THE TRIGEMINAL NERVE

The largest cranial nerve

The part of parasympathetic craniosacral

outflow
It is mixed nerve ( sensory and motor )
Contains 170,000 sensory fibres
7,700 motor fibres
The 3 divisions have approx ophthalmic 26,000
maxillary 50,000
mandibular 78,000

TRIGEMINAL

NUCLEI

1. SENSORY NUCLEI :

Mesencephalic nucleus - first order sensory nucleus .

cell body of pseudounipolar neurons
exception to a general rule that first
order neuron of CN lie outside CNS.
relay proprioception from muscles of
mastication, EOM, facial muscles.
forms monosynaptic reflex arc .
situated in midbrain just lat to
aqueduct.
Principal sensory nucleus- lies in pons lat to motor nucleus
relays discriminitive touch

Conti.
Spinal nucleus- extends from caudal end of principal sen. Nuc. In pons
to 2nd or 3rd spinal seg where its conti with sub.Gelatinosa. divided
in :
PARS ORALIS
PARS INTERPOLARIS
PARS CAUDALIS
topographical localization of fibres : V1 dorsal and caudal
part C1 C2
V2- middle part
V3- cranial and ventral part in
medulla.
2.

MOTOR NUCLEUS : innervates muscles of mastication and

tensor
tympani and tensor palatini
derived from first branchial arch.
located in pons med. to princi sen. Nuc.

FUNCTIONAL COMPONENTS
SENSORY ROOT
GENERAL SOMATIC AFFERENTS
FACE, SCALP, TEETH, GINGIVA, ORAL, NASAL ,CAVITIES, PNS ,CONJUNCTIVA,
AND CORNEA.
Pain,temp,light touch
touch, pressure
proprioception
trigeminal gang.

Bypasses trigem gang.

sensory root.
descending fibres

ascending fibres

Conti..
descending fibres
Spinal nuc.

ascending fibres
Principal sen nuc.

Mesencephalic

trigeminal leminiscus (after crossing over

and uncrossed dorsal trigeminothalamic tract
VPM nuc. Thalamus
IC
post central gyrus cerebral cortex (areas 3,2,1.)

MOTOR NUCLEUS
MOTOR ROOT
MANDIBULAR NERVE

muscles of mastication tensor tympani

massetor
lat med pterygoids
temporalis

tensor palatini

DIVISIONS OF TRIGEMINAL NERVE

Three divisions

1. ophthalmic nerve
2. maxillary nerve
3. mandibular nerve

OPHTHALMIC NERVE
Smallest div.
Only sensory
Supplies : cornea,conjuctiva,upper lid,forehead,ant part

of scalp,nose.
Course: emerges from trigeminal ganglion
lat wall cavernous sinus

3 branches in ant part of cavernous sinus

lacrimal, nasocilliary, frontal.
superior orbital fissure
orbit

LACRIMAL NERVE
Smallest
Passes into orbit through lat compartment of the sup

orbital fissure outside the tendinous ring.

Receives communicating branch from trochlear nerve
Receives branch from zygomaticotemporal nerve
Passes along sup border of LR with lacrimal art
Sensory to lat conjunctiva,UL, lacrimal gland(parasym
secretomotor).

FRONTAL NERVE
Largest
Enters through lat part of sup orbital fissure outside

tendinous ring
Passes forward between roof of orbit and LPS
Divides midway into SUPRATROCHLEAR NERVE
SUPRAORBITAL NERVE

SUPRATROCHLEAR N

SUPRAORBITAL N

Smaller nerve

Larger

Medial

Lies lateral

Receives commu branch

Passes through
supraorbital notch

from infratrochlear n
Curves around sup med
margin of orbit
supplies: med
conjunctiva and UL
lower part of forehead
Lies betwn frontalis and
corrugator supercilli

Lies beneath frontalis

Divides in med and lat
branches.
Supplies: conjunctiva,

scalp upto vertex,

mucous membrane of
frontal sinus

NASOCILLIARY NERVE
Sensory only
Passes through med part of sup. Orbital fissure within

the tendenious ring betwn the two div of occulomotor

nerve.
Crosses from lat to med above ON with ophthalmic
art
Runs along med wall of orbit betwn SO and MR
Divides into terminal branches ANT ETHMOIDAL
NERVE and INFRATROCHLEAR NERVE

5 branches in orbit.

conti
1. Communicating branch to cilliary ganglion:
passes along short cilliary nerves.
carries symp fibres from IC plexus and sensory fibres
from the eyeball.
2. LONG CILLIARY NERVES : 2 or 3.
run along med side of the ON

pierce sclera and supply cornea, iris, cilliary body.

carry pain temp and touch.
sympathetic motor supply to dilator pupillae.
3. POST ETHMOIDAL NERVE:
passes thru post ethmoidal foramen to supply the
ethmoid and sphenoid PNS.

4. INFRATROCHLEAR NERVE:
smaller terminal branch
emerges below trochlea
appears on face above med angle the eye.
supplies: upper half of external nose
skin of med most part of UL andLL
medial conjunctiva
lacrimal sac
caruncle

5. ANT ETHMOIDAL NERVE:

largar terminal branch
course: ant ethmoidal foramen and canal
into ant cranial fossa on sup surf of cribriform plate
Through slit lat to crista galli into nasal cavity
Med internal nasal branch
Supplies ant nasal septum

lat internal nasal branch

supplies ant part lat nasal
cavity emerges as
external nasal nerve to
skin of ala,vestibule,and
tip of nose

MAXILLARY NERVE
Second division of trigeminal nerve
Pure sensory
Supplies derivatives of maxillary process and frontonasal

process
Course: trigeminal gang. Middle cranial fossa

lat wall of cavernous sinus

foramen rotundum
pterigopalatine fossa
in groove on post surf of maxilla
through inf orbital fissure into orbit as INFRA ORBITAL N
through infraorbital foramen on face

BRANCHES
IN MIDDLE CRANIAL FOSSA: meningeal branch
IN PTERIGOPALATINE FOSSA:

1. ganglionic branches-

related to pterigopalatine ganglion

Carry sensations from orbital periosteum,m nose,
pharynx,palate
Carry post ganglionic parasymp. Secretomotor fibres to
lacrimal gland
2.post. Superior alveolar nerve-forms superior
dental plexus to supply mm of maxillary sinus and molars.

3.Zygomatic nerve :
enters orbit through inf orbital fissure

A. zygomaticofacial nerve
Appears on face thru foramen
in the zygomatic bone
Supplies skin on prominence of
cheek

B. zygomaticotemporal nerve
Runs along inf,lat orbital wall
Appears in infratemporal region
thru foramen in zygomatic
bone
Supplies skin of temporal
region after peircing
temporal fascia 2 cm above
zygoma
Gives communicating branch to
lacrimal N suppling parasymp.
Secretomotor fibres to
lacrimal gland.

IN THE INFRAORBITAL CANAL

1.middle superior alveolar nerve:
runs along lat wall of maxilla
Participates in superor dental plexus
Supplies premolars.
2. Anterior superior alveolar nerve:
Runs in canal in ant wall of maxilla=canalii sinosus
#Dental branches
# nasal branches
Joins sup dental plexus
to supply canines

lat wallof inf meatus to

opening of max sinus.

3. FACIAL BRANCHES:

1.palpebral nerves-peirces orbicularis occuli and supplies skin of

lower lid.
2.nasal branches-supplies skin of lat wall nose and mobile part of

septum.
3. superior labial nerve-forms infraorbital plexus

supplies skin and mm of upper lip,cheek and labial glands.

MANDIBULAR NERVE
Largest
Mixed
Nerve of 1st branchial arch
Motor root- from motor sensory root- gasserian ganglion

nucleus in pons exit through foramen ovale in grt. Wing of shenoid

from trunk in infratemporal fossa

travels between lat. Pterygoid and otic ganglion laterally and tensor
palatine medially anteriorly to med. Meningeal A.
small ant. Divisionlarge post. division

Branches
Trunk

Nervous spinosus
N. to med. Pterygoid

Ant. Division

Massetric N.
Deep temporal N.
N. to lat. Pterygoid
Buccal N.

Post. Division

Auriculo temporal
Inf. Alveolar
Lingual N.

Branches from trunk

Nervous spinosus
Through foramen spinosus
Dura mid cranial fossa
Nerve to med. Pterygoid
Supplies medial pterygoid
Through otic ganglion without interruption to
Tensor tympani
Tensor palatini

Branches from the anterior division

Nerve to lat pterygoid
Massetric nerve- lies sup to lat pterygoid,inf to temporalis

tendon and ant to TMJ.

supplies masseter and TMJ
Buccal nerve-is the only sensory branch of ant div. travels
betwn 2 heads of lat pterygoidand emerges in cheek at ant
border of masseter. Supplies skin and mm of cheek.
Deep temporal nerve-the 2 nerves ascend deep to lat
pterygoid and supply temporalis.

division
1.Auriculotemporal nerveArises from 2 roots which encircle the middle
meningeal art
The trunk passes post to lat pterygoid betwn neck of mandible
and sphenomandibular lig sup to 1st part of maxillary art.
Lies behind the TMJ close to the parotid
Ascends behind sup temporal vessels and then in temporal
region divides into superficial temporal branches.

Branches of auriculotemporal nerve

auricular branches-supply tragus,upper part of aurical,roof of

ext auditory meatus,anterosup part of tympanic memb

Superficial temporal branches-supply skin of temple
Articular branches-supply the TMJ.

2. Inferior alveolar nerve:

Is mixed nerve
Passes betwn mandible and sphenomandibular lig inf to lat
pterygoid,
Enters mandible through mandibular foramen to run in a bony
canal below the teeth
Branches: to molars and premolars
incisive nerve
mental nerve
mylohyoid nerve-mylohyoid and ant belly of
diagastric
communicating nerve to lingual nerve

3.Lingual nerve: lies ant to inf alveolar n betwn lat pterygoid and tensor
palatini
receives chorda tympani (SVA)
Emerges from inf border of lat pterygoid to lie betwn ramus and med
pterygoid

Betwn origins of sup constrictir and mylohyoid

1 cm below and behind 3rd molar in gingiva

Rests on hypoglossus lat to the tongue where it is related to the

submandibular ganglion
Gives sensory supply to presulcal tongue ,floor of mouth, mandibular
gums,and carries proprioception from tongue.

Branches of lingual nerve and its communications:

1.Chorda tympani
2.Communications with submandibular ganglion

3.Hypoglossal nerve

GANGLIA ASSO WITH THE TRIGEMINAL NERVE

1.CILLIARY GANGLION: connected with nasocilliary nerve by ganglionic
branches in orbit,
non synapsing
sensory for orbit

2.PTERYGOPALATINE GANGLION: connected to maxillary nerve in

infratemporal fossa
sensory to orbital septum, orbicularis and nasal cavity ,max sinus , palate ,
nasopharynx.
3. OTIC GANGLION: betwn trunk of mandibular n and tensor palatini , nerve
to med pterygoid passes thru but does not synapse in the ganglion.
4.SUBMSNDIBULAR GANGLION: related to lingual n,rest on hypoglossus
supplies post gang. Parasym secretomotor fibres to submandibular and
sublingual gland.

CUTANEOUS DISTRIBUTION OF TRIGEMINAL NERVE

Each half of face is supplied by 13 cut N
1motor and 12 sensory
Of 12 sensory : 11 are from trigeminal N
1 is c2 greater auricular N
Branches of trigeminal N
5 from ophthalmic:lacrimal
supraorbital
supratrocheal
infratrochlear
external nasal

 Refrences:

Anatomy of head neck face- Datta

Snells anatomy
Neuroanatomy by Snell
Anatomy of the CNS-Poddar
Parsons text book
Harrisson text of internal medicine
Clinical Ophthalmology Kanski
Anatomy and phisiology of the eye- khurana
Yanoff and Durker

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