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Flashcards in Trigeminal Nerve Deck (76):
1

Largest cranial nerve

Trigeminal nerve (CN 5)

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3 parts of the brainstem

Medulla oblongata, pons, midbrain

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4 nuclei of the trigeminal nerve

Mesencephalic nucleus, principle sensory nucleus, spinal nucleus, motor nucleus (all of the trigeminal nerve)

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Location of mencephalic nucleus

Slightly lateral to 3rd ventricle in midbrain

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Location of principle sensory nucleus

Slightly lateral to 3rd ventricle in pons

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Location of spinal nucleus

Slightly lateral to 4th ventricle in medulla oblongata

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Location of motor nucleus of trigeminal nerve

Immediates medial to principle sensory nucleus

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What is the continuation of the caudal end of the spinal nucleus into the spinal cord?

Spinothalamic tract

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Extension of trigeminal nerve from lateral surface of pons

Sensory root of trigeminal

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What does the sensory root of the trigeminal nerve connect?

lateral surface of pons to the medial surface of the trigeminal ganglion

11

What runs on the inferior surface of the filamentous sensory stalk of the trigeminal?

Motor root of the trigeminal

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Superior Cranial extension of the trigeminal

Opthalmic branch V1

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Inferior cranial extension of trigeminal

Maxillary branch V2

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Inferior extension passing out of the skull of the trigeminal

Mandibular branch V3

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What runs parallel to/merges with mandibular branch?

Motor root of the trigeminal

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What is enclosed in the Trigeminal Cave?

Roots of trigeminal nerve, trigeminal ganglion, proximal ends of the 3 trigeminal branches

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What are the layers of the trigeminal cave formed from?

2 layers from the tentorium cerebelli of the dura matter

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What venous structure does the trigeminal cave abut?

Cavernous sinus

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What parts of the trigeminal enter the cavernous sinus?

Opthalmic and maxillary on the lateral wall

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Path of maxillary branch

Thru F. rotundum to reach the pterygipalatine fossa, communicates with pterygopalatine ganglion, divides into zygomatic/infraorbital nerves (both enter inferior orbital fissure)

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Largest meningeal nerve branch

Middle meningeal nerve

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Path of middle meningeal branch of the trigeminal

Arises from maxillary just before it enters the f. rotundum

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Path of meningeal nerve

Arises from mandibular branch immediately after ot passes thru f. ovale then enters the skull via the f. spinosum with the middle meningeal ARTERY

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Smallest of trigeminal branches

Opthalmic branch V1

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3 subdivisions of the opthalmic branch

Front, lacrimal, nasocillary

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What passes thru the superior tip of the superior orbital fissure?

frontal and lacrimal subdivisions of ophthalmic division

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Where does the nasocilliary subdivision of the opthalmic branch enter the orbit?

Inferiorly within the tendinous ring of supraocular muscles

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What does the frontal split into?

Supratrochlear nerve, supraorbital nerve

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Path of supratrochlear nerve

Exits orbit near the medial corner, extends superiorly along the forehead. Is sensory

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Path of supraorbital nerve

Exits orbit thru supraorbital foramen, extends superiorly along forhead and posteriorly to near the vertex. Sensory

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Path of lacrimal nerve

Along superior surface of lateral rectus to lateral corner of the orbit. Supplies lacrimal gland.

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Path of nasociliary nerve

Along superior surface of optic nerve and medial border of the orbit between medial rectus and superior oblique muscles

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What does the nasociliary nerve intergrate with?

Parasympathetic/sympathetic axons, and inferior division of oculomotor nerve (3)

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Short ciliary nerves

Carries sensory info from the eye thru the ciliary ganglion via communicating branches into the nasociliary

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Long ciliary nerves

Carry sensory info from the eve, but bypasses ciliary ganglion*

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Posterior ethmoid nerve

Exits orbit thru posterior ethmoid foramen. Sensory to sphenoid sinus and posterior ethmoid air cells

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Anterior ethmoid nerve

Exits orbits via anterior ethmoidal foramen, passes thru margin of cribform plate to enter cranial cavity, gives off meningeal branch, passes inferiorly thru nasal slit to enter nasal cavity, terminates at lateral portion of the nose

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What passes thru the nasal slit?

Anterior ethmoidal foramen

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Infratrochlear nerve

The nasociliary distal to the branching of anterior ethmoidal nerve

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Path of infratrochlear nerve

Exits the orbit at medial corner, extends medially to bridge of nose

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Branches of maxillary nerve

ganglionic branches, posterior superior alveolar, zygomatic, infraorbital nerve

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Branches of zygomatic nerve

Communicating branch, sygomaticofacial, zygomaticotemporal

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Branches of infraorbital nerve

Anterior superior alveolar, inferior palpebral, lateral nasal, superior labial

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Path of infraorbital nerve

Exits near middle of inferior orbital fissure, enters infraorbital canal, gives off one branch, passes thru infraorbital foramen, branches on the face

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Divisions of mandibular nerve

Anterior/posterior

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Anterior division of mandibular branches

Medial /lateral pterygoid masseteric nerve, deep temporal, buccal

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Branches off of nerve to medial pterygoid

Otic ganglion (muscular branch but no synaptic connections), tensor tympani, tensor veli palatini

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Path of nerve to medial pterygoid

Runs over the deep surface of the medial pterygoid

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Deep temporal nerve path

Superior to lateral pterygoid, deep surface of temporalis, splits into anterior/posterior.

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Buccal nerve path

Courses deep to temporalis/masseter.

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Posterior division of the mandibular branch path

Courses inferiorly, and branches are more anterior than anterior division

52

Main branches of posterior division of mandibular branch

Auriculotemporal, lingual, inferior alveolar

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Path of auriculotemporal nerve

Posterior with an inferior arch to course around the neck of mandibul, pierces by middle meningeal artery, between temporomandibular joint/external meatus before running superior along the head

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Innervation of auriculotemporal nerve

Sensory to temporal region/TMJ/auditory canal/outer surface of tympanum. Autonomics to parotid gland

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Path of lingual nerve

Inferior to lateral pterygoid, medial to inferior alveolar nerve, then between medial pterygoid and ramus of mandible, connects to submandibular ganglion, bifurfactes at the hyoglossus to form sublingual gland and sublingual nerve

56

Path of inferior alveolar nerve

Inferior along posterior margin of lateral pterygoid, nerve to mylohyoid, passes thru mandibular foramen entering the mandibular canal, bifurcates anteriorly to form incisive and mental nerve

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Inputs of ciliary ganglion

postsynaptic sympathetic axons from superior cervical ganglion, presynaptic parasympathtic axons in the inferior division of CN 3, sensory fibers from nasociliary nerve

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Outputs of ciliary ganglion

Short ciliary nerve (caudal surface of eye)

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Function of ciliary ganglion

Autonomics that regulate accomidation of the lens and pupillary aperature

60

Inputs Pterygopalatine ganglion

Postsynaptic sympathetic axons from superior cervical ganglion, thru carotid plexus and into deep petrosal/pterygoid canal nerves. Presynaptic parasympathetic from greater petrosal (facial nerve). Sensory fibers from maxillary

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Posterior superior nasal nerve

From pterygopalatine ganglion. Enters nasal cavity thru sphenopalatine f. radiates over lateral/medial walls of nasal cavity

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Posterior inferior nasal nerve

From pterygopalatine ganglion. Inferiorly thru pterygopalatine fossa to enter palatine canal, exits canal, passes thru lateral wall of nasal cavity

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Nasopalatine nerve

Enters nasal cavity thru sphenopalatine foramen, runs anteriorly along roof of nasal cavity, anteroinferiorly across septum, thru incisive canal to reach hard palate, integrates with greater palatine nerve

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Greater palatine nerve path

From pterygopalatine ganglion. Inferiorly thru pterygopalatine fossa to enter palatine canal, exits canal via greater palatine foramen, splits in the posterior half of the hard palate

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Lesser palatine nerve path

From pterygopalatine ganglion. Inferiorly thru pterygopalatine fossa to enter palatine canal, exits canal via lesser palatine foramen, splits in the soft palate

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Orbital nerve path

Passes thru inferior orbital fissure

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Pharyngeal nerve path

From pterygopalatine ganglion. Exits pterygopalatine fossa via palatovaginal canal

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Function of pterygopalatine ganglion

Regulate lacrimation

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Inputs of Submandibular ganglion

postsynaptic sympathetic axons from superior cervical ganglion thru facial artery plexus, presynaptic parasympathtic axons in chorda tympana of facial nerve, sensory fibers from lingual nerve

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Outputs of submandibular ganglion

Course in lingual nerve or nerve to submandibular gland

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Function of submandibular ganglion

Autonomics regulate saliva expression in sublingual/submandibular glands

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Inputs of otic ganglion

postsynaptic sympathetic axons from superior cervical ganglion thru plexus around middle meningeal artery, presynaptic parasympathtic axons from CN 10 in lesser petrosal nerve, sensory and muscular axons from medial pterygoid nerve and from chorda tympana

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Outputs of otic ganglion

Auriculotemporal nerve to parotid gland

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Function of otic ganglion

Autonomics thru otic ganglion regulate salivation at parotid gland

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Trigeminal palsy

Paralysis of muscles of mastication (anterior division of mandibular nerve)

76

Trigeminal neuralgia

Typically unilateral, aka suicide disease, sharp jolts of intense pain, can last hours or days