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ANATOMY4: Cranial nerves > Trigeminal nerve > Flashcards

Trigeminal nerve Flashcards

1
Q

Which is the largest of the cranial nerves?

A

trigeminal nerve

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2
Q

What are 8 areas that are supplied by the sensory trigeminal nerve?

A
  1. oronasal cavities
  2. middle ear
  3. paranasal sinuses
  4. skin of face
  5. teeth
  6. cornea
  7. temporomandibular joint
  8. dura of anterior and middle cranial fossae
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3
Q

Describe how the dermatomes correspond to the trigeminal nerve major subdivisions

A
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4
Q

What is not shown in the diagrams of the three branches of the trigeminal nerve?

A

only cutaneous branches of the former two (ophthalmic and maxillary) divisions are illustrated

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5
Q

What are 2 key branches of the ophthalmic division of the trigeminal nerve?

A

frontal nerve + nasociliary nerve and ciliary ganglion

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6
Q

What are 3 key branches of the maxillary division of the trigeminal nerve?

A
  1. External nasal nerve
  2. Zygomatic nerve
  3. Infraorbital nerve
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7
Q

What are 5 key branches of the mandibular division of the trigeminal nerve?

A
  1. buccal nerve
  2. lingual nerve
  3. inferior alveolar nerve
  4. nerve to mylohyoid
  5. mental nerve
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8
Q

What are the 2 broad, separate functions of the trigeminal nerve?

A
  1. General somatic afferent (GSA)
  2. Special visceral efferent (SVE)
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9
Q

How do the 2 broad functions of the trigeminal nerve manifest in its physical anatomy?

A

Large nerve emerging from imd pons of brainstem as a large sensory root and a small motor root

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10
Q

Which part of the brainstem does the trigeminal nerve emerge from?

A

mid pons

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11
Q

Where does the trigeminal nerve emerge from the mid pons?

A

in the posterior cranial fossa at the level of the middle cerebellar peduncle as a large sensory root and small motor root

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12
Q

What is the function of the general somatic afferent (GSA) of the trigeminal nerve?

A

concerned with sensation to the face in the three dermatomes

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13
Q

What is the function of the special visceral efferent of the trigeminal nerve?

A

fibres supply motor fibres to muscle of mastication

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14
Q

Where does the GSA component of the trigeminal nerve have cell bodies?

A

trigeminal ganglion

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15
Q

How are sensory and motor divisions of the PNS divided?

A

sensory (afferent): somatic sensory vs visceral sensory

motor (efferent): somatic vs autonomic (sympathetic and parasympathetic)

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16
Q

How many sensory nuclei exist in the brainstem that are associated with the trigeminal nerve?

A

3

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17
Q

How are the 3 senosry nuclei associated with the trigeminal nerve arranged in the brainstem?

A

in a vertical continuous series

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18
Q

What are the 3 sensory nuclei located in the brainstem associated with the trigeminal nerve?

A
  1. mesencephalic nucleus
  2. main sensory or pontine nucleus
  3. spinal nucleus
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19
Q

What is the most rostral component of the sensory trigeminal nuclei in the brainstem?

A

mesencephalic nucleus

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20
Q

Which neurones are located in the mesencephalic nucleus? 2 key types

A
  1. first-order sensory neurones serving proprioreception from muscles of mastication and muscles of facial expression
  2. proprioreception for extraocular muscles (this is controversion)
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21
Q

At what level of do neurone cell bodies in the mesencephalic nucleus lie and how does this differ from other sensory neurone cell bodies?

A

the cell bodies lie at the level of the upper pons (not in trigeminal ganglion outside the CNS like other sensory neurone cell bodies)

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22
Q

What motor nucleus is the mesencephalic nucleus connected to and which reflex does this serve?

A

connected to motor nucleus of V - this is basis for the jaw-jerk reflex

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23
Q

At what level does the main sensory of pontine nucleus lie?

A

mid pons

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24
Q

What are 4 senses processes by the main sensory or pontine nucleus?

A
  1. Pain
  2. Touch
  3. Pressure
  4. Temperature
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25
Q

How do central processes from trigeminal sensory neurones entering the pons travel?

A
  • in both cranial and caudal directions
  • conscious proprioreception, pressure and tactile sensations travel in the trigeminothalamic tract to the VPN (ventral posteromedial nucleus) of the thalamus
  • (ipsilateral fibres travel in dorsal trigeminothalamic tract; contralateral in ventral trigeminothalamic tract)
26
Q

In which tract do central processes from sensory neurones entering the pons travel? Where does this travel to?

A

trigeminothalamic tract to VPN of thalamus

27
Q

Where does the spinal nucleus and tract of the trigeminal travel bewteen?

A

from mid pons to the C2-4 level

28
Q

What process is the spinal nucleus / tract of trigeminal continuous with?

A

substantia gelatinosa of the posterior grey horn of the spinal cord

29
Q

What type of sensation are conveyed by the spinal sensory nucleus / tract of trigeminal?

A

pain and temperature sensation - tactile, nocipcetive and thermal information from territories of the 3 divisions

30
Q

Where does the spinal nucleus / tract of trigeminal receive pain and temperature sensation to? Where does this travel subsequently?

A
  • receives to caudal aspect of the nucleus
  • ventral trigeminothalamic tract connects to the thalamus
31
Q

What are the afferent fibres terminating in the main sensory (pontine) nucleus + spinal nucleus, and where are the cell bodies?

A
  • they are central processes of sensory neurones
  • cell bodies located in trigeminal (Gasserian) ganglion (whereas mesencephalic nucleus cell bodies are in level of upper pons)
32
Q

Where do the peripheral processes of the main sensory and spinal nuclei terminate?

A

in appropriate sensory receptors in the territories of the three divisions

33
Q

Where is the motor trigeminal nucleus located in relation to the main sensory nucleus?

A

motor nucleus is medial to main sensory nucleus

34
Q

What are 6 structures that the motor trigeminal nucleus receives input from?

A
  1. both cerebral hemispheres
  2. reticular formation
  3. red nucleus
  4. tectum
  5. mesencephalic nucleus
  6. medial longitudinal fasciculus (MLF)
35
Q

How do motor fibres exit the motor nucleus of the trigeminal nerve and what do they supply?

A

as the motor root of the trigeminal; supply muscles of mastication

36
Q

What does the sensory root of the trigeminal nerve arise from and where are they located?

A
  • central processes of pseudo-unipolar sensory neurones
  • cell bodies lie in large trigeminal ganglion
  • –> located in cavum trigeminale
37
Q

What is the cavum trigeminale?

A

bony depression near apex of petrous temporal bone lined by evaginating dura mater from edge of tentorium cerebelli and roofed over by dura of middle cranial fossa

38
Q

What surrounds the trigeminal ganglion?

A

partly surrounded by CSF, continuous with subarachnoid space of posterior cranial fossa

39
Q

What is the trigeminal ganglion homologous to?

A

a dorsal root or sensory ganglion of a spinal nerve

40
Q

From what structure and where do the three named branches of the trigeminal nerve emerge (V1-3)?

A

the anterolateral convex surface of the flattened trigeminal ganglion

41
Q

Where does the ophthalmic division of the trigeminal nerve split into its three main branches?

A

anterolateral portion of the cavernous sinus

42
Q

What are the 3 main branches of the ophthalmic division of the trigeminal nerve?

A
  1. lacrimal
  2. frontal
  3. nasociliary
43
Q

What is the pathway of the maxillary nerve from the sensory root to the cutaneous branches of the face? 6 steps

A
  1. passes through foramen rotundum
  2. spans pterygopalatine fossa
  3. enters orbit through inferior orbital fisure as infraorbital nerve
  4. passes forward from IOF to infraorbital groove, becomes infraorbital canal
  5. emerges through infraorbital foramen
  6. here, radiates out as number of cutaneous branches supplying lower eyelid, nose, upper lip and cheek
44
Q

Which foramen does the maxillary nerve pass through?

A

foramen rotundum

45
Q

Why is the infraorbital nerve (what maxillary nerve becomes once enters orbit) not truly an orbital content?

A

it lies beneath the periorbita

46
Q

What 4 structures are supplied by the cutaneous branches of the maxillary nerve?

A
  1. lower eyelid
  2. nose
  3. uppler lip
  4. cheek
47
Q

What is a key branch of the infraorbital nerve (infraorbital part of maxillary nerve) and what is its course?

A
  • zygomatic nerve
  • runs along in inferior orbital fissure, beneath the periorbita, to the lateral wall of the orbit where it pierces the zygomatic bone as 2 branches (zygomaticotemporal and zygomaticofacial nerves)
48
Q

What are the 2 branches that the zygomatic nerve pierces the zygomatic bone as?

A
  1. zygomaticotemporal nerve
  2. zygomaticofacial nerve
49
Q

What communicating branch from the zygomatic nerves may there be (of questionble importance and presence)?

A

communicating branch passing up lateral wall of orbit to lacrimal nerve

50
Q

Which ganglion do branches of the maxillary nerve, other than the infraorbital/zygomatic branches, pass through?

A

pterygopalatine ganglion

51
Q

Do maxillary fibres synapse in the pterygopalatine ganglion?

A

no - pass through without synapsing

52
Q

What 4 structures are supplied by the branches of the maxillary nerve which pass through the pterygopalatine ganglion (without synapsing)?

A
  1. nasal cavity
  2. upper alveolar arch
  3. hard palate
  4. soft palate
53
Q

What are 3 functions of the mandibular division of the trigeminal nerve?

A
  1. sensory component
  2. supplies motor fibres to muscles of mastication
  3. receives proprioceptive fibres from muscles of mastication and muscles of facial expression in lower part of face
54
Q

What is another name for trigeminal neuralgia?

A

tic douloureux

55
Q

What characterises trigeminal neuralgia?

A

excruciating pain in the territory of one or more of the divisions of the trigeminal nerve

56
Q

What are 2 proposed causes of trigeminal neuralgia?

A
  1. osteitis of petrous temporal bone
  2. compression of nerve root or ganglion in the cavum trigeminale by enlarged or engorged vessels
57
Q

The territory of which branch of the trigeminal nerve is most frequently involved in trigeminal neuralgia?

A

maxillary nerve (then mandibular, least common ophthalmic)

58
Q

What are 3 commonly performed surgeries to manage trigeminal neuralgia?

A
  1. glycerol rhizotomy
  2. stereotactic radio-surgery (gamma knife)
  3. endoscopic vascular decompression
59
Q

What are the 4 parasympathetic ganglia of the head and neck (all of which are associated with the branches of the trigeminal)?

A
  1. ciliary
  2. pterogypalatine
  3. otic
  4. submandibular
60
Q

How are the four parasympathetic ganglia fo the head and neck connected?

A

short stalks containing pre- and postgaglionic fibres

61
Q

How do the fibres of the 4 parasympathetic ganglia of the head and neck interact with fibres of the trieminal nerve?

A

terminal fibres are distributed with the branches of the trigeminal; might share same perineural sheath for part of their course (hitch hikers)

62
Q

How may sympathetic fibres interact with branches of the trigeminal nerve?

A

may hitch-hike with branches of trigeminal for part of their course and be distributed to territories of this large nerve

ANATOMY4: Cranial nerves (6 decks)

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