unique mixed cranial nerve and its relation to teeth what does it supply? here is an overview

1. By:
Ahmed reda abdel-hameed
Trigeminal nerve
The maxillary and the mandibular branches

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LIST OF FIGURES ....................................................................................................... - 2 -
TRIGEMINAL NERVE (CN V)...................................................................................... - 3 -
ABSTRACT:.................................................................................................................- 4 -
PROPRIOCEPTION OF THE TRIGEMINAL NERVE ..................................................- 7 -
LESIONS OFTRIGEMINAL NERVE ...................................................................................- 7 -
TREATMENT ...........................................................................................................- 8 -
DIVISIONS/DISTRIBUTIONS BRANCHES..........................................................................- 10 -
MAXILLARY NERVE (CN V2) ....................................................................................- 11 -
STRUCTURE..............................................................................................................- 11 -
NERVEAND FORAMENS...............................................................................................- 13 -
NERVEPATHWAY AND DISTRIBUTION:...........................................................................- 13 -
MANDIBULAR NERVE (CN V3)..................................................................................- 14 -
STRUCTURE..............................................................................................................- 14 -
NERVEAND FORAMENS...............................................................................................- 16 -
NERVEPATHWAY AND DISTRIBUTION:...........................................................................- 17 -
CLINICAL CORRELATE............................................................................................- 18 -
CONCLUSION ............................................................................................................- 19 -
Maxillary division .................................................................. - 19 -
Mandibular ............................................................................ - 19 -
REFERENCES ............................................................................................................- 23 -

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List of figures
FIGURE 1.2(TRIGEMINA L N LATERAL VIEW) .....................................................................................- 3 -
FIGURE 1. 3(OPEN BOOK VIEW)................................................................................................................- 4 -
FIGURE 1. 4(INNERVATION ZONES)......................................................................................................- 5 -
FIGURE 1. 5(C.N.S)...........................................................................................................................................- 5 -
FIGURE 1. 6(ROOTS OF TRIG N).................................................................................................................- 5 -
FIGURE 1. 7(BRANCHES)..............................................................................................................................- 6 -
FIGURE 1. 8(ACOUSTIC NEUROMA)......................................................................................................- 9 -
FIGURE 1. 9(MAX AND MAND DIVISIONS).........................................................................................- 10 -
FIGURE2. 1(MAXILLARY NERVE) ........................................................................................................- 13 -
FIGURE3. 1(MANDIBULAR NERVE) .....................................................................................................- 17 -
FIGURE4. 1(TEETH INERVATIION BY BOTH MAX AND MAND NERVES) .............................- 18 -
FIGURE5. 1(ILLUSTRATED DIAGRAM SHOWS BRA NCHES OF TRIGEMINAL N)...............- 20 -

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TRIGEMINAL NERVE (CN V)
Figure 1. 1(position)
Figure 1.2(trigeminal n lateral view)

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2
Figure 1. 3(open book view)
1
Abstract:
Face Cutaneous (sensory) innervation of the face is provided primarily by
the trigeminal nerve) and the motor innervation to the muscles of
mastication by the mandibular nerve, the motor root of the trigeminal
nerve.1

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Figure 1. 4(innervation zones)
The trigeminal nerve is considered to be one of the cranial nerves.
Cranial nerves or cerebralnerves:
Figure 1. 5(C.N.s)
They are those peripheral nerves that leave the brain or brainstem
the cranial nerves customarily are subdivided into 12 pairs:
I: Olfactory nerve VII: Facial nerve
II: Optic nerve VIII: Vestibulocochlear nerve
III: Oculomotornerve IX: Glossopharyngeal nerve
IV: Trochlear nerve X: Vagus nerve
V: Trigeminal nerve XI: Spinal accessorynerve
VI: Abducens nerve XII: Hypoglossal nerve
Because of the high degree of differentiation in the brain of humans,
cranial nerves are more complex in structure and function than spinal
nerves
The trigeminal nerve (CN V)
Figure 1. 6(roots of trig n)

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Emerges from the lateral aspectof the pons by a large sensory
root and a small motor root. CN V is the principal general sensory nerve
for the head (face, teeth, mouth, nasal cavity, and dura of the cranial
cavity). The sensory rootof CN V is composed mainly of the central
processes ofneurons in the trigeminal ganglion. The peripheral processes
Figure 1. 7(branches)
The trigeminal nerve (CN V) is the sensorynerve for the face and the
motor nerve for the muscles of mastication and several small muscles

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PROPRIOCEPTIONOF THE TRIGEMINALNERVE
Sensory fibers carry input from the neuromuscular spindles along the
mandibular division of the trigeminal n. The nerve cell bodies of these
sensory neurons are located in the mesencephalic nucleus of the midbrain
These fibers project to the motor nucleus of the trigeminal n. innervate
the muscles of mastication, to control the jaw jerk reflex and force of bite.
Lesions of Trigeminal Nerve
Lesions of the entire trigeminal nerve cause widespread anesthesia
involving the
• Corresponding anterior half of the scalp
• Face, except for an area overlying the angle of the mandible
• Cornea and conjunctiva
• Mucous membranes of the noseand paranasal sinuses, mouth, and
anterior part of the tongue Paralysis of the muscles of mastication also
occurs.

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TREATMENT
Commonly, trigeminal neuralgia is treated pharmacologically with
anticonvulsants, suchas carbamazepine (Tegretol) if drug therapy is
unsuccessful, neurosurgery may be required, such as percutaneous
radiofrequency rhizotomy of the nerve, glycerol injection of the
trigeminal ganglion, or nerve decompressionAlternative and
complementary medicine treatments have included acupuncture and
meditation.Zones of skin innervation of trigeminal nerve divisions, where
pain may occurin trigeminal neuralgia Common trigger points.
3
4
Trigeminal neuralgia (tic douloureux) is a sensory disorder of the
sensory rootof CN V.
Etiology
Cause is unknown—theories involve nerve irritation from
abnormal vascularity or tumor compression (some investigators
believe that most affected people have an anomalous blood vessel
that compresses the sensory rootof CN V. some investigators
believe that most affected people have an anomalous blood vessel
that compresses the sensory rootof CN V.), or a nerve injury
(pathological processes affecting neurons of the trigeminal
ganglion.)
CLINICAL MANIFESTATIONS
More common in the 5th and 6th decades of life
Characterized by sudden attacks of excruciating, lightning-like
jabs of facial pain. A paroxysm (sudden sharp pain) can last for 15
minutes or more. The maxillary nerve (CN V2) is most frequently
involved; then the mandibular nerve (CN V3); and, least frequently,
the ophthalmic nerve (CN V1). The pain often is initiated by
touching a sensitive trigger zone of the skin. The cause of
trigeminal neuralgia is unknown; however, when the aberrant artery
is moved away from the root, the symptoms usually disappear.

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Figure 1. 8(acoustic neuroma)
Injury to Trigeminal Nerve CN V may be injured by
trauma, tumors, aneurysms, or meningeal infections,
causing • Paralysis of the muscles of mastication,
producing deviation of the mandible toward the side
of the lesion • Loss of the ability to appreciate soft
tactile,thermal,orpainful sensationsinthe face • Loss
of the corneal reflex (blinking in response to the
cornea being touched) and the sneezing reflex
Trigeminal neuralgia (tic douloureux), the principal
disease affecting the sensory root of CN V, produces
excruciating,episodic pain that is usually restricted to
the areas suppliedbythe maxillaryand/or mandibular
divisions of CN V.

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Divisions/Distributions Branches
Three large groups of peripheral processesfrom nerve cell bodies of
the trigeminal ganglion—the large sensory ganglion of CN V—form the
ophthalmic nerve (CN V1), the maxillary nerve (CN V2), and the sensory
component of the mandibular nerve (CN V3). These nerves are named
according to their main regions of termination: the eye, maxilla, and
mandible, respectively. The first two divisions (CN V1 and CN V2) are
totally sensory. CN V3 is different as it mostly sensory but also receives
motor fibers from the CN V. The major cutaneous branches of the
trigeminal nerve are
• Ophthalmic nerve (CN V1): lacrimal, supra-orbital, supratrochlear,
infratrochlear, and external nasal nerves
• Maxillary nerve (CN V2): infra-orbital, z ygomaticotemporal, and
zygomaticofacial nerves
• Mandibular (CN V3): auriculotemporal, buccal, and mental nerves.
From the anterior borderof the trigeminal ganglia, the three terminal
branches of the trigeminal n arise which in the correct descending order
are:
 The Ophthalmic nerve (CN V1)( This is not our main concern for
now)
 The maxillary nerve (CN V2)
 The Mandibular nerve (CN V3)
Figure 1. 9(max and mand divisions)

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Maxillary nerve (CN V2)
Structure

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5
Somatic sensory only passes through foramen rotundum Supplies dura
mater of anterior part of middle cranial fossa;conjunctiva of the lower
part of eyelid; mucosa of postero-inferior nasal cavity, maxillary
sinus, anterior part of superior oral vestibule, and palate; upper teeth;
and skin of lateral external nose, inferior eyelid, anterior cheek, and
upper lip
Meningeal branch Zygomatic nerve Zygomaticofacial branch
Zygomaticotemporal branch Communicating branch to lacrimal nerve
Ganglionic branches to sensory rootof pterygopalatine ganglion Posterior
superior alveolar branches Infra-orbital nerve Anterior and middle
superior alveolar branches Superior labial branches Inferior palpebral
branches External nasal branches Greater palatine nerves Posterior

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inferior lateral nasal nerves Lesser palatine nerves Posterior superior
lateral nasal branches Nasopalatine nerve Pharyngeal nerve.6
Nerve and foramens
Nerve pathway and distribution:
Figure2. 1(maxillary nerve)

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Mandibular nerve (CN V3)
Structure

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Somatic sensoryand somatic (branchial) motor Passes through the
foramen ovale supplies sensoryinnervation to mucosa of anterior two
thirds of tongue, floor of mouth, and posterior and anterior inferior oral
vestibule; mandibular teeth; and skin of lower lip, buccal, parotid, and
temporal regions of face; and external ear (auricle, upper external
auditory meatus, and tympanic membrane) Supplies motor innervation to
muscles of mastication, mylohyoid, anterior belly of digastric, tensor
tympani, and tensor veli palatini.
Somatic sensory branches meningeal branch (nervus spinosum) Buccal
nerve Auriculotemporal nerve Lingual nerve Inferior alveolar nerve
Inferior dental plexus mental nerve Somatic (branchial) motor branches
to: Masseter Temporalis Medial and lateral pterygoids Mylohyoid

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Anterior belly of digastric Tensor tympani Tensorveli palatini of the
ganglionic neurons form three nerves or divisions are the ophthalmic
nerve (CN V1), maxillary nerve (CN V2), and sensorycomponent of the
mandibular nerve (CN V3). For a summary of CN V. The fibers of the
motor root of CN V are distributed exclusively via the mandibular nerve
(CN V3) to the muscles of mastication, mylohyoid, anterior belly of the
digastric, tensor veli palatini, and tensor tympani.
Receives the motor root of the trigeminal nerve (CN V) and descends
through the foramen ovale to enter the infratemporal fossa, dividing into
anterior and posterior trunks. The branches of the large posterior trunk are
the auriculotemporal, inferior alveolar, and lingual nerves. The smaller
anterior trunk gives rise to the buccal nerve and branches to the four
muscles of mastication (temporalis ,Masseter, and medial and lateral
pterygoids) but not the buccinator, which is supplied by the facial nerve
(CN VII).
Nerve and foramens

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Nerve pathway and distribution:
7
Figure3. 1(mandibular nerve)

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Clinical Correlate
Dental clinical relation for mandibular and maxillary nerves
Figure4. 1(teeth inervatiion by both max and mand nerves)

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Conclusion
The trigeminal nerves
 It is considered as mixed nerve motor and sensory.
 It is the largest and most complex of the cranial nerves.
 The trigeminal nerve is emerges from the pons and divides into
ophthalmic maxillary and mandibular nerves (divisions that receive
sensory supply from the face with an exception of a small area over
the ramus of the mandible).
 All motor fibers belong to the mandibular division and supply
muscle of the mastication
Maxillary division
The maxillary division of trigeminal nerve has a sensory function. It
transmits sensation from the:
 lower eyelid plus associated mucous membranes
 middle part of the maxillary sinuses
 nasal cavity and middle part of the nose
 cheeks
 upper lip
 The maxillary teeth plus alveolar boneand other investing structures
(anterior superior alveolar. middle superior alveolar & posterior
superior alveolar nerves).
 roof of the mouth(the palate)
Mandibular
The mandibular division is the only part of the trigeminal nerve that has
both sensory and motor functions.
It communicates sensation from the:

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 outer part of the ear
 lower part of the mouth and the associated mucous membranes
 anterior 2/3 the of tongue
 the mandibular teeth plus alveolar bone and other investing structures
 lower lip
 The chin
 The motor branches : supply the movement to 8 muscles (4 muscles
of mastication & other 4 muscles)
Figure5. 1(illustrated diagram shows branches of trigeminal n)

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 Divisions/Distributions  Branches
 Maxillary nerve (CN V2) Somatic
sensory only Passes through foramen
rotundum Supplies dura mater of
anterior part of middle cranial fossa;
conjunctiva of inferior eyelid; mucosa
of postero-inferior nasalcavity,
maxillary sinus, palate, and anterior
part of superior oral vestibule;
maxillary teeth; and skin of lateral
external nose, inferior eyelid, anterior
cheek, and upper lip
 Meningeal branch Zygomatic nerve
Zygomaticofacial branch
Zygomaticotemporal branch
Communicating branch to lacrimal
nerve Ganglionic branches to (sensory
root of)
 pterygopalatine ganglion Posterior
superior alveolar branches Infra-
orbital nerve Anterior and middle
superior alveolar branches Superior
labial branches Inferior palpebral
branches External nasal branches
Greater palatine nerves Posterior
inferior lateral nasal nerves Lesser
palatine nerves Posterior superior
lateral nasal branches Nasopalatine
nerve Pharyngeal nerve
 Mandibular nerve (CN V3) Somatic
sensory and somatic (branchial) motor
Passes through the foramen ovale
Supplies sensory innervation to
mucosa of anterior two thirds of
tongue, floor of mouth, and posterior
and anterior inferior oral vestibule;
mandibular teeth; and skin of lower
lip, buccal, parotid, and temporal
regions of face; and external ear
(auricle, upper external auditory
meatus, and tympanic membrane)
Supplies motor innervation to muscles
of mastication, mylohyoid, anterior
 Somatic sensory branches Meningeal
branch (nervus spinosum) Buccal
nerve Auriculotemporal nerve Lingual
nerve Inferior alveolar nerve Inferior
dental plexus Mental nerve Somatic
(branchial) motor branches to:
Masseter Temporalis Medial and
lateral pterygoids Mylohyoid Anterior
belly of digastric Tensor tympani
Tensor veli palatini

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belly of digastric, tensor tympani, and
tensor veli palatini
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References
1. Moore, Keith L., author. Essential clinical anatomy / Keith L.
Moore, Anne M.R. Agur, Arthur F. Dalley II. — Fifth edition
2. Parent text: Clinically oriented anatomy / Keith L. Moore, Arthur
F. Dalley, Anne M.R. Agur. 7th ed. c2014. Includes
bibliographical references and index
3. https://books.google.com/books?hl=en&lr=&id=5AnZDwAAQBA
J&oi=fnd&pg=PA208&dq=Trigeminal+neuralgia+(tic+douloureux
&ots=LyuzJ63H8G&sig=XQ87s0IST48FvN3lMJuZgLx6LlQ
4. Bell WE. Orofacial Pains: Differential Diagnosis. 2nd. Year Book
Medical Publisher; 1979.
5. Agur, A. M. R., author. II. Dalley, Arthur F., II, author. III. Moore,
Keith L. clinically oriented anatomy. Digest of (work): IV. Title.
[DNLM: 1. Anatomy—Handbooks. QS 39]
6. https://slideplayer.com/slide/12940793/
7. Agur AMR, Dalley AE. The Cranial Nerves. Grant’s Atlas of
Anatomy. Baltimore: Williams & Wilkins; 2004.
8. SooyCD, Boles R. Neuroanatomy for the Otolaryngologist Head
and Neck Surgeon. Paparella MM, and Shumrich DA.
Otolaryngology: Basic Sciences and Related Principles.
Philadelphia: WB Saunders; 1991.