacrimal
sacs and upper half of nose.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 20

21. SNELL’S ANATOMY, 7TH EDITION, RICHARD S. SNELL. 21
APPLIED ASPECT:
Loss of Corneal Reflex.
HERPES ZOSTER OPHTHALMICUS
1. Recurrent neuro-cutaneous inf.
2. In ophthalmic Division of trigeminal dermatome, most freq. affecting
nasociliary branch.
3. HHV3 / vericella zoster

22. MAXILLARY NERVE
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 21

23. MAXILLARY NERVE
 Second division of trigeminal nerve
 Pure sensory
 Supplies: derivatives of maxillary process and frontonasal
process
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 22

24. COURSE:
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 24

25. BRANCHES:
1) In the cranium:
2) In the pterygopalatine fossa:
3) In the infra orbital canal:
4) On the face:
Meningeal
Ganglionic,
Zygomatic,
Post.superior alveolar
Middle sup. alveolar,
Anterior superior/ Greater alveolar
Palpebral, nasal, superior labial
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 25

26. I. In the cranium:
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 26
Meningeal branch: It is given off near the foramen
rotundum.
Supplies: duramater of the anterior & middle cranial fossae.
II. In the pterygopalatine fossa.
1.The ganglionic branches:
Connect the maxillary nerve to the pterygopalatine ganglion.
Contain secretomotor fibres to the lacrimal gland.
Provide sensory fibres to the orbital periosteum & mucous
membrane of the nose, palate & pharynx.

27. 2.The zygomatic nerve:
In the Inferior orbital fissure it divides into 2 branches.
The Zygomaticofacial nerve :
the skin over the zygomatic bone.
The Zygomaticotemporal nerve :
the skin over the anterior temporal fossa region.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 27

28. 3. Posterior superior alveolar nerve:
3 branches , emerge through the pterygomaxillary fissure.
2 branches enter the posterior wall of the maxilla above the tuberosity
Supply the molar teeth(except the mesiobuccal root of first molar).
THE THIRD BRANCH pierces the buccinator
Supplies : adjoining part of the gingiva & cheek along the buccal side of the upper
molar teeth.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 28

29. III.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 29
Branches in the Infraorbital canals
1.Middle superior alveolar nerve:
runs downwards & forwards along the infraorbital
groove along the lateral wall of the maxillary sinus.
Supply the maxillary premolars & mesiobuccal root of
the first molar teeth.

30. 2.Anterior superior alveolar nerve:
It runs in the anterior wall of the maxillary antrum.
It runs inferiorly & divides into the branches, which supply the canine &
incisors.
A nasal branch from this nerve, given off from the superior dental plexus
supplies the mucous membrane of the anterior part of the lateral wall & floor of
the nasal cavity. It ends in the nasal septum.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 30

31. IV. Branches given on the face:
1. The palpebral branches: They arise deep to the
orbicularis oculi & pierce the muscle, supplying the skin
over the lower eyelid& lateral angle of the eye along with
the Zygomaticofacial & Facial nerves.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 31

32. 2.The nasal branches: They supply the skin of the nose & tip of
the nasal septum & join the External nasal branch of the anterior
ethmoidal nerve.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 32

33. 3.The superior labial branches:
These are large & numerous. They supply the skin over the
anterior part of the cheek & upper lip including the mucous
membrane & labial glands. They are joined by the facial nerve &
form the infraorbital plexus.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 33

34. APPLIED ASPECT:
Maxillary Nerve Blocks:
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 34

35. INFRAORBITAL NERVE BLOCK
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 35

36. SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 36

37. LOSS OF SENSATION OF THE ENTIRE FACE
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 37

38. MANDIBULAR NERVE
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 38

39. MANDIBULAR NERVE
Third & largest division
large sensory root - foramen ovale
small motor root which passes deep to the ganglion, & unites with the
sensory root in the infratemporal fossa ..
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 39

40. BRANCHES:
ANTERIOR
DIVISION
undivided nerve
1.Meningeal
branch /
Nervous
spinosus
Nerve to the
medial
pterygoid
divided nerve
1.Buccal nerve
Masseteric
nerve
Deep temporal
nerve
Nerve to the
lateral pterygoid
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 40

41. POSTERIOR
DIVISION
Auriculotemporal
nerve
Lingual nerve Inferior alveolar
nerve
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 41

42. BRANCHES FROM THE UNDIVIDED BRANCH:
1.Nervous spinosus or Meningeal branch of Mandibular nerve:
Enters cranial cavity through foramen spinosus along
with middle meningial artery
Supply : Dura matter of middle cranial fossa
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 42

43. 2.Nerve to medial Pterygoid
Supplies medial pterygoid Through Otic ganglion to
supply the medial pterygoid muscle.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 43

44. BRANCHES OF THE DIVIDED NERVE
I. Anterior division
1.The buccal nerve:
It passes between the 2 heads of the lateral pterygoid &
it supplies the buccinator muscle and it is a sensory
branch
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 44

45. 2.The massetric nerve:
~arises from the upper border lateral pterygoid muscle
~It suplies the masseter muscle.
~It also gives a branch to the TMJ.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 45

46. 3.The deep temporal nerves:
~2 in number.
~supply the temporalis muscle.
4.The nerve to the lateral pterygoid.
~2 in number; one supplying each muscle head.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 46

47. Branches Of Posterior Division
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 47

48. 1. Auriculotemporal nerve-
Arises from 2 roots which run backwards and encircle the
middle meningeal artery and form single trunk
The trunk passes backward to lateral pterygoid between
neck of mandible and sphenomandibular ligament.
Lies behind the TMJ close to the parotid gland
2 branches-auricular and temporal branches
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 47

49. Branches Of Auriculotemporal Nerve
1. Auricular branches- supply tragus ,tympanic membrane,pinna
2. Superficial temporal branches-supply parotid gland,TMJ and
skin of the temple.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 48

50. Lingual Nerve:
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 50

51. Communication of the facial nerve (Chorda tympani)
with the lingual nerve.
As the lingual nerve passes 2cm below the skull it is
joined from behind by the chorda tympani.
This nerve conveys secretory fibres from the facial nerve.
The parasympathetic secretory fibres control the
submandibular & sublingual salivary glands.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 51

52. Inferior alveolar nerve.
~largest terminal branch
~Exits through the mandibular foramen along with the
inferior alvelolar artery passing lateral to medial pterygoid
and sphenomandibular ligament.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 52

53. Branches of the nerve :-
Mental nerve: skin of the chin & the mucous membrane skin of the lower lip.
Incisive branch: canine & incisors.
Mylohyoid nerve: mylohyoid muscle.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 53

54. Communicating Branch:
Runs from the inferior alveolar nerve to the lingual nerve
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 54

55. APPLIED ASPECT:
MANDIBULAR NERVE BLOCK:
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 55

56. LINGUAL NERVE INJURY
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 56

57. MENTAL NERVE INJURY
1. Improper Mental Nerve Block
2. Incision extending to the mental foramen and lingual vestibular fold.
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 57

58. 58
Mental nerve neuralgia
Due to resorption of the lower alveolar ridge, the borders of the
denture flange may compress on the mental nerve, causing pain.
Radiologically, the foramen can be seen at the level of the surface of
the ridge. Shifting the foramen down is the treatment of choice.
Similar pain is felt due to narrowing of the foramen. Decompression of
the nerve by carefully enlargement the foramen is the treatment of
choice.
SNELL’S ANATOMY, 7TH EDITION, RICHARD S. SNELL.

59. INFERIOR ALVEOLAR NERVE INJURY:
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 59

60. DIMINISHED STRENGTH OF THE MASTICATORY MUSCLES
SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 60

61. A Recep, I Selen, T Ülkü. Trigeminal Neurinoma Admitting With Temporal Muscle Atrophy. The Internet
Journal of Neurology. 2005 Volume 5 Number 2. 61
Cryptic Trigeminal Neurinoma
Rarely encountered tumors in the intracranial
portion of the trigeminal nerve.
Clinical manifestation is along the course of the trigeminal nerve.

62. Trigeminal neuralgia:
SHARP,SHOOTING, paroxysmal
Characteristics: unilateral, presence of trigger
zones, presence of refractory period. Restricted
to the areas supplied by the trigeminal nerve.
The etiology IDIOPATHIC
Suggested causes:
demyelination of the nerves, tumour in the
cerebellopontine angle, grooving of the nerve
root.
62
WARD BOOTH, SCHENDEL, HAUSAMEN; MAXILLOFACIAL SURGERY, SECOND EDITION, VOL 2

63. 1. Carbamazepine(Tegretol) 100 mg od, bd or tid,
depending on the severity or frequency of pain.
2. Injection of 60 to 90% alcohol in the nerve trunk or
ganglion.
3. Peripheral neurectomy or cryotherapy of the
peripheral trigger zone.
4. Peripheral radiofrequency thermolysis
5. radiofrequency thermogangliolysis.
6. Microvascular nerve root decompression
procedure. It is a nuerosurgical procedure wherein
the internal vascular loops of the superior
cerebellar artery is made to compess on the
trigeminal nerve root.
63
TREATMENT
:
WARD BOOTH, SCHENDEL, HAUSAMEN; MAXILLOFACIAL SURGERY, SECOND EDITION, VOL 2
Diagnosis:
Based on C/f s & diagnostic test block on the trigger zones.

64. WARD BOOTH, SCHENDEL, HAUSAMEN; MAXILLOFACIAL SURGERY, SECOND EDITION, VOL2
64
MULTIPLE SCLEROSIS:
A plaque of demyelination at the root entry zone of the trigeminal nerve
POST HERPETIC NEURALGIA:

65. SNELL’S ANATOMY, 7TH EDITION,
RICHARD S. SNELL. 65
NEOPLASIA:
Intracranial neoplasms at the cerebellopontine angle
compress the root or the ganglion of the trigeminal nerve

66. V - Lipoma
Young patient with left trrgem[nal nerve sensory symptom, s due
to compression by asmall lipoma at
the
left root entry zone
Axial C!SS., T1 and T2, coronal CISS and FlA]Rdemonstrate the
small lesion to be hyper-intense across all sequences with
cor resp
o
nding negative HU on CTconsistent with fat

67. Gradenigos syndrome
 Petrous bone osteitis due to otitis media
 Characterized by I/L trigeminal N palsy
 Retro orbital pain I/L sixth N palsy.
62

68. BIBLIOGRAPHY:
 Gray Henry; Gray’s anatomy; 39th edition
 Snell Richard S. ; Clinical Anatomy by Regions; 8th
edition; Wolters Kluwer
 Gyton ; Hall John; Textbook of medical physiology;
13th edition; Elsevier
 Fonseca, 2nd edition, vol 1
 Booth ward , Schendel, Hausamen; Maxillofacial
surgery,2nd edition, vol 2
 Bennett Richard; Monheim’s local anaesthesia and
pain control in dental practice; 7th Edition; CBS
68

69. 69
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RICHARD S. SNELL.