Cranial Nerve V Flashcards

1
Q

Describe the course of the trigeminal nerve from origin to its three divisions.

A

pons-> large sensory (great sensory nerve of the face) and small motor roots -> trigeminal (Meckel’s) cave in dura mater ->creates trigeminal (semilunar, Gasserian) ganglion which has the sensory cell bodies -> creates three divisions

  1. ophthalamic (sensory)
  2. maxillary (sensory)
  3. Mandibular (sensory + motor)
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2
Q

What kind of fibers does V have?

A

general sensory

branchial motor/special visceral

does NOT have parasymp fibers but CN III, VII, IX use it as a carrier

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3
Q

How do the three branches exit the skull?

A
  1. ophthalamic - superior orbital fissure
  2. maxillary - foramen rotundum
  3. mandibular - foramen ovale
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4
Q

What does the ophthalamic branch divide into?

A
  1. frontal
  2. lacrimal
  3. nasociliary
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5
Q
  1. What does the frontal branch come from?
  2. what does it branch into?
  3. what does it supply?
A

from ophthalamic branch (V1)

divides to:

  1. supratrochlear branch (medial)
  2. supraorbital branch (lateral, goes through supraorbital foramen)

sensory of eye muscles, scalp, and upper eyelid

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6
Q

What does the lacrimal branch come from? What does it do? What hitchhikes on it?

A

from ophthalamic branch (V1)

sensory to lacrimal gland and upper eyelid.

postganglionic parasympathetic fibers from the pterygopalatine ganglion through the zygomatic branch of maxillary nerve (V2)

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7
Q

What does the nasociliary branch come from? What does it branch to and what do they do?

A

from ophthalamic branch (V1)

  1. long ciliary (sensory to eyeball/cornea)
  2. posterior ethmodial (sensory to sphenoidal air sinuses and posterior ethmoidal air cells)
  3. anterior ethmodial (sensory to middle and ant ethmoidal air cells, meninges, nasal septum, inside nose and lower nose)
  4. infratrochlear (sensory to side of nose and medial upper eyelid) sensory root of the ciliary ganglion
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8
Q

Trace the posterior and anterior ethmoidal nerves.

A

Posterior ethmoidal: Enters the posterior ethmoidal foramen, sends sensory fibers to the sphenoidal air sinuses and the posterior ethmoidal air cells.

Anterior ethmoidal (Larger)

  • Enters anterior ethmoidal foramen
  • sends sensory fibers to the middle and anterior ethmoidal air cells.
  • enters the cranial cavity at the side of the cribriform plate of the ethmoid and sends sensory fibers to the meninges.
  • enters nasal cavity through the nasal slit; gives off sensory fibers to anterior part of the nasal septum and anterior parts of the lateral walls.
  • leaves the nasal cavity as the external nasal branch, which supplies the skin of the lower half of the nose
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9
Q
  1. How does the maxillary division leave the skull and where does it end up?
  2. When there, what does in exchange fibers with?
  3. Where does it go then?
A
  1. goes from cavernous sinus. through the foramen rotundum to enter the pterygopalatine fossa
  2. (a) pterygopalatine ganglion (postg. parasym) (b) greater petrosal nerve (taste, preg. parasym from VII) (c) deep petrosal nerve (postg. sym from internal carotid plexus)
  3. proceeds through the inferior orbital fissure to the floor of the orbit becoming the infraorbital nerve. It passes along the infraorbital groove, canal, and foramen, and finally emerges on the face
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10
Q

In the ________, fibers get exchanged between 4 nerves/ganglion. They are, and they contribute these types of fibers.

A

pterygopalatine fossa

  1. maxillary branch (V3) - general sensory
  2. pterygopalatine ganglion - postg. parasym; after synapse with VII
  3. greater petrosal nerve - taste from VII (also preg. parasym but not mentioned in any branches)
  4. deep petrosal nerve - postg. sym. from internal carotid plexus 3 and 4 are nerves of the pterygoid canal
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11
Q

What are the branches of the maxillary nerve arising from the pterygopalatine ganglia? What types of fibers do they have?

A
  1. greater and lesser palatine (ALL types)
  2. posterior nasal branches and nasopalatine nerves (ALL except taste)
  3. pharyngeal branches (ALL except taste)
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12
Q

What are the branches of the maxillary nerve arising from the main trunk? What fiber types do they have?

A
  1. orbital (ALL except taste)
  2. zygomatic (ALL except taste)
  3. superior alveolar nerves (post, middle, ant) (ALL except taste)
  4. infraorbital nerve (no taste., no parasym)
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13
Q

Describe the course and innervation of the pterygopalatine ganglia maxillary nerve branches.

A
  1. greater and lesser palatine: descend through palatine canal and emerge via greater/lesser palatine foramen to reach palates of mouth
  2. posterior nasal/nasopalatine: pass into nasal cavity via sphenopalatine foramen to supply nasal septum and cavity
  3. pharyngeal branches: supplies mucus and glands of nasopharynx
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14
Q

Describe the course and innervation of the main branch maxillary nerve branches.

A
  1. orbital: passes through inferior orbital fissure to supply orbital wall and paranasal sinuses
  2. zygomatic: splits to zygomaticofacial and zygomaticotemporal; some of its postg. parasym fibers hitchhike on lacrimal nerve of V1
  3. superior alveolar nerves (post, middle, ant): supply maxillary sinus and top teeth, thus referred pain
  4. infraorbital: lower eyelid, side of nose, upper lip, front of cheek, nasal vestibule
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15
Q

What type of fibers is the mandibular division? What is its course?

A

general sensory (mostly) and branchial motor

Leaves the skull through the foramen ovale and enters the infratemporal fossa where it is connected to the otic ganglion (auriculotemporal nerve).

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16
Q

What do the motor branches of the trigeminal nerve supply? What divisions are they from?

A
  1. muscles of mastication
  2. mylohyoid and ant. belly of digastric
  3. tensor of the palate
  4. tensor tympani

ALL FROM MANDIBULAR DIVISION

17
Q

What are the branches of the mandibular division?

A

(from main trunk)

  1. meningeal branch (nervus spinosus)
  2. medial pterygoid nerve

(from anterior division)

  1. masseteric nerve
  2. deep temporal nerves (ant, post)
  3. lateral pterygoid nerve
  4. long buccal nerve

(from posterior division)

  1. auriculotemporal nerve
  2. inferior aveolar nerve
  3. lingual nerve
18
Q

Describe the branches off the main trunk of the mandibular division.

A

Meningeal branch (nervus spinosus)

  • Enters the skull through the foramen spinosum with the middle meningeal artery.
  • Supplies the dura of the middle cranial fossa and the mastoid air cells.

Medial pterygoid nerve

  • Enters the deep surface of the medial pterygoid muscle and supplies it.
  • Gives off Nerve to the tensor tympani and Nerve to the tensor of the palate
19
Q

Describe the anterior division of branches from the mandibular division.

A

Masseteric nerve

  • Passes through the mandibular notch to supply the masseter muscle
  • Gives a sensory twig to the temporomandibular joint

Deep temporal nerves (anterior and posterior)

  • Supply the temporalis muscle
  • Gives a sensory twig to the temporomandibular joint

Lateral pterygoid nerve

  • Supplies the lateral pterygoid muscle Long buccal nerve
  • Passes laterally between the two heads of the lateral pterygoid muscle
  • Descends over the buccinator muscle
  • Only sensory of the anterior division: Supplies the mucous membrane of the cheek and gums (molar area) and the skin of the overlying cheek.
20
Q

Describe the auriculotemporal nerve.

A
  • branch of the posterior mandibular
  • splits around the middle meningeal artery, reforms and runs through the parotid gland to be distributed to the external ear and scalp over the temporal region.
  • While in the substance of the parotid gland it delivers postganglionic parasympathetic fibers it received from the otic ganglion.
  • branches include temporomandibular joint, parotid gland, and others
21
Q

Describe the parasympathetic pathway from CN XI to the parotid gland.

A

CN IX (glossopharyngeal) -> tympanic branch -> lesser petrosal nerve -> (lesser petrosal hiatus, foramen ovale) -> syapse on otic ganglion -> hitchhike on auriculotemporal nerve -> parotid gland

22
Q

Describe the inferior alveolar nerve.

A

branch off of posterior mandibular division.

Three branches:

  1. mylohyoid branch (mylohyoid and ant. belly of gastric) then enters mandibular foramen
  2. mental nerve (lower lip/chin, gums, teeth)
  3. incisive nerve (lower canine, incisor teeth)
23
Q

Describe the lingual nerve.

A

branch off of posterior division of mandibular nerve.

  • supplies anterior 2/3 of the tongue, lingula gums, and floor of the mouth
  • joined by chorda tympani (VII) which has taste fibers and preg. parasym.
  • can be damaged during extraction of third molar tooth b/c runs close
  • also closely related to submandibular duct
24
Q

Describe the parasympathetic fibers on the lingual nerve.

A

chorda tympani

  • Leaves the facial nerve while it runs through the facial canal
  • it runs along the lateral wall of the tympanic cavity and emerges through the petrotympanic fissure to hitchhike on the lingual nerve.
  • departs in the region of the submandibular ganglion.
  • They synapse in the submandibular ganglion,
  • Postganglionic parasympathetic fibers either proceed to the submandibular gland or join the lingual nerve via communicating branches to end in the sublingual and lingual salivary glands.
25
Q

Describe lesion of the trigeminal nerve.

A

Loss of facial sensation and deviation of the jaw toward the side of the lesion due to weakness of the muscles of mastication. Trigeminal neuralgia (tic douloureau) is a common occurrence. This may involve the entire nerve or divisions only. Trigeminal neuralgia most commonly effects the maxillary division. Pain may be referred from one branch of the trigeminal to another. For example, pain from an infected tooth may be referred to the ear and temporomandibular joint.

26
Q

Draw V1

A
27
Q

Draw V2

A
28
Q

Draw V3

A