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Anat Exam 4: The PNS > PNS3 > Flashcards

PNS3 Flashcards

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1
Q

What 2 Functional Components (nerve fiber types) does the Trigeminal Nerve, CN V, contain?

A
  1. GSA

2. SVE

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2
Q

CN V Afferents mediate general sensation in what 7 areas?

A
  1. Skin of the face and anterior scalp
  2. Oral, nasal & paranasal mucosa (including lingual and body mucosa)
  3. Most Dura
  4. Cornea and Conjunctiva
  5. Teeth & Gingiva
  6. Nasopharyngeal mucosa
  7. PROPRIOCEPTION from 1st arch muscles & TMJ
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3
Q

CN V emerges from the lateral aspect of the Midpons as a large Sensory Root (GSA) and a smaller Motor Root (SVE). What cranial fossa is this in?

A

The POSTERIOR CRANIAL FOSSA.

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4
Q

The SVE fibers of the trigeminal nerve are limited to which branch? Which of the 3 branches contain GSA fibers?

A

The MANDIBULAR DIVISION of CN V = V3 is the ONLY division to contain SVE fibers. ALL divisions of CN V contain GSA fibers.

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5
Q

The SVE fibers from CN V are BRANCHIAL Motor Nerves or BRANCHIAL EFFERENTS. What muscle group do they innervate?

A

The Branchial Efferent fibers of V3 innervate the 8 muscles derived from the 1st pharyngeal arch.

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6
Q

What is the Sensory Ganglion that ALL GSA & SVE fibers return to before being sorted and projected to brainstem nuclei?

A

The TRIGEMINAL GANGLION

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7
Q 
After exiting the Trigeminal Ganglion GSA fibers from all 3 divisions project to 3 main Sensory (brainstem) Nuclei.
1. Mesencephalic Nucleus
2. Pontine Trigeminal Nucleus
3. Spinal Trigeminal Tract & Nucleus
What is the purpose of each?
A
  1. Mesencephalic Nucleus: Proprioception
  2. Pontine Trigeminal (Principal Sensory) Nucleus: Touch sensation from the face
  3. Spinal Trigeminal Tract & Nucleus: Pain & temperature.
    - Note: Spinal Trigeminal also receives GSA inputs from CN VII, IX, X.
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8
Q

What are the 3 Sensory Nuclei that CN V sends GSA fibers to?

A
  1. Mesencephalic Nucleus
  2. Pontine Trigeminal (principal sensory) Nucleus
  3. Spinal Trigeminal Tract & Nucleus
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9
Q

SVE fibers of CN V arise from what Nucleus before traveling to the Trigeminal Ganglion? What part of the pons is this nucleus located in? Note: it is the same location as CN V itself.

A

SVE fibers arise from the MOTOR or MASTICATOR NUCLEUS in the TEGMENTUM of the PONS.
Note: Both names describe actions of the SVE fibers. Motor b/c SVE fibers are motor neurons that cause muscle contraction. Masticator b/c SVE fibers innervate the masticatory muscles associated with V3

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10
Q

Of the 3 sensory nuclei associated with CN V, mesencephalic, pontine trigeminal, and spinal trigeminal nuclei, which contains PRIMARY Sensory Neurons (directly receive inputs from the CN V subdivision) and which 2 contain Secondary Neurons (that receive inputs from primary neurons in the TRIGEMINAL GANGLION)?

A
  • PRIMARY Neurons = MESENCEPHALON (proprioception)

- SECONDARY Neurons = Pontine & Spinal Trigeminal Nuclei.

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11
Q

The trigeminal ganglion sits in the Trigeminal Impression on the floor of the Middle Cranial Fossa in what Dural ‘cave?’

A

MECKEL’S CAVE

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12
Q

How do each of the 3 CN V divisions exit the skull? To where?

A

V1 - Opthalmic division - exits via the Superior Orbital Fissure to the ORBIT
V2 - Maxillary Division - Exits via the Foramen Rotundum to the PTERYGOPALATINE FOSSA
V3 - Mandibular Division - Exits via the Foramen Ovale to the INFRATEMPORAL FOSSA

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13
Q

Like CN III, CN IV, & CN VI what two CN V divisions pass through the Cavernous Sinus en route to leaving the middle cranial fossa? What is a danger to this?

A
  • V1 (Opthalmic) & V2 (Maxillary) divisions pass through the cavernous sinus.
  • This makes them vulnerable to compression.
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14
Q

Not all fibers of V1, V2, & V3 leave the skull. All 3 divisions contribute MENINGEAL BRANCHES. What do these branches do?

A

The CN V Meningial Branches innervate DURA of the Anterior and Middle Cranial Fossa as well as the FALX CEREBRI and TENTORIUM CEREBELLI.

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15
Q

The Mandibular Nerve (V3) DERMATOME cover the majority of the skin overlying the mandible and the temporal bones. However, the skin overlying the angle of the mandible is innervated cutaneus branches from another source. What? What is a possible side affect, involving referred pain, of this innervation?

A
  1. The skin overlying the mandible is innervated by Cutaneus branches of the CERVICAL PLEXUS.
  2. Certain people may experienced Referred Pain in here. This is an indication of a Heart Attack (MI).
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16
Q

What are the 5 major Cutaneous branches of the Opthalmic division of the Trigeminal Nerve (V1)?

A
  1. Supraorbital N.
  2. Supratrochlear N.
  3. Palpebral Branch of Lacrimal N.
  4. Infratrochlear N.
  5. External Nasal Branch of Anterior Ethmoid
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17
Q

What are the 3 major Cutaneous branches of the Maxillary division of the Trigeminal Nerve (V2)?

A
  1. Infraorbital N.
  2. Zygomaticofacial N.
  3. Zygomaticotemporal N.
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18
Q

What are the 3 major Cutaneous branches of the Mandibular division of the Trigeminal Nerve (V3)?

A
  1. Mental N.
  2. Buccal N.
  3. Auriculotemporal N.
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19
Q

What 4 Ganglia of the head are all suspended from branches of CN V & all send postganglionic fibers via terminal branches of the nerve to reach their targets?

A

The 4 PARASYMPATHETIC GANGLIA of the head all ‘piggyback’ with the Trigeminal Nerve to reach their destinations.

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20
Q

V1 has three main branches in the orbit. What is a useful pneumonic to help remember them? What are they?

A

NFL

  1. Nasociliary N.
  2. Frontal N.
  3. Lacrimal N.
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21
Q

The Nasociliary nerve has two branches; one that goes to the nose and one that stays in they orbit. What is the orbital branch called and what does it do?

A

The orbital branch is called the LONG CILIARY NERVES and have CILIARY GANGLION.
-These nerve branches convey sensation from the CORNEA (Very Sensitive). It is the Afferent Limb of the Corneal Reflex (V1-V2)

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22
Q

What are the 2 branches of the FRONTAL Nerve? Describe each briefly.

A
  1. SUPRAORBITAL N. Innervates forehead & scalp skin & the Frontal Sinus (couple minor branches)
  2. SUPRATROCHLEAR N. Innervates Conjuctiva (membrane that covers the white of eye & lines inner surface of lids), Upper Lid, skin of Forehead & Lateral Nose.
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23
Q

What is the purpose of the INFRATROCHLEAR N.? Note: A branch of the Nasociliary N. The Nasociliary N. enters the orbit through the annular tendon.

A

Infratrochlear N. innervates the lacrimal sac and related structures. Also lateral nose.

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24
Q

What are the 2 branches of the Nasociliary N. that innervate the nasal cavity?

A

ANTERIOR & POSTERIOR ETHMOIDAL NERVES

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25
Q

The V2, Maxillary Nerve, exits the skull through the Foramen Rotundum into what Fossa where it branches Extensively?

A

PTERYGOPALLATINE FOSSA.

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26
Q

V2 divides into what 4 main branches?

A
  1. INFRAORBITAL
  2. ZYGOMATIC
  3. SUPERIOR ALVEOLAR Nerves
27
Q

The Infraorbital and Zygomatic branches of V2 each divide into what 3 further branches?

A 
Infraorbital
1. INFERIOR PALPEBRAL
2. NASAL
3. SUPERIOR LABIAL
Zygomatic
1. ZYGOMATICOTEMPORAL
2. ZYGOMATICOORBITAL
3. ZYGOMATICOFACIAL
28
Q

Superior alveolar nerves form what plexus before giving rise to the Dental branches, which supply the maxillary teeth and roots, and Gingival branches?

A

The Superior Dental Plexus

29
Q

Infection and swelling of the hard-to-drain Maxillary Sinus may cause Referred Pain to be felt where? Why?

A

A maxillary sinus infection may result in referred pain felt in the Maxillary Teeth b/c the Superior Alveolar Nerve may be compressed, causing a sensation of pain w/in the teeth.

30
Q

What ganglion gives rise to POSTGANGLIONIC SYMPATHETICS that are distributed by V2?

A

The PTERYGOPALATINE GANGLION.

-Note: should be easy to remember. Just think about where V2 exits the skull…the PTERYGOPALATINE FOSSA!

31
Q

The Pterygopalatine ganglia receives PREganglionic sympathetics from what CN?

A

The GREATER PETROSAL NERVE of CN VII

32
Q

Both V1 & V2 innervate the Nasal Cavity. Give the important nerves from each and describe how their origination sites differ.

A

V1: Ethmoidal Nerves. Enter from the orbit and innervate the anterior lateral and medial walls of the nose.
V2: Enters from the Pterygopalatine Fossa and innervates the posterior of the nasal cavity.
1. Nasopalatine nerve: Innervates medial wall of nose and joins Greater Palatine nerve in incisive foramen.
2. Posterior Superior Lateral nasal branch of the MAXILLARY Nerve innervates upper lateral wall
3. Posterior Inferior Lateral nasal branch of Greater Palatine Nerve innervates lower lateral wall

33
Q

Where does the Nasopalatine nerve terminate?

A

INCISIVE CANAL of the hard palate.

34
Q

What V2 nerves innervate the hard and soft palate?

A

GREATER PALATINE NERVE = Hard Palate

LESSER PALATINE NERVE = Soft Palate

35
Q

What are the primary nerves that must be anesthetized before dental procedures?

A

Posterior, Middle, and Anterior SUPERIOR ALVEOLAR NERVES

36
Q

At what site is an injection administered to anesthetize the Posterior Superior Alveolar Nerves? What teeth will be numb following this injection?

A
  • Anesthetic will be administered by piercing the mucobuccal fold at M2 with the needle that is then advanced superoposteriorly to the injection site above the roots of M3.
  • This will result in the numbing of M3, M2, & the distal half of M1.
37
Q

At what site is an injection administered to anesthetize the Middle Superior Alveolar Nerves? What teeth will be numb following this injection?

A
  • Anesthetic is injected above the root tips of the 1st Maxillary Premolar.
  • Causes numbness in the 2 premolars and the mesial half of M1.
38
Q

Why is M1 a difficult tooth to anesthetize?

A

B/c it has dual innervation from both the Posterior and Middle superior alveolar nerves.

39
Q

At what site is an injection administered to anesthetize the Anterior Superior Alveolar Nerves? What teeth will be numb following this injection?

A
  • Anesthetic may be infiltrated in the Canine Fossa above the root tip of the Maxillary Canine.
  • The lateral incisor and the canine will be numb. The central incisor is also usually numb as well BUT may also be innervated by Anterior Sup Alveolar Nerve on the Opposite side so may have to numb both.
40
Q

Why are central incisors difficult teeth to anesthetize?

A

May be Dually innervated by Left & Right Anterior Superior Alveolar nerves.

41
Q

If it will be necessary to anesthetize the Mucosa of the Anterior Hard Palate what nerve must be anesthetized? How?

A

The NASOPALATINE NERVE must be anesthetized to numb the anterior hard palate. The anesthetic is injected into the INCISIVE FORAMEN on either side of the INCISIVE PAPILLA.

42
Q

Inadvertent penetration of either the Posterior Superior Alveolar Vessels or the Pterygoid Venous Plexus may result in what?

A

A HEMATOMA.

43
Q

Why would you anesthetize the Greater Palatine Nerve? How?

A

Necessary for anesthetizing Mucosa of the Posterior Hard Palate. Done by injection at an imaginary line halfway b/t the mid plate raphe and the free gingival edge.

44
Q

While a full Maxillary Nerve BLOCK is very rare, how would you do it if necessary?

A

Stick a long needle up through the Greater Palatine Foramen and Canal into the PTERYGOPALATINE FOSSA.

45
Q

What is the only division of CN V that contains Branchial Motor Fibers (SVE fibers)?

A

V3 - The mandibular branch

46
Q

SVE fibers in V3 innervate what 8 muscles? Note: 4 are the muscles of mastication.

A
  1. Temporal
  2. Masseter
  3. Lateral Pterygoid
  4. Medial Pterygoid
  5. Tensor Tympani
  6. Tensor Veli Palatini
  7. Mylohyoid
  8. Anterior Digastric
47
Q

What are the V3 nerve branches that innervate the 4 muscles of mastication (Temporalis, Masseter, Lateral & Medial pterygoids)?

A
  1. Deep Temporal Nerves –> Temporalis
  2. Masseteric Nerve –> Masseter
  3. Lateral Pterygoid Nerve –> Lateral Pterygoid
  4. Medial Pterygoid Nerve –> Medial Pterygoid
48
Q

What is the V3 SVE branches that send fibers to both the Mylohyoid & anterior digastric muscles?

A

The NERVE TO MYLOHYOID

49
Q

CN V lower motor neuron lesions (SVE) result in what type of deviation of the jaw upon Protrusion? Why?

A

Ipsilateral protrusion. B/c the lesion of V3 SVE fibers will result in paralysis and atrophy of the masticatory muscles and upon protrusion the working Lateral Pterygoid muscle will push the jaw to the side of the paralyzed Lateral Pterygoid.

50
Q

V3 has FOUR main sensory (GSA) branches. What are they and what is the Pneumonic used to remember them?

A

B.A.I.L.

  • long Buccal
  • Auricular temporal
  • Inferior alveolar
  • Lingual
51
Q

The AURICULOTEMPORAL Nerve is formed by two roots that surround what ARTERY, as this artery approaches the Foramen Spinosum?

A

The MIDDLE MENINGEAL ARTERY

52
Q

Due to its position as it moves posteriorly and then anteriorly, the Auricolotemporal Nerve is Vulnerable to fractures of what part of the mandible?

A

The NECK of the CONDYLE. B/c the auriculotemporal passes around the condyle just inferior to the TMJ.

53
Q

What does the LONG BUCCAL N. of V3 mediate sensation from? What branch of the facial N. has a very similar name, innervates the Buccinator, and should not be confused with the Long Buccal N.?

A

The Long Buccal Nerve mediates sensation from the SKIN Superficial to, and the MUCOSA Deep to the buccinator muscle of the Cheek.
-Don’t confuse the Buccal Nerve branch of the Facial nerve, which actually innervates the buccinator.

54
Q

the LINGUAL NERVE provides sensation to where? (3 places)

A
  1. Mucosa of the anterior 2/3 of the tongue (=mucosa of the presulcal tongue).
  2. The floor of the mouth
  3. Mandibular Gingivae
55
Q

What nerve travels the length of the middle ear cavity before leaving the temporal bone through the petral-tympanic fissure to enter the infratemporal fossa, where it joins the Lingual Nerve to travel to and innervate the anterior 2/3s of the tongue?

A

CHORDA TYMPANI from CN VII joins the lingual nerve in the infratemporal fossa

56
Q

The anterior 2/3 of the tongue has a dual innervation. What types of sensory innervation do the Lingual Nerve (of CN V3) and Chorda Tympani (of CN VII) each provide?

A

Lingual Nerve: GSA - General sensory such as hot and cold.

Chorda Tympani: SSA - special taste sensory

57
Q

What are the four nerves that innervate the tongue? Which two provide both taste and general somatic sensation and which two only provide either one or the other?

A

Both:
1. Vagus Nerve (CN X) - Posterior tongue/oropharynx
2. Glossopharyngeal Nerve (CN IX) - Posterior 1/3 of tongue
Taste (SSA) only:
-Chorda Tympani (CN VII) - Ant 2/3 of tongue
Somatic Sensation (GSA) only:
-Lingual Nerve (CN V3) - Ant 2/3 of tongue

58
Q

Besides SSA sensation what other fiber type does Chorda Tympani contain? Where do these fibers synapse?

A

GSE fibers, which synapse in the Submandibular Ganglion.

59
Q

Chorda Tympani GSE fibers synapse in the Submandibular Ganglion. What do the postganglionic parasympathetics from the Submandibular ganglion innervate?

A

The Postganglionic Parasympathetics from the Submandibular Ganglion travel with terminal branches of the Lingual Nerve to innervate the SUBMANDIBULAR & SUBLINGUAL SALIVARY GLANDS

60
Q

The Inferior Alveolar Nerve of CN V3 gives rise to what two major branches?

A
  1. DENTAL BRANCHES (PLEXIFORM) - ends in INCISIVE NERVES

2. MENTAL NERVE - Cutaneous innervation of chin

61
Q

A Mandibular Block anesthetizes what two nerves? Describe injection?

A

A mandibular block anesthetizes the Lingual Nerve and the Inferior Alveolar Nerve. To complete the block you inject anesthetic where the inferior alveolar enters the mandible (the Mandibular Foramen. Note: often blocked by the Lingula) and on the lingual nerve as the needle is retracted

62
Q

A mandibular block may not completely anesthetize the molars. In order to ensure molars are numb what nerve should be anesthetized? Why?

A

LONG BUCCAL NERVE. Supplies Buccal gingiva adjacent to the Mandibular Molars.

63
Q

What is Trigeminal Neuralgia?

A

it is a demyelination or compression of the sensory roots of the second and third divisions of the trigeminal nerve. Causes excruciating/disabling pain.

Anat Exam 4: The PNS (7 decks)

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