1. TRIGEMINAL NERVE
DR. GALLATZ KATALIN

2. 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

3. DIVISIONS OF THE TRIGEMINAL NERVE

4. 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

5. 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

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

8. 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.

9. 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.)

13. OPHTHALMIC NERVE V/1

14. 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.

15. 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.

18. V/2 maxillary nerve

19. 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

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

21. 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

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

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

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

27. MANDIBULAR NERVE (V/3)

28. 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)

29. BRANCHES OF THE MANDIBULAR NERVE

30. - 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

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

33. Lingual nerve

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

35. Inferior alveolar nerve
MANDIBULAR NERVE
Inferior alveolar nerve

36. MANDIBULAR NERVE
MOTOR ROOT
SENSORY ROOT

37. 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

40. 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.)

42. CUTANEOUS INNERVATION OF THE HEAD

43. 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

44. (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

45. 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.

46. 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

47. 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)

48. 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

49. 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

51. 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.

52. Thank you for your attention!