TRIGEMINAL NERVE DR. GALLATZ KATALIN

CRANIAL NERVES I. N. ophtalmicus II. N. opticus III. N. occulomotorius IV. N. trochlearis V. Trigeminal nerve VI. N. abducens VII. Facial nerve VIII. N. vestibulocochlearis IX. Glossopharyngeal nerve X. N. vagus XI. N. accessorius XII. N. hypoglossus CRANIAL NERVES

DIVISIONS OF THE TRIGEMINAL NERVE

Nuclei of the trigeminal nerve nucleus of spinal trigeminal tract protophatic principal sensory nucleus epicritic mesencephalic nucleus proprioceptív motor nucleus of V. nerve special visceromotor or branchialmotor

Nuclei of the trigeminal nerve SOMATOSENSORY nucleus of spinal trigeminal tract prothopathic principal sensory nucleus epicritic mesencephalic nucleus proprioceptív SPECIAL VISCEROMOTOR OR BRANCHIALMOTOR motor nucleus of V. nerve

Spinal trigemininal nucleus 1. Caudal part 2. Interpolar part 3. Oral part

Trigeminal nerve innervates the skin of the scalp and frontal region, V/1 the mucous membrane of the oral cavity, V/2 the mucous membrane of the nasal cavity, V/1, V/2 and paranasal sinuses, V/1, V/2 the eye, V/1 the teeth and gingiva, V/2, V/3 the dura mater, V/1, V/2, V/3 the anterior wall of the ext.acustic meatus, V/3 the anterior part of the tympanic membrane, V/3 the temporomandibular joint, V/3 the salivary glands and lacrimal gland, V/1, V/2, V/3 the anterior 2/3 of the tongue V/3 with sensory fibers with motor fibers V/3 the muscles of mastication, the tensor veli palatini, the tensor tympani, the anterior belly of digastric, the mylohyoid m.

Quality of the nerve fibers in the trigeminal nerve General somatosensory (or GSA) (pressure, vibration, discriminative sensation, pain, heat sensation) 2. Branchiomotor or special visceromotor (SVM, SVE) (innervation of the masticatory muscles) „Guest fibres”: 3. General visceromotor (GVM or GVE) / parasympathetic, secretomotor 4. Special viscerosensory (or SVA) Taste Superior (VII.) and inferior salivatory Nucleus (IX.) Nucleus of solitary tract (VII.)

OPHTHALMIC NERVE V/1

Branches of the ophthalmic nerve tentorial branch frontal nerve supratrochlear n. medial supraorbital n. lateral supraorbital n.n. lacrimal nerve communicating branch with zygomatic nerve nasociliary nerve infratrochlear n. anterior ethmoidal n. posterior ethmoidal n. long ciliary n.

Branches of the ophthalmic nerve tentorial branch frontal nerve supratrochlear n. medial supraorbital n. lateral supraorbital n. lacrimal nerve communicating branch with zygomatic nerve nasociliary nerve infratrochlear n. anterior ethmoidal n. posterior ethmoidal n. long ciliary n.

V/2 maxillary nerve

Maxillary nerve innervates the mucous membrane of the oral cavity, the post. part of mucous membrane of the nasal cavity, and paranasal sinuses (except the sphenoid) the upper teeth and gingiva, the dura mater, the nasal and palatine glands the inferior eyelid the externaal surface of the nose the superior lipV/3 with somatosensory fibers

Branches of the maxillary nerve - Meningeal branch (1) - Zygomatic nerve (6) - Pterygopalatine nerves - Infraorbital nerve (17)

Infraorbital nerve - sup., post. alveolar nerves - sup., middle alveolar nerves - sup., ant. alveolar nerves Terminal branches - inf.palpebralis branch - external nasal branch - Superior labial branch

Zygomatic nerve Communicating branch with the lacrimal nerve - Zygomaticoorbital nerve - Zygomaticofacial nerve - Zygomaticotemporal nerve

Pterygopalatine nerves - post., sup. nasal nerves medial rami lateral rami - post., inf. nasal nerves - greater palatine nerve - lesser palatine nerves

- post., sup. nasal nerves NASOPALATINE (SCARPA’ nerve)

MANDIBULAR NERVE (V/3)

BRANCHES OF THE MANDIBULAR NERVE 1. meningeal branch 1 2. MOTOR ROOT masseteric nerve deep temporal nerves lateral pterygoid nerve medial pterygoid nerve nerve for tensor tympani nerve for tensor veli palatini buccal nerve (only sensory branch of the motor root)

BRANCHES OF THE MANDIBULAR NERVE

- anterior auricular branch 3. SENSORY ROOT Auriculotemporal nerve - anterior auricular branch - external acustic branch - branch for the tympanic membr. - articular branches (to TMJ) - parotid branches

Lingual nerve - lingual branches - sublingual branches - ganglionar branches - branches for the isthmus of the fauces

Lingual nerve

Inferior alveolar nerve - mylohyoid nerve - dental and gingival branches - mental nerve

Inferior alveolar nerve MANDIBULAR NERVE Inferior alveolar nerve

MANDIBULAR NERVE MOTOR ROOT SENSORY ROOT

elülső motoros ágcsoport Mandibular nerve (V/3.) f from Dr.Kozsurek menigeal n. auriculotemporalis ggl. trigeminale foramen ovale foramen spinosum elülső motoros ágcsoport rr. buccales (!) Motor root masseteric br. deep temporal br. med. pterygoid br. lat. pterygoideus br. br. for tensor tympani m. Br. for tensor veli palatini Buccal branch (!) n. alveolaris inferior Mylohyoid n. (!) mylohyoid m. ant. belly of digastric n. lingualis

elülső motoros ágcsoport r. meningeus n. mandibularis n. auriculotemporalis ggl. trigeminale gl. parotidea n. petrosus minor ex n. IX. foramen ovale foramen spinosum elülső motoros ágcsoport rr. buccales (!) motoros ágcsoport r. massetericus r. temporalis profundus r. pterygoideus med. r. pterygoideus lat. r. musculi tensoris tympani r. musculi tensoris veli palatini gl. sublingualis gl. submandibularis chorda tympani ex n. VII. nyelv ízlelőbimbói ggl. oticum n. alveolaris inferior n. mylohyoideus (!) m. mylohyoideus m. digastricus venter ant. n. lingualis ggl. submandibulare n. mandibularis (V/3.)

CUTANEOUS INNERVATION OF THE HEAD

IMPORTANT! TRIGEMINAL NERVE PROVIDES THE SENSORY INNERVATION of the big salivary glands (submandibular, sublingual, parotid) , the palatine, the nasal glands and the glands of the tongue, but IT HAS NO PARASYMPATHETIC NUCLEUS, therefore it gets parasympathetic fibers from the VII. and IX. nerves. THE POSTGANGLIONIC FIBERS OF THESE NERVES JOIN TO THE SENSORY BRANCHES OF THE TRIGEMINAL NERVE

(mucous glands of the nasal cavity and hard and soft palate) Branches of trigeminal nerve Facial nerve Superior salivatory nucl. Zygomatic nerve Communicating branch Lacrimal nerve (lacrimal gland) Pterygopalatine ggl. Greater petrosal n. Post. nasal nerves. Nasopalatine n., Greater and lesser palatine nerves (mucous glands of the nasal cavity and hard and soft palate) Preganglionic fiber Postganglionic fibers

Submandibular ggl. Otic ggl Branches of trigeminal nerve n. facialis nucl. saliv. sup Zygomatic n./lacrimal n. Lacrimal gland Pterygopalatine ggl. Greater petrosal n. Post.nasal nerves, nasopalatine n.,greater and lesser palatine nerves Palatine and nasal glands Submandibular ggl. Lingual n. submandibular, sublingual and anterior lingual gl. chorda tympani Glossopharyngeal n. inf. salivatory n. Otic ggl auriculotemporal n. Parotid gland tympanic n. /lesser petrosal n.

PAIN Receptors - nociceptors The pain is an unpleasant sensation, but it is life-important in our connection with the outside-world - The brain can recognize and localize the pain, and activates a lot of mechanizms. - The organism gives different and complex answers for the pain. In the formation of the pain participate: - sensory receptors, - sensory fibers, - ascending pathway- neurons. Receptors - nociceptors

Nociceptors respond to a variety of noxious stimuli: - extreme hot or cold temperatures, - intense mechanical manipulations (pinching, pinpricks, cutting), - increased tissue acidity, and other causes of injury, - a variety chemical agents released from cells that are damaged or responding to a foreign body such as an infectious agent (for example, a bacterium)

The answers for the pain-producing stimuli - protective reflex – spinal cord, brainstem - vegetative reflex – spinal cord, brainstem - recognition and localization of the pain - primer és secunder sensory cortex - emotional reactions -- limbic cortex - hormonal changes - hypothalamus

SPINOTHALAMIC TRACT SPINORETICULOTHALAMIC TRACT Trigeminothalamic tract (Trigeminal lemniscus) SPINORETICULOTHALAMIC TRACT Trigeminoreticular tract phylogenetically new pain localization and discrimination monosynaptic contralateral VPL/VPM phylogenetically old motivational behavior polysynaptic bilateral midline thalamic nuclei

Trigeminal neuralgy - Suddenly appearing, sharp pain in the trigeminal nerve-innervated regions. - The smallest stimuli may generate the attack. The attack causes the spastic contraction of the muscles of the face tic douloureux. - The attack is accompanied by vegetative symptoms. - The pressure of the exit-place of the supraorbital , infraorbitalis, and mental nerve may generate the attack.

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