v1 and v2 Flashcards
the trigeminal nerve provides the GENERAL SENSORY supply to
- almost all structures of mouth but not the posterior parts of oral cavity (e.g. post. 1/3 of tongue is supplied by glossopharnygeal)
- orbits
- nasal cavity
- paranasal air sinuses
- skin of face and forehead
the trigeminal nerve travels from the posterior cranial fossa to the middle cranial fossa. what happens to the sensory root of the trigeminal nerve here
develops into the trigeminal ganglion= contains all the CELL BODIES of the sensory nerve fibres of the trigeminal nerve
sensory nerve cells found in trigeminal ganglion are which type of nerve fibres
psuedo-unipolar
derived from 2 seperate fibres which fused together near the cell body
the trigeminal ganglion splits into…
v1 opthalmic, only sensory
v2 maxillary, only sensory
v3 mandibular, sensory AND motor
opthalmic nerve supplies
GS to
- orbit
- eye (but not visual information (optic nerve))
- skin: upper eye lid, centre of nose
- parts of nasal cavity
- some paranasal sinuses
maxillary nerve supplies
GS to
- upper teeth
- gingiva of upper teeth and related structures
- hard AND soft palate
- central part of skin and face (lower eyelid, side of nose, upper lip)
describe the journey of the maxillary nerve as it emerges from the trigeminal ganglion in the middle cranial fossa…
- it will leave the cranial cavity via the FORAMEN ROTUNDUM (which is a foramen in the sphenoid bone) to emerge into the pterygopalatine fossa
- some of the maxilary nerve will branch here, but majority will leave the pterygopalatine fossa via the INFERIOR ORBITAL FISSURE (between the greater wing of sphenoid and maxilla). now called ION.
- ION will travel in the INFRA ORBITAL GROOVE ( groove in the maxilla) which becomes roofed over and called the INFRA ORBITAL CANAL
- ION emerges out via the INFRA-ORBITAL FORAMEN
- splits into many fine branches
when is the maxillary nerve called the infra orbital nerve
when it emerges out of the inferior orbital fissure
the pteryogopalatine fossa is adjacent to… and posterior to…
adjacent to: palatine bone and pterygoid plates of sphenoid bone
posterior to: maxilla
the pteryogopalatine fossa is a key place for secretomotor fibres. why
contains the pterygopalatine ganglion which is an AUTONOMIC GANGLION
- here some pre-ganglionic PARA sympathetic FACIAL nerve cells will synapse with post-ganglionic as they travel on their way to supply
1) lacrimal glan in orbit (tears)
2) nasal glands in nasal cavity
3) accessory saliva glands in palate
the maxillary nerve fibres do NOT synapse at the pterygopalatine ganglion, simply travel through it via
the ganglionic branches of the maxillary nerve
the maxillary nerve will LEAVE the pterygopalatine ganglion by nerves which emerge directly from the ganglion. some of these are…
- grater palatine nerves
- lesser palatine nerves
- nasal nerves
what does the greater palatine nerve innervate
GS
-mucosa of hard palate AND the palatine gingiva of upper teeth (applies to WHOLE hard palate and not just up to the 1st pre-molar)
how does the greater palatine nerve enter the hard palate
through the greater palatine foramen
what does the lesser palatine nerve innervate
GS
-soft palate
the nasal nerves are branches of the ptergopalatine ganglion which passed medially and into the nasal cavity. there is one such nasal nerve however that is linked with supplying the oral cavity, what does it supply
a long nasal nerve which runs the whole length of the nasal septum actually passes through the INCISIVE CANAL and will emerge into the ANTERIOR part of the HARD PALATE
- supplies the anterior aspects of the hard palate
- palatine gingiva of teeth up to and including canines (this area is also innervated by the greater palatine nerve)
after giving off its pterygopalatine ganglionic branches (greater/ lesser palatine, nasal), the maxillary nerve branches into…
PSA
posterior superior alveolar nerve
it travels down to POSTERIOR side of maxilla and branches as it does so
describe how the PSA enters the maxilla to form the superior dental plexus/ superior aleveolar plexus
branches of the PSA enter the maxilla via small foramina
will travel under the mucosa of the lateral wall of the maxillary AIR SINUS (branching further)
all these branches combine to form a plexus of nerves located SUPERIOR TO TEETH thus called the superior dental plexus OR superior alveolar plexus
what does the PSA nerves supply
- most of upper MOLAR TEETH and their BUCCAL gingivae
what are the branches of the ION- inFRA orbital nerve
MSA (in minority of people)
ASA
describe how the MSA enters the maxilla and what it supplies
middle superior alveolar nerve
it travels under the mucosa on the lateral wall of the maxillary air sinus to join the superior dental plexus
supply the GS
- small part of the 1st upper MOLAR
- upper PRE-molars and their BUCCAL gingivae
describe how the ASA enters the maxilla and what it supplies
anterior superior alveolar nerve
it travel under the mucosa of the lateral wall of the maxillary air sinus to join the ANTERIOR part of the superior dental plexus
supply the GS
- anterior maxillary teeth and their LABIAL gingivae
what will supply the regions of the MSA, in patients who dont have the MSA nerve
the ASA and the PSA branches of the maxillary nerve
what is the implication of nerves running under the mucosa of the maxillary air sinus
referred pain when there is inflammation in sinus, will stimulate nerves supplying teeth= dental pain but teeth are healthy
maxilla is porous. how do you anaesthetise the maxillary nerve branches
local infiltration of L.A solution near site you want to anaesthetise
AND can do
nerve blocks to larger branches of V2 and want to anaesthetise larger areas
