Wednesday, October 26, 2011

Examination of Trigeminal nerve Video

Trigeminal Nerve

Examination of Trigeminal nerve Video
Trigeminal Nerve—Sensory Components
Trigeminal Nerve—Sensory Components
Modality Nerve Branch(es) Associated Parasympathetic Ganglion/Nerve Sensory Region Served
Ophthalmic (V1) Division of Trigeminal Nerve
GSA Lacrimal Zygomaticotemporal of V2, delivers post. para. from pterygopalatine ganglion (VII) for lacrimal gland (GVE) Lacrimal gland, adjacent conjunctiva, lateralaspect of skin of upper eyelid


Conjunctiva and skin of the medial portion of the eye and skin over the forehead

Filament to frontal sinus, upper eyelid, forehead, and scalp
Nasociliary Ciliary ganglion (III) & possibly post. sym. from carotid plexus (GVE) (Postganglionic sympathetic to dilatator pupillae)

Long ciliary
Posterior ethmoidal

Orb, cornea
P.E. foramen—ethmoidal, sphenoidal, frontal sinuses
Anterior ethmoidal

A.E. foramen—ethmoidal, sphenoidal, frontal sinuses
Internal nasal

Mucous membranes
External nasal

Ala and globus of nose

Conjunctiva, eyelid, caruncula, lacrimal sac, side of nose
Maxillary (V2) Division of Trigeminal Nerve
Zygomatic Pterygopalatine ganglion (VII) delivers post. para. secretomotor fibers to zyygomatico-temporal nerve for distribution to lacrimal nerve to lacrimal gland (GVE)

Skin of the cheek
Zygomaticotemporal Delivers secretomotor fibers to lacrimal nerve for lacrimal gland Skin of temporal region
Pterygopalatine These nerves serve as a functional connection to the pterygopalatine ganglion permitting passage of post. para. to zygomatic nerve and sensory fibers from maxillary through ganglion to become other named branches of the maxillary nerve

Periorbita, ethmoid, and sphenoid sinuses
Greater palatine Pterygopalatine ganglion (VII) delivers post. para. secretomotor fibers to glands of the nasal cavity, pharynx, and palate (GVE) Adjacent soft palate, hard palate, gingiva, mucous membranes anteriorly to incisor teeth (communismall cates with nasopalatine)
Lesser palatine Delivers secretomotor fibers to glands of soft palate Soft palate, tonsil, and uvula. (Many of the afferents were communicated from facial nerve)
Posterior superior nasal branches Delivers secretomotor fibers to glands of nasal cavity Nasal cavity supplying mucous memb. of sup. and middle conchae, median nasal septum and ethmoid sinus. Major trunk is nasopalatine
Nasopalatine Delivers secretomotor fibers to glands of nasal cavity Between septum and mucous memb. to incisive canal. Serves anterior palate as far laterally as cuspid. (Communicates with greater palatine nerve)
Pharyngeal br. Delivers secretomotor fibers to glands of nasopharynx and spheniod sinus Enters pharyngeal canal. Serves m. memb. and nasopharynx to auditory tube
Posterior superior alveolara

Sometimes branched. Passes over max. tuberosity to serve m. memb. of cheek and adjacent gingiva. Enters P.S.A.F to distribute to max. sinus and to roots of 3 max. molars (except mesial buccal root of 1st molar)
Infraorbital This nerve is a continuation of the maxillary nerve into the floor of the orbit via the inferior orbital fissure and exiting the skull at the infraorbital foramen
Middle superior alveolara

Lateral wall of max.sinus, enters mesial buccal root of 1st molar and all roots of premolars
Anterior superior alveolara

Anterior max. sinus, and roots of anterior teeth, and twigs to floor of nasal cavity serving inferior meatus, and adjacent m. membrane
Inferior palpebral brs.

Skin and conjunctiva of the lower eyelid
External nasal brs

Skin about the lateral aspect of the nose
Superior labial brs

Skin and mucous memb. of the upper lip
Mandibular (V3) Division of Trigeminal Nerve
GSA Sensory root Sensory and motor roots join outside the skull (F. ovale) to form a mixed nerve. Some branches are sensory, some motor, whereas some are mixed
From trunk

Dura and mastoid air cells
Recurrent meningeal
From anterior division Buccal

Articular br. to TMJ From: masseteric nerveb
From posterior division Lingual

Joined by chorda tympani (VII) delivering taste fibers (SVA) to ant. 2/3 of tongue, and pre. para to submandibular ganglion (VII) delivers post.para from ganglion to sublingual and minor salivary glands of the floor of the mouth (GVE)

Skin of cheek over buccinator muscle passes through buccinator muscle to serve buccal mucosa and adjacent gingiva. (May communi cate with facial nerve for distribution purposes)


Anterior 2/3 of tongue with GSA and delivers SVA (taste) from facial nerve to taste buds in anterior 2/3 of tongue. Post.para from submandibular ganglion pass directly to submandibular gland. Those destined for sublingual gland and other minor glands reenter the lingual and get distributed to the glands.
Inferior alveolar

Mandibular teeth and supporting tissues via a dental plexus, two terminals—main trunk continues to incisor teeth, other terminal is mental nerve

Skin of chin, lower lip including mucous membrane
Auriculotemporal Otic ganglion (IX) communicates post. para fibers for distribution to the parotid gland (GVE) Distribute superficial temporal nerves over skin of temple. Articular brs. to TMJ secretomotor fibers from otic ganglion to parotid gland
GSA indicates general somatic afferent; GVE, general visceral efferent; TMJ, temporomandibular joint.
a Posterior, middle, and anterior superior alveolar nerves communicate, forming a dental plexus before innervating the teeth.

b The masseteric nerve from the anterior division is a mixed nerve. Its sensory fibers are the articular branches to the TMJ.

Trigeminal Nerve—Motor Components
Trigeminal Nerve—Motor Components
Division of Trigeminal Nerve Modality Nerve Branch Motor to Muscles
Mandibular (V3)


Sensory and motor roots of the trigeminal nerve exit the foramen ovale and then join to form the trunk of the nerve, which then divides into anterior and posterior divisions. Some nerves are sensory, some motor, and some mixed. Only motor components are presented.
From Trunk
Nerve to medial pterygoid Medial pterygoid
Nerve to tensor tympani Tensor tympani
Nerve to tensor veli palatini Tensor veli palatini
From Anterior Division
Deep temporal nerves (anterior and posterior) Temporalis
Lateral pterygoid nerve Lateral pterygoid
Masseteric nerve Masseter
From Posterior Division
Mylohyoid nerve Mylohyoid
Nerve to anterior digastric Anterior diagastric
SVE indicates special visceral efferent.

Examination of cranial nerves....ppt



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