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Anatomy Module IV > Gross Anatomy of the Trigeminal Nerve > Flashcards

Gross Anatomy of the Trigeminal Nerve Flashcards

1
Q

Trigeminal Nerve portions

A

V1 - Opthalmic nerve
V2 - Maxillary Nerve
V3 - Mandibular Nerve

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2
Q

CN-V emerges from the brain-stem as?

A

a large sensory GSA and a small motor SVE root

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3
Q

resident fobers of Cn-V

A

GSA and SVE

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4
Q

GSA

A

General somatic afferent

- general sensations from the face like pain, temperature, touch, proprioception

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5
Q

SVE

A

special visceral efferent

muscles of the first pharyngeal arch

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6
Q

acquired fibers of CN-V

A

SA -special afferent (taste)
GVE - general visceral efferent - like parasympathetic fibers to smooth muscles - constrictor of the pupil and glands - submandibular gland

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7
Q

Where does CN-V emerge

A

into the posterior cranial fossa –> courses anteriorly to reach the middle cranial fossa

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8
Q

If the trigeminal ganglion is a sensory ganglion - what cells are in it?

A

pseudounipolar neurons

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9
Q

where is the trigeminal ganglion located?

A

in the trigeminal impression/trigeminal cave or meckel’s cave

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10
Q

what emerges from the trigemnial ganglion?

A

V1 V2 and V3

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11
Q

course of V1 and V2

A

pass in the lateral wall of the cavernous sinus to reach the superior orbital fissure –> into orbit and the foramen rotundum –> pterygopalatine fossa, respectively

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12
Q

course of V3

A

takes a more anterior course –> to the foramen ovale –> infratemporal fossa

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13
Q

branches off of the opthlamic nerve (v1)

A

Meningeal branch
Lacrimal nerve
Frontal nerve (Suprs orbital and supra trochlear nerve)
Nasociliary nerve - a lot of branches

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14
Q

meningeal branch (tentorial nerve)

A

sensory branch that emerges from V1 BEFORE it traverses the superior orbital fissure
this is smaller nerve and passing back more posterior

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15
Q

Lacrimal nerve

A

branch from V1

travels along the lateral border of the orbit to reach the lacrimal gland and lateral eye

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16
Q

frontal nerve and branches

A

from V1
within the orbit, the frontal nerve branches into the supraorbital and supratrochlear nerves
- both of these branches will course anteriorly through the orbit and emerge superior to the eye along with same named arteries

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17
Q

Nasociliary nerve

origin and course

A

from v1 - opthalmic nerve

travels deep/inferior to the lacrimal and frontal nerves

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18
Q

branches of the nasociliary nerve

A 
Sensory root --> CILIARY GANGLION--> short ciliary nerves
long ciliary nerves
Posterior ethmoidal nerve
Anterior ethmoidal nerve
Infratrochlear nerve
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19
Q

where is the location of the trigenminal ganglion?

A

middle temporal fossa

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20
Q

what fibers do the ciliary ganglion receive? general

A

sensory root
parasympathetic root
sympathetic root

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21
Q

where do the preganglionic parasympathetic fibers that reach the ciliary ganglion come from - be specific

A

these are PREGNAGLIONIC FIBERS that originate in the Edinger-Westphal nucleus. These fibers travel with CN III to the ciliary ganglion and WITHIN THE CG THEY SNAPASE W? PARASYMPATHETIC GANGLION CELLS
now the ganglion is where we have post ganglionic cell bodies (pre synapsing)

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22
Q

postganglionic parasympathetic fibers of the Ciliary ganlgion

A

these leave the CG via SHORT CILIARY NERVES and enter the globe and provide innervation to the constrictor of the pupil and ciliary muscle

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23
Q

what synapses and does not synapse in ciliary ganglion

A

sensory (GSA) from V1 and POSTGANGLIONIC sympathetic (GVE) do NOT synapse – parasympathetic fibers from EDW (from CN III) synapse here

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24
Q

Branches of the maxillary nerve (v2) prior to traversing the foramen rotundum

A

Meningeal branch - nervous meningeus medius

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25
Q

Branches of V2 in the prerygopalatine fossa (PPF)

A

Zygomatic nerve and branches

Communicating branch (2) with pterygopalatine ganglion (more to this

Posterior superior alveolar nerve

Infraorbital nerve - CONTINUATION OF THE MAXILLARY NERVE - plus its branches

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26
Q

Zygomatic Nerve

A

enters the orbit via the inferior orbital fissure and gives rise to the zygomaticofacial and zygomaticotemporal nerves which then leave the orbit through the same named formamen

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27
Q

what does the zygomaticotemporal nerve do?

A

gives off COMMUNICATING BRANCH to the lacrimal nerve of V1 - so we now have communication between V1 and V2

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28
Q

Communicating roots to PPG

A

aka pterygopalatine nerves
suspend the PPG in the PPF
primary GSA fibers
THESE PASS THROUGH THE PPG WITHOUT INTERRUPTION (NO SYNAPSE) and give off many branches

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29
Q

GSA fibers pass through PPG without interruption and the communicating roots to PPG give off what nerves

A 
orbital branches 
Nasopalatine nerve 
medial posterior superior nasal nerve
lateral posterior superior nasal nerve
greater palatine nerve
lesser palatine nerve
pharyngeal nerve

group to orbit
3 to the nasal cavity
2 to palatine
1 to pharynx (nasopharynx)

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30
Q

orbital branches from PPG

A

traverse the inferior orbital fissure to reach the orbit

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31
Q

nerves from PPG that go to the nasal cavity

names and what they go through

A

Nasopalatine
medial posterior superior nasal
lateral posterior superior nasal
go through the sphenopalatine foramen to enter the nasal cavity

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32
Q

pharyngeal nerve

A

off of the PPG and descend through the palatovaginal canal to reach the nasopharynx

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33
Q

nerves from the PPG that go to the palate

A

Greater and lesser palatine nerves

go through the palatine(greater) canal to reach the hard and soft palate

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34
Q

pterygoid canal and contribution

A

NERVE of the PTERYGOID CANAL - which includes GVE and SA fibers from CN VII will course through the pterygoid canal (housing this nerve) to reach the PPG

CNVII contributing fibers to the PPG via this canal and nerve

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35
Q

posterior superior aveolar nerve

A

from the maxillary nerve just before it enters the inferior orbital fissure
- this leaves teh PPF through the pterygomaxillary fissure and enters the maxilla via the alveolar foramen/foramina

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36
Q

infraorbital nerve

A

CONTINUATION OF THE MAXILLARY NERVE -name change once it enters the orbit
nerve then courses through the infraorbital groove and canal before emerging on the face via the infraorbital foramen

37
Q

branches from the infraorbital nerve

A

middle superior alveolar nerve
anterior superior alveolar nerve
supplying maxillary teeth (with the posterior superior alveolar nerve from the maxillary nerve)

38
Q

how does the infraorbital nerve terminate? What are their distributions

A

as palpebral–> skin of lower eyelid, nasal–>lateral nose, anterior or nasal septum, and labial branches–> skin of cheeck and upper lip, labial mucosa, and labial/vestibular gingival tissue

39
Q

superior dental plexus

A

formed by the nerves that carry sensory information from the MAXILLARY TEETH AND ADJACENT GINGIVAL TISSUE
posterior superior alveolar nerve (from maxillary nerve)
middle superior alveolar nerve
anterior superior alveolar nerve
middle and anterior are from the infraorbital nerve

40
Q

middle superior alveolar nerve

A

part of the superior dental plexus
- this is inconsistent and if absent the area this supplies will be filled in either by the anterior superior alveolar nerve or the posterior superior alveolar nerve

41
Q

innervation of the tooth via the dental plexus

A

dental pulp is innervated by A-delta and C fibers from CN V (GSA) as well as postganglionic sympathetic fibers from the superior cervical ganglion (GVE)

42
Q

A delta fibers and C-fibers in dental tooth plexus

A

enter the root canal along with blood vessels and ramify a plexus
NERVE FIBERS MAY CONTINUE INTO THE ODONTOBLAST LAYER, AND ENTER THE DENTINAL TUBULES - one of the theories of pain as nerves can continue into the dentinal tubule and direct stimulation can cause pain

43
Q

Theories of pain in the teeth

A
  1. DIRECT stimulation of nerve fibers in the dentin
  2. Odontoblasts as a mediator between the stimuli and the nerve fibers
  3. Hydrodynamic theory - fluid movement causes the pain in a closed area
44
Q

clinical correlation with a posterior superior alveolar nerve block

A

close to the orbit
could have some paralysis to nerves that supply the eye/orbit
double vision
temporary blindness if reach fibers of CN II

45
Q

Distribution of the posterior superior alveolar nerve

A

supplies the maxillary molars

EXCEPT THE MESIAL BUCCAL ROOTS

46
Q

DISTRIBUTION of the middle superior alveolar nerve

A

mesial buccal roots of the first maxillary molar and the pre molars
maxillary sinus

47
Q

distribution of the anterior superior alveolar nerve

A

the incisors and canines
- each also doing the buccal gingival tissue adjacent maxillary sinus

anterior also does the labial gingival tissue, lower lateral nasal wall and floor

48
Q

distribution of the nasopalatine nerve

A

portion of the nasal septum, anterior hard palate and adjacent lingual gingival tissue of the maxillary incisors and canines

49
Q

how does the lacrimal gland get parasympathetic innervation?

A

synapse in the PPG (ganglion) from the greater petrosal nerve –> nerve of the pterygoid palatine canal from CN VII and synapse here – then have post ganglionic fibers leaving the ganglion - distributed GVE fibers nowwithin V2 branches

50
Q

GVE parasympathetic fibers of maxillary nerve distribution

A

maxillary sinus, nasal, palatine glands via the branches of V2

51
Q

acquired GVE sympathetic fibers of V2

origin and distribution

A

Deep petrosal Nerve–> Nerve of the pterygoid canal –> and distibuted fibers to maxillary sinus, nasal, paltine glands via branches of V2
-cell bodies in the superior cervical ganglion

52
Q

where is the cell body of the postganglionic sympathetic fibers

A

in the superior cervical ganglion

thus there is NO synapse in the PPG of these fibers - pass uninterupted to their respective V2 branches

53
Q

SA fibers acquired in V2

origin and distribution

A

from nerve of the pterygoid canal in the pterygoid canal from CN VII and pass into the lesser palatine nerve - going to taste in soft palate
NO SYNAPSE IN THE GANGLION

54
Q

zygomaticotemporal distribution

A

skin of the temporal area

55
Q

zygomaticofacial distribution

A

skin over the zygomatic arch

56
Q

orbital branches distribution

A

sphenoid sinus, post ethmoidal air cells, orbital periosteum

57
Q

greater palatine distribution

A

hard palate and adjacent lingual gingival tissue - adjacent the maxillary pre molars and molars

58
Q

summary of innervation of gingiva and tooth pulp

A

look at notes and picture drawn

know the gingiva and teeth

59
Q

Immediate Branches of V3 - mandibular nerve

A 
Meningeal branch (nervus spinosus)
Nerve to the medial pterygoid
60
Q

Nerve to the medial pterygoid distribution

A 
Carries motor (SVE) and proprioceptive fibers (GSA) 
motor to medial pterygoid muscle, tensor veli palatini muscle, and tensor tympani muscle
61
Q

Nervous spinosus

A

a recurrent meningeal branch which re-enters the cranial cavity via the foramen spinosum (travels with the middle meningeal artery) and carries GSA from the meninges of the anterior and middle cranial fossae

62
Q

anterior division branches of V3

A

nerve to the lateral pterygoid
deep temporal nerves 2 (anterior and posterior)
masseteric nerve
Long buccal nerve (buccal nerve of V3)

63
Q

Posterior Division of V3

A

Auricolotemporal nerve
Lingual nerve
Inferior alveolar nerve

64
Q

location of the otic ganglion

A

infratemporal fossa

65
Q

location of the submandibular ganglion

A

floor of oral cavity

66
Q

lingual nerve of posterior division

A

receives chorda tympani (VII) and has communicating fibers with the submandibular ganglion

67
Q

inferior alveolar nerve branches

A

nerve to mylohyoid

terminates as the mental nerve and incisive nerve

68
Q

space medial to the mandible

A

infratemporal fossa

69
Q

T/F the long buccal nerve does not supply the buccinator muscle

A

TRUE - it pierces it but it is not supplying it - it supplies the buccal mucosa and the gingival tissue adjacent to mandibular molars

70
Q

Inferior alveolar nerve block - important to anesthetize?

A

important you also numb the long buccal nerve as this is supplying the buccal mucosa and also the buccal gingival tissue adjacent to the mandibular molars

71
Q

long buccal nerve distribution

A

GSA - proprioception of skin of cheek, buccal mucosa, buccal gingival tissue adjacent to mandibular molars

72
Q

lingual nerve distribution

A

GSA - proprioception to anterior 2/3 of tongue, floor of oral cavity, mandibular lingual gingival tissue

73
Q

inferior alveolar nerve travels? distribution

A

in the mandibular canal and then enters the mandibular foramen – then GSA fibers for mandibular molars and 2nd pre molar, with few gingival branches

74
Q

Mental nerve distribution

A

skin of chin and lower lip, labial mucosa, labial gingival tissue adjacent to premolars, canine and incisors
will go through the mental foramen

75
Q

insicive nerve distribution

A

1st mandibular premolar, canine, and incisors

76
Q

location of mental foramen

A

inferior to 2nd premolar

77
Q

T/F the distribution of the long buccal nerve would not be anesthetized with an inferior alveolar nerve block

A

TRUE - long buccal nerve is supplying buccal gingiva of the mandibular molars

78
Q

V3 is the only part of CN V that includes what type of resident fibers

A

SVE - going to muscles of mastication from the first pharyngeal arch

79
Q

Parasympathetic acquired fibers for V3 - general

A

from lesser petrosal nerve (CN IX) and chorda tympani from (CN VII)

80
Q

Course of lesser petrosal nerve (from CN IX) and its contributions

A

supplies GVE fibers for V3
Comes through foramen ovale –> to otic ganglion (synapse) and post ganglionic parasympathetic fibers join with the auriculotemporal nerve and supply GVE to the Parotid gland

81
Q

Course of chorda tympani nerve (from CN VII) and its contributions

A

Fibers from chorda tympani from CN VII enter the lingual nerve
will go to the submandibular ganglion and SYNAPSE and supply the submandibular gland and some fibers go back into lingual nerve (stay here) and pass to the sublingual gland and glands of oral cavity

82
Q

Sympathetic GVE fibers of V3

A

V3 acquires sympathetic GVE fibers from external carotid artery and its plexus to reach the partoid gland - more come from this than the auriculotemporal nerve that receives GVE vis the middle meningeal artery (more from ECA) and also facialartery contributign to GVE in the submandiular and sublingual glands
- will pass through the submandibular ganglion WITHOUT SYNAPSING

83
Q

lesion of CN VII as it leaves brainste? what does this do for taste

A

you would lose taste to the anterior 2/3 of the tongue - because these fibers supply the SA fibers to the lingual nerve of V3 that is doing taste for anterior 2/3
WOULD NOT LOSE GENERAL SENSATION - GSA FIBERS TO THE TONGUE BECAUSE THIS IS FROM CN V

84
Q

lesion to the lingual nerve WITHIN oral cavity

A

would still lose taste to the anterior 2/3 of the tongue - carrying the SA fibers from the chorda tympani of CN VII
AND GENERAL SENSATION - GSA FIBERS

85
Q

lesion of CN V at the brainstem

A

patient can still taste - but loss of general sensation due to no GSA fibers
SA fibers are through CN VII - so can still taste

86
Q

lesion to lingual once the lingual nerve has sa fibers

A

loss of taste
loss of general sensation
decrease of saliva production becuase lingual going to submandibular and sublingual

87
Q

sympathetic GVE fibers associated with v3

A

acquired
most fibers reach the parotid gland via the external carotid artery and its branches, - few via the auriculotemporal nerve
- some that go to parotid are also from the middle meningeal artery

facial artery is contributing to the sublingual and submandibular sympathetic innervation

88
Q

general rule with sympathetic fibers

A

GVE SYMPATHETIC - all those come from the superior cervical ganglion and TRAVEL ALONG SOME BLOOD VESSEL TO GET TO THEIR TARGET
PASSING TO THE REGION OF GLANDS

89
Q

where are the taste fibers sacquired

A

in the infratemporal fossa

Anatomy Module IV (12 decks)

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