Fifth cranial nerve
Have a large sensory root and a small motor root.
Motor root arises – arises from the lateral aspect of lower pons (cranially) the motor root cross the apex of the petrous temporal bone beneath the superior petrosal sinus, to enter the middle cranial fossa.
Sensory root – arises from the lateral aspect of lower pons (caudally).
RELATIONS
Medially
(a) internal carotid artery
(b) posterior part of cavernous sinus
Laterally - middle meningeal artery
Superiorly - parahippocampal gyrus
Inferiorly
motor root of trigeminal nerve
(b) greater petrosal nerve
(c) apex of the petrous temporal bone
(d) foramen lacerum.OPTHALIMIC DIVISION
Terminal branches of Ophthalmic division of trigeminal nerve, are
1. Frontal
Supratrochlear
Supraorbital
2. Nasociliary
Branch of ciliray ganglion
2-3 long ciliary nerves
Posterior ethmoidal
Infratrochlear
Anterior ethmoidal
3. Lacrimal
Branches
From main trunk
Meningeal branch
Nerve to medial pterygoid
From the anterior trunk
Sensory branch
Buccal nerve
Motor branch
Masseteric
Deep temporal nerve
Nerve to lateral pterygoid
From the posterior trunk
Auriculotemporal
Lingual
Inferior alveolar nerves
Face develops in humans between 4th – 10th week of intrauterine life.
prenatal growth of the maxilla
DEVELOPMENT OF UPPER LIP
Development of lower lip
Development of nose
hare lip
OBLIQUE FACIAL CLEFT
macrostomia
lateral facial cleft
microstomia
Face develops in humans between 4th – 10th week of intrauterine life.
prenatal growth of the maxilla
DEVELOPMENT OF UPPER LIP
Development of lower lip
Development of nose
hare lip
OBLIQUE FACIAL CLEFT
macrostomia
lateral facial cleft
microstomia
The anatomy of the nerve supply of the head and neck has many significant applications in maxillofacial surgery. Understanding these important anatomic relations- variations enables surgeons to perform the surgical procedures safely. Knowledge of these concepts helps us to recognize the problems and complications as and when they occur and manage them accordingly.
The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The anatomy of the nerve supply of the head and neck has many significant applications in maxillofacial surgery. Understanding these important anatomic relations- variations enables surgeons to perform the surgical procedures safely. Knowledge of these concepts helps us to recognize the problems and complications as and when they occur and manage them accordingly.
The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Definition
General properties
Composition
Function of saliva
Formation of saliva
Method for collecting saliva
Advantages
Limitations
Analysis of saliva done for the diagnosis of systemic disease
Definition:
by Stedmann’s & Lipincott medical dictionary.
A clear, tasteless, odourless, slightly acidic (pH 6.8) viscous fluid, consisting of the secretion from the parotid, sublingual, submandibular salivary glands and the mucous glands of the oral cavity.
General properties
Volume: 1000 to 1500 mL of saliva is secreted per day and, it is approximately about 1 ml/ minute.
Contribution by each major salivary gland is:
i. Parotid glands: 25%
ii. Submandibular glands: 70%
iii. Sublingual glands: 5%.
Reaction: Mixed saliva from all the glands is slightly acidic with pH of 6.35 to 6.85.
Specific gravity: It ranges between 1.002 and 1.012.
Tonicity: Saliva is hypotonSalivary flow
The average person produces approximately 0.5 L – 1.5 L per day
Unstimulated Flow (resting salivary flow―no external stimulus)
Typically 0.2 mL – 0.3 mL per minute
Stimulated Flow (response to a stimulus, usually taste, chewing, or medication [eg, at mealtime])
Typically 1.5 mL – 2 mL per minute
INTRODUCTION
Tongue is a muscular organ
Situated in the floor of the mouth
FUNCTION
Taste
Speech
Mastication
Deglutition
EXTERNAL FEATURES
Tongue has
A Root
A tip
A body
ROOT
Is attached to the mandible and soft palate above and hyoid bone below.
These attachments prevent the swallowing of the tongue.
In between the 2 bones it is related to the geniohyoid and mylohyoid muscles.
TIP
Of the tongue forms the anterior free end which lies behind the upper incisor teeth.
BODY
Has
A curved upper surface or dorsum
An inferior or ventral surface MUSCLES OF THE TONGUE
Middle fibrous septum divides the tongue into right and left halves.
Intrinsic muscles
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
Extrinsic muscles
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
Central face begins to develop by 4th week, when olfactory placodes appear on both sides of the frontonasal process.
Gradually both placodes develop to form the median and lateral nasal process.
Upper lip is formed by 6th week by fusion of two median nasal processes in midline and the maxilllary process of the 1st branchial arch.
PRE-NATAL GROWTH AND DEVELOPMENT OF PALATEFormation of primary and secondary palate
Elevation of palatal shelves
Fusion of palatal shelves
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
Occipital (2-4)
Superior nuchal line between sternocleidomastoid and trapezius
Occipital part of scalp
Superficial cervical lymph nodes
Accessary lymph nodes
Mastoid (1-3)
Superficial to sternocleidomastoid insertion
Posterior parietal scalp
Skin of ear, posterior external acoustic meatus
Superior deep cervical nodes Accessary lymph nodes
Preauricular (2-3)
Anterior to ear over parotid fascia
Drains areas supplied by superficial temporal artery
Anterior parietal scalp
Anterior surface of ear
Superior deep cervical lymph nodes
Parotid (up to 10 or more)
About parotid gland and under parotid fascia
Deep to parotid gland
External acoustic meatus
Skin of frontal and temporal regions
Eyelids, tympanic cavity
Cheek, nose (posterior palate)
Superior deep cervical lymph nodes
Facial
Superficial(up to 12)
Maxillary
Buccal
Mandibular
Distributed along course of facial artery and vein
Skin and mucous membranes of eyelids, nose, cheek
Submandibular nodes
Deep
Distributed along course of maxillary artery lateral to lateral pterygoid muscle
Temporal and infratemporal fossa
Nasal pharynx
Superior deep cervical lymph nodesSuperficial
Anterior jugular vein between superficial cervical fascia and infrahyoid fascia
Skin, muscles, and viscera of infrahyoid region of neck
Superior deep cervical lymph nodes
Deep
Between viscera of neck and investing layer of deep cervical fascia
Adjoining parts of trachea, larynx, thyroid gland
Superior deep cervical lymph nodes
Anterior cervical/Superficial
Submental (2-3)
Submental triangle
Chin
Medial part of lower lip
Lower incisor teeth and gingiva
Tip of tongue
Cheeks
Submandibular lymph node to jugulo-omohyoid lymph node and superior deep cervical lymph nodes
Is a phenomenon of reflex sequence of muscle contractions that propels the ingested materials and pooled saliva from the mouth to the stomach.
PATTERNS
Infantile (visceral) swallow
Adult/mature swallow
ADULT SWALLOWING
Is composed of 4 stages
Voluntary
Preparatory phase
Oral or buccal
Involuntary: Controlled By Medulla and Lower Pons
Pharyngeal
b. Oesophageal
• Function
• External features
• Papillae of tongue
• Muscles of the tongue
• Arterial supply
• Venous drainage
• Lymphatic drainage
• Nerve supply
• Histology
• Development of tongue -
Intrinsic muscles
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
- Extrinsic muscles
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
1. Vallate or circumvallate papillae
These are large in size 1-2mm in diameter and are 8-12 in number.
They are situated immediately in front of the sulcus terminalis.
Each papillae are cylindrical projection surrounded by a circular sulcus.
The walls of the papilla are raised above the surface.
2. Fungiform papillae
Are numerous
Near the tip and margins of the tongue, but some of them are scattered over the dorsum.
These are smaller than the vallate papillae but larger than the filliform papillae.
Each papilla consists of a narrow pedicle and a large rounded head.
They are distinguished by their bright red colour.
3. Filliform papillae
Conical papilla
Cover the presulcal area of the dorsum of the tongue and gives it a characteristic velvety appearance.
They are the smallest and most numerous of the lingual papillae.
Each are pointed and covered with keratin
The apex is often split into filamentous processes.
COTTON-WOOL APPEARANCE
Active phase showing disorganised bone architecture with numerous, large, multinucleated osteoclasts. The stroma is vascular and fibrous
The late phase features thick trabeculae with a prominent mosaic pattern of prominent, hematoxyphilic, cement lines at the interfaces of episodes of resorption followed by deposition.
Paget disease showing very prominent blue cement lines. The lamellae are arranged haphazardly giving an overall effect of a jigsaw puzzle.
Hume- “caries is essentially a progressive loss by acid dissolution of the apatite component of the enamel then the dentin or of the cementum then dentin.”
According to location:
Pit or Fissure caries
Smooth Surface caries
According to rapidity:
Acute
Chronic
Arrested
According to occurrence:
Primary (Virgin) caries
Secondary (Recurrent) caries
According to the site of occurrence:
Enamel caries
Cemental caries.
Acidogenic [ Miller’s Chemico-parasitic] theory.
Proteolytic theory.
Proteolysis- chelation theory.
The lymphatic system has three functions:
Fluid recovery.
Immunity
Lipid absorption
The lymphatic vessels of the small intestine receive the special designation of lacteals or chyliferous vessels.
The components of the lymphatic system are :-
lymph, the recovered fluid;
Lymphatic vessels, which transport the lymph;
Lymphatic tissue, composed of aggregates of lymphocytes and macrophages that populate many organs of the body; and
Lymphatic organs, in which these cells are especially concentrated and which are set off from surrounding organs by connective tissue capsules.
A Magnified Microscopic Image Is Worth More Than A Thousand Words.
DARK FIELD MICROSCOPE
PHASE CONTRAST MICROSCOPY
POLARIZED LIGHT MICROSCOPY
FLUORESCENT MICROSCOPY
STEREO MICROSCOPE
ELECTRON MICROSCOPY
Maxillary Second Premolar
the maxillary first premolar in function
Less angular ,rounded crown in all aspects.
Single root
Smaller crown cervico occlusally
Root length is as great or greater
BUCCAL ASPECT
Not as long as that of the first premolar
Less pointed
Mesial slope is
shorter than the distal slope
Buccal ridge of the crown may not be so prominent whencompared with the first premolarLINGUAL ASPECT
Lingual cusp is longer making the crown longer on the lingual sideMESIAL ASPECT
Cusps of second premolar are shorter with the buccal and lingual cusps more nearly the same length
Greater distance between cusp tips-that widens the occlusal surface buccolingually
No developmental depression on the mesial surface of the crown as on the first premolar
Crown surface is convex instead
No deep dev. Groove crossing the mesial marginal ridgeOCCLUSAL ASPECT
Outline of the crown is more rounded or oval rather than angular
Central dev. groove is shorter and more irregular
Tendency toward multiple supplementary grooves radiating from the central groove that may extend out to the cusp ridges
Makes for an irregular occlusal surface and gives a very wrinkled appearance
Centered in the maxilla, one on either side of median line, with mesial surface of each in contact with mesial surface of other
Two in number
Larger than the lateral incisor
These teeth supplement each other in function, and they are similar anatomically
Shearing or cutting teeth
Major function is to punch and cut food material during the process of mastication
These teeth have incisal ridges or edges rather than
cusps such as are found on canines & posterior teeth
First evidence of calcification
Crown completion
Eruption
Root completion
3-4 months
4-5 years
7-8 years
10-11 years
PHYSICAL PROPERTIES
CHEMICAL PROPERTIES
STRUCTURE OF ENAMEL
DEVELOPMENT OF ENAMEL
EPITHELIAL ENAMEL ORGAN
AMELOGENESIS
LIFE CYCLE OF AMELOBLASTS
AGE CHANGES IN ENAMEL
DEFECTS OF AMELOGENESIS
CLINICAL IMPLICATIONS
PRENATAL GROWTH OF MANDIBLE
Occurs between the 4th and 7th week of intrauterine life.
4th week of intrauterine life
Formation of the head fold
Following which the developing brain and the pericardium form 2 prominent bulges on the ventral aspect of the embryo.
The 2 bulges are separated from each other by a shallow depression called stomatoedum (corresponding to the primitive mouth).
Floor of the stomatodeum is formed by the Buccopharyngeal membrane, which separates the stomatodeum from the foregut.Soon, mesoderm covering the developing forebrain proliferates, and forms a downward projection that overlaps the upper part of the stomatodeum – this downward projection is called frontonasal process.
Since the formation of various parts of the face involves fusion of diverse components.
Occasionally this fusion can be incomplete give rise to various anomalies
MANDIBULOFACIAL DYSOSTOSIS OR FIRST ARCH SYNDROME
- Entire first arch may remain underdeveloped on one or both sides, affecting
Lower eyelid
Maxilla
Mandible
External ear.
- Prominence of the cheek is absent
- Ear is displaced ventrally and caudally
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. TRIGEMINAL NERVE
- Fifth cranial nerve
- Have a large sensory root and a small motor root.
- Motor root arises – arises from the lateral aspect of lower pons (cranially)
the motor root cross the apex of the petrous temporal bone beneath the
superior petrosal sinus, to enter the middle cranial fossa.
- Sensory root – arises from the lateral aspect of lower pons (caudally).
3. TRIGEMINAL GANGLION
- Sensory ganglion of fifth cranial nerve.
- Homologous with the dorsal nerve root ganglia of spinal
nerves.
- All such ganglia are made of pseudounipolar nerve cells,
with a T shaped arrangement of their process; one process
arises from the cell body which then divides into a central
and peripheral process.
- Ganglion is cresentic or semilunar in shape with its
convexity directed anterolaterally.
4. - 3 divisions of trigeminal nerve emerge from this convexity.
- Posterior concavity of the ganglion receives the sensory root of the nerve.
- Situation and meningeal relations
- Ganglion lies on the trigeminal impression, on the anterior surface of the petrous temporal
bone near its apex.
- It occupies a special space of dura matter called the trigeminal or Meckel’s cave.
- There are 2 layers of the dura below the ganglion.
- The cave is lined by pia arachnoid, so that ganglion along with the motor root of the
trigeminal nerve is surrounded by CSF.
- The ganglion lies at a depth of about 5cm from the preauricular point.
5. RELATIONS
- Medially
(a) internal carotid artery
(b) posterior part of cavernous sinus
- Laterally - middle meningeal artery
- Superiorly - parahippocampal gyrus
- Inferiorly
(a) motor root of trigeminal nerve
(b) greater petrosal nerve
(c) apex of the petrous temporal bone
(d) foramen lacerum.
6. Associated root and branches
- Central processes of ganglion cells form the large sensory root of the trigeminal nerve
which is attached to the pons at its junction with the middle cerebellar peduncle.
- Peripheral processes of the ganglion cells form 3 divisions of the trigeminal nerve, namely
ophthalmic, maxillary and mandibular.
- Small motor root of the trigeminal nerve is attached to the pons superomedial to the
sensory root.
- It passes under the ganglion from its medial to the lateral side, and join the mandibular
nerve at the foramen ovale.
7. OPTHALIMIC DIVISION
Terminal branches of Ophthalmic division of trigeminal nerve, are
1. Frontal
Supratrochlear
Supraorbital
2. Nasociliary
Branch of ciliray ganglion
2-3 long ciliary nerves
Posterior ethmoidal
Infratrochlear
Anterior ethmoidal
3. Lacrimal
8. LACRIMAL NERVE
- Smallest of the 3 terminal branches of
ophthalmic nerve
- It enters the orbit through the lateral part of the
superior orbital fissure and runs forwards along
the upper border of the lateral rectus muscle in
company with the lacrimal artery.
- Anteriorly it receives communication from the
zygomaticotemporal nerve, passes deep to the
lacrimal gland and ends in the lateral part of the
upper eyelid.
9. Supplies
- Lacrimal gland, conjunctiva, upper eyelid.
- Its own fibers to the gland are sensory.
- Secretomotor fibers to the gland come from the greater petrosal nerve through its
communication with zygomaticotemporal nerve.
10. FRONTAL NERVE
- Is the largest of the 3 terminal branches of the
ophthalmic nerve.
- Begins in the lateral wall of the anterior part of
cavernous sinus.
- It enters the orbit though the lateral part of the
superior orbital fissure, and runs forwards on the
superior surface of levator palpebrae superioris.
- At the middle of the orbit it divides into small
supratrochlear branch and large supraorbital
branch.
11. NASOCILIARY NERVE
- One of the terminal branches of the ophthalmic division of trigeminal nerve
- Begins in the lateral wall of the anterior part of the cavernous sinus.
- It enters the orbit through the middle part of the superior orbital fissure between the two
divisions of the occulomotor nerve.
- It crosses above the optic nerve from lateral to medial side along with ophthalmic artery and
runs along the medial wall of the orbit between the superior oblique and the medial rectus. It
ends at anterior ethmoidal foramen by dividing into the infratrochlear and anterior ethmoidal
nerves.
12. - Its branches are as follows
1. A communicating branch to ciliary ganglion – forms the sensory root of the ganglion. It
is often mixed with the sympathetic root.
2. Two to three long ciliary nerves run on the medial side of the optic nerve, pierce the
sclera, and supply sensory nerves to the cornea, the iriss and the ciliary body.
They also carry sympathetic nerves to dilator papillae.
3. Posterior ethmoidal nerve – passes through the posterior ethmoidal foramen and
supplies the ethmoidal and sphenoidal air sinuses. It is frequently absent.
13. 4. Infratrochlear nerve – smaller terminal branch of the nasociliary nerve given off at the
anterior ethmoidal foramen. It emerges from the orbit below the trochlear for the tendon
of the superior oblique and appears on the face above the medial angle of the eye. It
supplies the conjunctiva, the lacrimal sac and caruncle, the medial ends of the eyelids and
the upper half of the external nose.
14. 5. Anterior ethmoidal nerve – is the larger terminal branch of the nasociliary nerve. It
leaves the orbit by passing through the anterior ethmoidal foramen. It appears for a very
short distance, in the anterior cranial fossa, above the cribriform plate of the ethmoid
bone. It then descends into the nose through a slit at the side of the anterior part of the
crista galli. In the nasal cavity, it lies deep to the nasal bone. It gives off 2 internal nasal
branches medial and lateral to the mucosa of the nose. Finally, it emerges at the lower
border of the nasal bone as the external nasal nerve which supplies the skin of the lower
half of the nose.
16. MAXILLARY NERVE
- Arises from the trigeminal ganglion
- Runs forward in the lateral wall of the cavernous sinus below the ophthalmic nerve and leaves
the middle cranial fossa by passing through the foramen rotandum .
- Next, the nerve crosses the upper part of the pterygopalatine fossa, beyond which it is
continues as the infraorbital nerve.
- In the pterygopalatine fossa the nerve is intimately related to the pterygopalatine ganglion,
and gives off zygomatic and posterior superior alveolar arteries.
- The posterior superior alveolar nerve enters the posterior surface of the body of the maxilla,
and supplies the three upper molar teeth and the adjoining part of gum.
17. PTERYGOPALATINE GANGLION
- Is the largest parasympathetic peripheral ganglion.
- It serves as a relay station for secretomotor fibers to the lacrimal gland and to the mucous
glands of the nose, paranasal sinuses the palate and pharynx.
- Topographically relatedo the maxillary nerve, but functionally connected to the facial nerve
through its greater petrosal branch.
- Location – the flattened ganglion lies in the pterygopalatine fossa just below the maxillary
nerve, in front of the pterygoid canal and lateral to the sphenopalatine foramen.
18. Connections
1. Motor or parasympathetic root of the ganglion
- By the nerve of pterygoid canal.
- It carries preganglionic fibers that arise from neurons present near the superior
salivatory and lacrimatory nuclei, and pass through the nervus intermedius, the facial
nerve, the geniculate ganglion, greater petrosal nerve, nerve of pterygoid canal, to
reach the ganglion.
- The fibers relay in the ganglion.
- Post ganglionic fibers arise in the ganglion to supply secretomotor nerves to the lacrimal
gland and to mucous gland of the nose, paranasal sinuses, palate and nasopharynx.
19. 2. Sympathetic root
- Is also derived from the nerve of pterygoid canal.
- It contains postganglionic fibers arising in the superior cervical sympathetic ganglion which
pass through the internal carotid plexus, deep petrosal nerve, nerve of pterygoid canal to
reach the ganglion .
- The fibers pass through the ganglion without relay and supply vasomotor nerves to the
mucous membrane of the nose, the paranasal sinuses, palate an dnasopharynx.
3. Sensory root
- Comes from the maxillary nerve
- Its fibers pass through the ganglion without relay.
- They emerge in the branches
20. Branches
- The branches of the ganglion are actually branches of he maxillary nerve.
- They also carry parasympathetic and sympathetic fibers which pass through the ganglion.
- The branches are
a. Orbital branches
Pass through the inferior orbital fissure
Supply the periosteum of orbit and orbitalis muscle
b. Palatine branches
The greater or anterior palatine nerve descends through the greater palatine canal, and
supplies the hard palate and the lateral wasll of the nose, i.e inferior conchaand adjoining
meatuses.
The lesser or middle and posterior palatine nerves supply the soft palate and the tonsil.
21. c. Nasal branches
Enter the nasal cavity through the sphenopalatine foramen.
The lateral posterior superior nasal nerves (about 6 in number), supply the posterior part
of the roof of the nose and of the nasal septum.
The largest oof these nerves are called nasaopalatine nerve, which descends upto the
anterior part of the hard palate through the incisive foramen.
d. Pharyngeal branch
Passes through the palatogingival canal and supplies the part of the nasopharynx behind
the auditory tube
22. e. Lacrimal branch
The postganglionuc fubers pass back into the maxillary nerve to leave it through its
zygomatic nerve and its zygomatic temporal branch.
It is a communicating branch to lacrimal nerve to supply secretomotor fibers to the
lacrimal gland.
Preganglionic fibers have their origin in the lacrimatory nucleus.
23. INFRAORBITAL NERVE
- It is the continuation of the maxillary nerve.
- It enters the orbit through the inferior orbital fissure.
- It then runs forwards on the floor of the orbit or the roof of the maxillary sinus, at the first in
the infraorbital groove and then in the infraorbital canal remaining outside the periosteum of
the orbit.
- It emerges on the face through the infraorbital foramen and terminates by dividing into
palpebral, nasal and labial branches.
- The nerve is accompanied by the infraorbital branch of the third part of the maxillary artery
and the accompanying vein.
24. Branches
a. Middle superior alveolar nerve
b. Anterior superior anterior superior alveolar nerve arise in the infraorbital canal and runs in a
sinuous canal having a complicated course in the anterior wall of the maxillary sinus. It
supplies the upper incisor and canine teeth, the maxillary sinus and the antero inferior part
of the nasal cavity.
c. Terminal branches – palpebral, nasal and labial – supply a large area of the skin on the face.
They also supply the mucous membrane of the upper lip and cheek.
25. ZYGOMATIC NERVE
- It ia branch of the maxillary nerv, given off in the pterygopalatine fossa.
- It enters the orbit through the lateral end of the inferior orbital fissue, and runs along the
lateral wall, outside the periosteum, to enter the zygomatic bone.
- Just before or after entering the bone it divides into its 2 terminal branches, the
zygomaticofacial and zygomatiotemporal nerves which supply the skin of the face and of the
anterior part of the temple.
- The communicating branch to the lacrimal nerve, which contains secretomotor fibers to the
lacrimal gland, may arise either from the zygomatic or the zygomaticotemporal nerve, and
runs in the lateral wall of the orbit.
27. MANDIBULAR NERVE
- Is the largest of the 3 divisions of the trigeminal nerve
- It is the nerve of first branchial arch
- It has both sensory and motor fibers
- It supplies all structures derived from the mandibular or first branchial arch
28. Course and relations
- Mandibular nerve begins in the middle cranial fossa through a large sensory root and a small
motor root.
- Sensory root arises from the lateral part of the trigeminal ganglion, and leaves the cranial
cavity through the foramen ovale.
- Motor root lies deep to the trigeminal ganglion and to the sensory root.
- It also passes through the foramen ovale to join the sensory root just below the foramen
thus forming the main trunk.
- The main trunk lies in the infratemporal fossa, ON the tensor veli paltini, DEEP to the lateral
pterygoid.
- After a short course, the main trunk divides into a
Small anterior trunk and a
29. Branches
- From main trunk
a. Meningeal branch
b. Nerve to medial pterygoid
- From the anterior trunk
Sensory branch
a. Buccal nerve
Motor branch
a. Masseteric
b. Deep temporal nerve
c. Nerve to lateral pterygoid
- From the posterior trunk
a. Auriculotemporal
b. Lingual
c. Inferior alveolar nerves
30. Meningeal branch or nervus spinosus
- Course - Meningeal branch enters the skull through the foramen spinosum with the middle
meningeal artery
- Supplies – dura matter of middle cranial fossa
Nerve to medial pterygoid
- Origin – arises close to the otic ganglion
- Supplies - medial pterygoid from its deep surface.
- This nerve gives a motor root to the otic ganglion which does not relay and supplies tensor
veli palatine and tensor tympani muscles.
31. BUCCAL NERVE
- Only sensory branch of the anterior division of the mandibular nerve.
- It passes between the 2 heads of the lateral pterygoid, runs downwards and forwards
- Supplies – skin and mucous membrane related to buccinator. Also supplies buccal aspect of
gums of the molar and premolar teeth of both maxillary and mandibular teeth.
32. MASSETRIC NERVE
- Emerges at the upper border of the lateral pterygoid just in front of the TMJ, passes laterally
through the mandibular notch in company with the massetric vessels and enters the deep
surface of the masseter.
- It also supplies the TMJ
33. DEEP TEMPORAL NERVES
- There are 2 deep temporal nerves
a. Anterior
b. Posterior
- They pass between the skull and the lateral pterygoid and enter the deep surface of the
temporalis.
- Anterior nerve is often a branch of the buccal nerve.
- Posterior nerve may arise in common with the massetric nerve.
34. NERVE TO LATERAL PTERYGOID
- Enters the deep surface of the muscle.
- It may be an independent branch or may arise in common with the buccal nerve.
35. AURICULOTEMPORAL NERVE
Origin
- Arises by 2 roots
Course
- 2 roots run backwards, encircling the middle meningeal artery
- Unites to form a single trunk
- Then continues backwards between the neck of the mandible and the sphenomandibular
ligament, above the maxillary artery
- Behind the neck of mandible it turns upwards and ascends on the temple behind the
superficial temporal vessels.
36. Supplies
- Auricular part – supplies the skin of the tragus, upper parts of the pinna, the external
acoustic meatus, tympanic membrane. (note:- the lower parts of these regions are supplies
by the great auricular nerve and the auricular branch of the vagus nerve)
- Temporal part – supplies the skin of the temple.
- Articular branches – to TMJ
- In addition secretomotor supply to the parotid gland (and also sensory)
37. LINGUAL NERVE
- Is one of the 2 terminal branches of the posterior division of trigeminal nerve.
Orgin
- Begins 1 cm below the skull.
Course and relations
- It runs first between the tensor veli palatini and the lateral pterygoid and then between the
lateral and medial pterygoid.
- 2cm below the skull it is joined by the chorda tympani.
- Emerging at the lower border of the lateral pterygoid, the nerve runs downwards and
forwards between the ramus of the mandible and the medial pterygoid.
38. - Next it lies in direct contact with the mandible, medial to the third molar tooth between the
origins of superior constrictor and the mylohyoid muscle.
- It soon leaves the gums and runs over the hyoglossus deep to the mylohyoid.
- Finally lies on the surface of the genioglossus deep to mylohyoid.
- Here it winds round the submandibular duct and divides into terminal branches.
39. Supplies
- Sensory to the anterior 2/3rd of the tongue and to floor of the mouth.
- However, fibers of chorda tympani (branch of facial nerve) which is sceretomotor to the
submandibular and sublingual glands and gustatory to the anterior 2/3rd of the tongue, are
also distributed through this lingual nerve.
40. INFERIOR ALVEOLAR NERVE
- Is the largest terminal branch of the posterior
division of the mandibular nerve.
- Runs vertically downwards lateral to the
spenomandibular ligament and medial
pterygoid.
- Enters the mandibular foramen and runs in the
mandibular canal.
- It is accompanied by inferior alveolar artery.
Branches
41. a. Mylohyoid branch
- Arises just before the inferior alveolar nerve enters the mandibular foramen.
- Contains all the motor fibers of posterior division
- Pierces the spenomandibular ligament with the mylohyoid artery, runs in the mylohyoid
groove
- Supplies the mylohyoid muscle and the anterior belly of the digatsric.
42. b. Branches in the mandibular canal – inferior dental plexus
- While running in the mandibular canal the inferior alveolar nerve gives branches that supply
the lower teeth and gums. (molar and premolar teeth and gums)
c. Mental nerve
- Emerges at the mental foramen
- Supplies the skin of the chin and the skin and mucous membrane of the lower lip.
d. Incisive branch
- Its incisive branch supplies the labial aspect of the gums of canine and incisor teeth.