Nervous System Part 2 Flashcards
Located within the sensory root is the
trigeminal ganglion
The largest sensory ganglion in the nervous system
Trigeminal ganglion
The Trigeminal ganglion contains various
peptides and neurotransmitters
Involved in sensory transmission, particularly nociception
Trigeminal ganglion
Nociception
the detection of painful stimuli (pain)
Sensory root of trigeminal nerve divides into what 3 segments anterior to the trigeminal ganglion?
Ophthalmic, maxillary, mandibular
All three segments of the sensory root of the trigeminal nerve pass into the skull through
different fissures or foramina in the sphenoid bone
Ophthalmic nerve passes into the skull through the
superior orbital fissure
Maxillary nerve passes into the skull through the
foramen rotundum
Mandibular nerve passes into the skull through the
foramen ovale
The mandibular nerve of the sensory root of the trigeminal nerve travels and functions with the
motor root of the trigeminal nerve
Ophthalmic nerve provides sensation to the
upper face and scalp
Maxillary nerve provides sensation to the
mid face
Mandibular nerve provides sensation to the
lower face
Motor root of the trigeminal nerve controls
muscles of mastication and muscles in the floor of the mouth
Ophthalmic nerve divides into what three branches?
Frontal nerve
Nasociliary nerve
Lacrimal nerve
Frontal nerve provides sensation to the
forehead and anterior scalp
Nasociliary nerve provides sensation to the
eyelids and sides of the nose
Lacrimal nerve provides sensation to the
upper eyelids, conjunctiva, and lacrimal glands
The ophthalmic nerve Also contains parasympathetic fibers responsible for
production of lacrimal fluid
What is Shingles (herpes zoster)?
Unilateral painful vesicles and/or ulcers which follow the pathway of the involved nerve
_______ is most commonly affected by shingles
The facial area served by the ophthalmic nerve (or ophthalmic division of the trigeminal nerve, V1)
Chickenpox (varicella) is caused by
acute infection with VZV (varicella zoster virus)
Shingles (herpes zoster) is caused by
reactivation of dormant VZV in tissue of cranial nerve V (trigeminal)
Reactivation of VZV causing shingles may be associated with
immunodeficiency
If involving the eyes, shingles can cause
blindness
If involving the skin, shingles may result in
neuralgia (painful area
Vaccines for VZV can prevent both
chickenpox and shingles
Treatment of shingles is
supportive: possibly antivirals such as acyclovir
Maxillary nerve divides into several branches, including:
• Infraorbital nerve
• Zygomatic nerve
• Anterior superior alveolar nerve
• Middle superior alveolar nerve
• Posterior superior alveolar nerve
• Greater palatine nerve
• Lesser palatine nerve
• Nasopalatine nerves
All of the branches of the maxillary nerve begin at the
pterygopalatine ganglion, located within the pterygopalatine fossa
All of the branches of the maxillary nerve begin at the
pterygopalatine ganglion, located within the pterygopalatine fossa
The zygomatic nerve Provides sensation to the
skin of the cheek
skin of the temporal region
The infraorbital nerve passes through the
infraorbital foramen of the maxilla
The infraorbital nerve Provides sensation to the
skin of the cheek, the upper lip, the lateral aspect of the nose, and the ipsilateral upper teeth
The infraorbital foramen of the maxilla is a landmark for the
infraorbital block
An infraorbital block Anesthetizes
the infraorbital nerve as well as both the anterior and middle superior alveolar nerves
The infraorbital nerve travels posteriorly along the ________ and the Anterior superior alveolar nerve branches from the ____
infraorbital canal, infraorbital nerve
The Anterior Superior Alveolar Nerve Provides sensation to the
maxillary central incisors, lateral incisors, and canines
labial periodontium and gingiva associated with these teeth
The ASA nerve runs through the ____ in the teeth, exits the pulp chamber through the
pulp; apical foramina
The ASA nerve is one of three nerves that make up the
superior dental plexus
A network of nerves in the upper iaw that supplies sensation to the upper teeth, gums, and surrounding tissues
superior dental plexus
superior dental plexus is Made up of what three nerves?
• anterior superior alveolar nerve (ASA),
• middle superior alveolar nerve (MSA), and
• posterior superior alveolar nerve
(PSA).
The superior dental plexus nerves descend from the ______and then anastomose to form the plexus
maxillary nerve and infraorbital nerve
The ASA nerve can be anesthetized by:
• Infraorbital block - Anesthetizes the infraorbital nerve as well as both the anterior and middle superior alveolar nerves
• Anterior and middle superior alveolar block -
A palatal injection that anesthetizes the anterior and middle superior alveolar nerves
The ASA nerve can be involved in _____ to the contralateral side in a patient
crossover innervation
Crossover innervation
the overlap of terminal nerve fibers from the contralateral side of the dental arch
The middle superior alveolar nerve provides sensation to the
maxillary premolar teeth and the MB root of the maxillary first molar
buccal periodontium and gingiva associated with these teeth
The MSA nerve runs through the ____ in the teeth, exits the pulp chamber through
pulp; the apical foramina
The MSA nerve is one of three nerves that make up the
superior dental plexus
The middle superior alveolar nerve can be anesthetized by:
• Infraorbital block - Anesthetizes the infraorbital nerve as well as both the anterior and middle superior alveolar nerves
• Anterior and middle superior alveolar block -
A palatal injection that anesthetizes the anterior and middle superior alveolar nerves
The MSA nerve is not always present but present in approximately ____ of the population
28%
The MSA nerve is not always present but present in approximately ____ of the population
28%
If MSA nerve is not present, the area is innervated by both the
ASA and posterior superior alveolar nerves, but mainly by the ASA nerve
If present, there is also communication between the MSA nerve and
both the ASA nerve and posterior superior alveolar nerve
Posterior Superior Alveolar Nerve provides sensation to the
mucous membranes of the maxillary sinus
Provides sensation to the maxillary molars
Provides sensation to buccal periodontium and gingiva associated with these teeth
The PSA nerve runs through the___ in the teeth, exits the pulp chamber through the
pulp; apical foramina
The PSA nerve is one of three nerves that make up the
superior dental plexus
The PSA nerve can be anesthetized by:
Posterior superior alveolar block - Anesthetizes the posterior superior alveolar nerve
Greater palatine nerve Provides sensation to the
posterior hard palate and associated palatal periodontium and gingiva of the ipsilateral maxillary posterior teeth
Greater palatine nerve Passes through the
greater palatine foramen
Lesser palatine nerve Provides sensation to the
soft palate and palatine tonsils
Lesser palatine nerve Passes through the
lesser palatine foramen
The GP nerve can be anesthetized by:
- Greater palatine block - Anesthetizes the greater palatine nerve
- Anterior and middle superior alveolar block - A palatal injection that anesthetizes the anterior and middle superior alveolar nerves as well as the GP nerve
Nasopalatine Nerve Provides sensation to the
anterior hard palate and associated palatal periodontium and gingiva of the ipsilateral maxillary anterior teeth
Provides sensation to the nasal septum
Nasopalatine Nerve Passes through the
sphenopalatine foramen and then the incisive foramen
The NP nerve can be anesthetized by:
- Nasopalatine block - Anesthetizes the nasopalatine nerve
- Anterior and middle superior alveolar block - A palatal injection that anesthetizes the anterior and middle superior alveolar nerves, GP nerve, and NP nerve
Mandibular nerve of the trigeminal nerve has a main trunk that further divides into what two branches?
- In the main trunk (before the split), the branches are:
- Meningeal branches (Afferent)
- Medial ptergoid nerve (Efferent)
What are the two divisions of the mandibular nerve after the split?
Anterior and posterior división
What nerves make up the anterior division of the mandibular nerve?
- Masseteric nerve (Efferent)
- Deep temporal nerves (Efferent)
- Buccal nerve (Afferent)
- Lateral ptergoid nerve (Efferent)
What nerves make up the Posterior division of the mandibular nerve?
- Auriculotemporal nerve (Afferent)
- Lingual nerve (Afferent)
- Inferior alveolar nerve (Efferent and afferent)
Buccal nerve is an ___ nerve
Afferent
Buccal nerve Provides sensation to the
skin of the cheek, buccal mucosa
periodontium and gingiva associated with the mandibular molars
This nerve must not be confused with the buccal branch of the facial nerve
The buccal nerve of the anterior division of the mandibular nerve
The buccal nerve (long buccal nerve) can be anesthetized by:
- Buccal block
- Gow-Gates mandibular block - An injection at the neck of the condyle that anesthetizes almost the entire mandibular division of the trigeminal nerve
The deep temporal nerves Arise from the
motor root of the trimgeminal nerve
The deep temporal nerves are____ nerves
Efferent
How many deep temporal nerves are there?
Usually 2 in number
The deep temporal nerves Provides innervation to the
temporalis muscle
Masseteric Nerve Arises from the
motor root of the trigeminal nerve
The masseteric nerve is an___ nerve
Efferent but has a small sensory branch
Masseteric nerve Provides innervation to the
masseter muscle
A small sensory branch of this nerve goes to the temporomandibular joint
Masseteric nerve
Lateral Pterygoid Nerve Arises from the
motor root of the trimgeminal nerve
The lateral pterygoid nerve is an_____ nerve
Efferent
The lateral pterygoid nerve Provides innervation to the
lateral pterygoid muscle
Auriculotemporal Nerve is an ____nerve
Afferent
Auriculotemporal nerve Provides sensation to
the external ear, scalp, and temporomandibular joint
Lingual Nerve is an ___nerve
Afferent
Lingual Nerve Provides sensation to the
associated lingual periodontium and gingiva of the mandibular teeth, body of the tongue and floor of the mouth
The lingual nerve Contains parasympathetic fibers for the
sublingual and submandibular glands
The lingual nerve can be anesthetized by:
- Inferior alveolar block
Current thought has implicated most of the paresthesia of the mandible after local anesthesia administration with trauma to the
lingual nerve
Inferior Alveolar Nerve is an ____nerve
Afferent
Inferior alveolar nerve Passes through the
mandibular foramen
The inferior alveolar nerve Travels within the
mandibular canal
The inferior alveolar nerve Provides sensation to the
mandibular teeth and associated facial periodontium and gingiva of the mandibular anterior teeth and premolars
Provides sensation to the labial mucosa through its incisive and mental branches
The inferior alveolar nerve Has what three significant branches?
- Mental nerve
- Incisive nerve
- Mylohyoid nerve
The lA nerve is one of three nerves that make up the
inferior dental plexus
Inferior Dental Plexus
A network of nerves in the lower jaw that supplies sensation to the lower teeth, gums, and surrounding tissues
The inferior dental plexus is Made up of what three nerves?
- Inferior alveolar nerve (IA)
- Mental nerve
- Incisive nerve
These plexus of nerves descend from branches of the mandibular nerve
Inferior dental plexus
The lA nerve can be anesthetized by:
Inferior alveolar block
Mental Nerve is an ____nerve
Afferent
The mental nerve Exits the mandible
through the mental foramen
The mental nerve Provides sensation to the
chin, lower lip, labial mucosa
Provides sensation to the associated periodontium and gingiva of the mandibular anterior teeth and premolars
The mental nerve is one of three nerves that make up the
Inferior dental plexus
The mental nerve can be anesthetized by:
Mental block
Incisive Nerve is an ___nerve
Afferent
Incisive nerve Travels within the
Anterior continuation of the mandibular canal
The incisive nerve Provides sensation to
mandibular anterior teeth and premolars
associated periodontium and gingiva of the mandibular anterior teeth and premolars
The incisive nerve is one of three nerves that make up the
inferior dental plexus
The incisive nerve can be anesthetized by:
Incisive block
Has the same landmark as the mental block, which is the opening of the mental foramen but is Technique sensitive, as it requires pressure to direct the anesthetic inside the mental foramen
Incisive block
When preforming an incisive block what should be considered?
Crossover innervation should be considered
Mylohyoid Nerve is an___ nerve
Efferent
Mylohyoid Nerve Provides motor innervation to the
mylohyoid muscle and anterior belly of the digastric muscle
AKA tic douloureux
Trigeminal Neuralgia
Trigeminal Neuralgia
Chronic pain condition that Causes sudden, intense Electrifying, stabbing, sharp, or shooting facial pain lasting for seconds or minutes occuring multiple times per day
Cause of Trigeminal Neuralgia
- No known cause
Trigeminal Neuralgia Affects
right side more often than left side
Trigeminal Neuralgia Involves the
afferent components of the fifth cranial or trigeminal nerve and Usually involves the maxillary or mandibular nerve branches but not the ophthalmic branch
Facial Nerves are_____ nerves.
Efferent and afferent
The Efferent nerves of the facial nerves control
the muscles of facial expression and posterior suprahyoid muscles
The efferent nerves of the facial nerves Also provides parasympathetic innervation to the
lacrimal gland, submandibular salivary gland, and sublingual salivary gland
The Afferent nerves of the facial nerve - serves
a tiny patch of skin behind the ear, and taste sensation with the taste buds of certain lingual papillae from the anterior two-thirds of the tongue
The facial nerve Leaves the cranial cavity by passing through the ___ and exits the skill thru the
internal acoustic meatus; stylomastoid foramen
Facial Nerve Branches into what three segments?
- Facial nerve (Main trunk)
- Chorda tympani
- Greater petrosal nerve
Greater Petrosal Nerve branches from the facial nerve when?
before the facial nerve exits the stylomastoid foramen
The greater petrosal nerve is an ___ nerve
Efferent nerve but carries afferent fibers
The greater petrosal efferent nerves supply parasympathetic innervation to
most of the face’s glands, including the lacrimal, nasopharyngeal, and palatine mucosal glands
The greater petrosal nerve Carries afferent fibers for
general sensation from the nasal mucosa, and taste in the palate
Chorda tympani nerve branches from the facial nerve when?
before the facial nerve exits the stylomastoid foramen
Chorda tympani nerve is an ____nerve
Efferent nerve but carries afferent fibers
The efferent nerves of the chorda tympani nerve Supplies parasympathetic innervation to
the submandibular and sublingual salivary glands
The chorda tympani nerve Carries afferent fibers for
taste for the anterior two-thirds of the tongue
The chorda tympani exits the skull by the
petrotympanic fissure, located posterior to the TMJ
chorda tympani nerve travels with the
lingual nerve along the floor of the mouth
The Posterior Auricular, Stylohyoid, &
Posterior Digastric Nerves Branches from the facial nerve when?
after the facial nerve exits the stylomastoid foramen
The posterior auricular, stylohyoid, and posterior digastric are ___ nerves
Efferent
Posterior auricular nerve supplies the
occipital belly of the epicranial muscle, & some small muscles that move the auricle
Stylohyoid nerve supplies the
stylohyoid muscle
Posterior digastric nerve supplies the
posterior belly of the digastric muscle
Additional efferent nerve branches of the facial nerve originate within the parotid salivary gland and pass to the muscles they innervate. There are what five simple branches?
- Temporal branches
- Zygomatic branches
- Buccal branches
- Mandibular branches
- Cervical branches
Typically The temporal branches supply___
- Muscles anterior to the ear
- Frontal belly of the epicranial muscle
- Superior part of the orbicularis oculi muscle
- Corrugator supercilii muscle
Typically, The zygomatic branches supply:
- Inferior part of the orbicularis oculi muscle
- Zygomaticus major and minor muscles
Typically, The buccal branches supply:
- Muscles of the upper lip
- Nose
- Buccinator
- Risorius
- Orbicularis oris muscles
The zygomatic and buccal branches are usually
closely associated, exchanging many fibers
Typically, The mandibular branch supplies:
- Muscles of the lower lip
- Mentalis muscle
The cervical branch runs inferior to the mandible to supply:
Platysma muscle
Bell’s Palsy Involves
unilateral facial paralysis
Bell’s Palsy Has no known cause, except
that there is a loss of excitability of the involved facial nerve