Trigeminal Nerve - Maxillary Branch (V2)

Trigeminal Nerve - Maxillary Branch (V2)

• The trigeminal nerve is the 5th cranial nerve.
• It's the largest of the cranial nerves.
• Knowledge of this nerve is crucial for dental professionals.
• The maxillary branch (V2) is one of the three divisions (ophthalmic (V1), maxillary (V2), and mandibular (V3)).

GDC Learning Outcomes

• Describe relevant dental, oral, craniofacial, and general anatomy.
• Explain their application to patient management.

Intended Learning Outcomes

• Describe the function of the maxillary branch of the trigeminal nerve (CN V).
• Outline the anatomical regions it supplies.
• Explain the maxillary branch's relevance to dentistry.

Nerve Roots

• Each nerve has two closely adapted roots:
  • Motor root (thinner)
  • Sensory root (thicker)
• The trigeminal nerve senses facial touch, pain, temperature, and controls chewing muscles.
• Differentiate the trigeminal nerve from the facial nerve (CN VII), which controls other facial movements.

What is Supplied?

• Sensory (afferent) roots supply:
  • Maxillary dentition
  • Mandibular dentition
  • Skin of face and head
  • Oral mucosa
  • Nasal mucosa
  • Air sinuses
  • Meninges
• Motor (efferent) roots supply:
  • Muscles of mastication (masseter, temporalis, medial pterygoid, lateral pterygoid, anterior belly of digastric)
  • Mylohyoid
  • Tensor tympani
  • Tensor veli palatini

Brain Origin

• Arises from the pons.
• Contains one motor nucleus and three sensory nuclei.

Pathway from Skull

• Branches exit the middle cranial fossa:
  • Ophthalmic (V1): Enters the orbit through the superior orbital fissure (SOF).
  • Maxillary (V2): Leaves via the foramen rotundum, enters the pterygopalatine fossa, and then through the infra-orbital canal to the infra-orbital foramen.
  • Mandibular (V3): Leaves via the foramen ovale.

Gasserian Ganglion

• The three divisions of the trigeminal nerve come together in this area.
• Signals travel through the trigeminal nerve to specialized clusters of neurons called the trigeminal nerve nucleus within the brain stem.

Branches of Ophthalmic Nerve (V1)

• Ophthalmic nerve (V1): the smallest division—senses the conjunctiva, cornea, eyeball, orbit, forehead, and portions of the dura mater.
• It has several branches which sense different areas:
  • Lacrimal nerve: conjunctiva and side of the upper eyelid
  • Frontal nerve: Supplies the upper eyelid, forehead, and scalp. Has supraorbital and supratrochlear branches
  • Nasociliary nerve: Senses the nasal cavity, sinuses, and related structures. Includes the anterior ethmoidal, posterior ethmoidal, and infratrochlear branches

Pterygo-maxillary fissure

• Located between the posterior surface of the maxilla and the pterygoid process of the sphenoid bone.
• It is the triangular gap between the lower ends of the medial and lateral pterygoid plates.
• The maxillary nerve passes through the foramen rotundum to enter the pterygo-maxillary fissure.

Maxillary Nerve (V2)

• The maxillary branch exits through the foramen rotundum and enters the upper part of the pterygopalatine fossa.
• Branches:
  • Zygomatic nerve: sensation to the temple.
  • Infraorbital nerve: has multiple branches including anterior superior alveolar nerve, middle superior alveolar nerve and Posterior superior alveolar nerve
  • Posterior superior alveolar nerve: maxillary sinus and molar teeth.
  • Pterygopalatine nerves: supply the nasal cavity and palate

Infra-orbital Nerve

• The terminal branch of the maxillary nerve.
• It enters the orbit at the inferior orbital fissure, runs through the infraorbital groove, and exits through the infraorbital foramen.
• Branches:
  • Middle superior alveolar nerve
  • Anterior superior alveolar nerve
  • Terminal branches (palpebral, nasal, labial)

Terminal Branches

• Arise from the infra-orbital foramen.
• Palpebral nerve: skin of the lower eyelids.
• Nasal nerve: skin of the side of the nose.
• Labial nerve: skin and mucosa of the upper lip, labial gingiva for anterior maxillary teeth, and skin of the cheek.

Posterior Superior Alveolar Nerve

• Leaves the pterygopalatine fossa through the pterygomaxillary fissure.
• Enters the tuberosity of the maxilla.
• Supplies buccal gingiva of maxillary molars, maxillary sinus, maxillary molars (3rd, 2nd, and 1st)

Middle & Anterior Superior Alveolar Nerves

• Arise from the infraorbital nerve.
• Middle: Supplies maxillary premolars and the mesiobuccal root of the first maxillary molar.
• Anterior: Supplies maxillary incisors and canines.

Pterygopalatine Nerves

• Branches of the maxillary nerve.
• Three key nerves:
  • Greater palatine nerve
  • Lesser palatine nerve
  • Nasopalatine nerve

Greater Palatine Nerve

• Passes through the greater palatine canal and exits at the greater palatine foramen.
• Supplies mucosa of the hard palate.

Lesser Palatine Nerve

• Passes through the greater palatine canal to the lesser palatine foramen.
• Supplies the soft palate.

Nasopalatine Nerve

• Enters the nasal cavity through the sphenopalatine foramen.
• Supplies part of the nasal septum, incisive canal of the hard palate, and oral mucosa around the incisive papilla.

Zygomatic Nerve

• Travels through the inferior orbital fissure.
• Branches:
  • Zygomaticotemporal nerve (sensation to the temple)
  • Zygomaticofacial nerve (sensation to the prominence of the cheek).

Maxillary Nerve Summary

• Sensory fibres.
• Maxillary teeth, supporting structures, hard & soft palate, maxillary sinus, and skin of the middle face.

Trigeminal and facial nerve examination

Summary

• The trigeminal nerve is the 5th cranial nerve.
• Three divisions: ophthalmic (V1), maxillary (V2), and mandibular (V3).
• Ophthalmic (V1): Enters orbit through superior orbital fissure.
• Maxillary (V2): Leaves via foramen rotundum, pterygopalatine fossa, infraorbital canal, and infraorbital foramen. Supplies maxillary teeth, palate, maxillary sinus, and skin.
• Mandibular (V3): Leaves via foramen ovale.

Test your knowledge on the maxillary branch of the trigeminal nerve, crucial for dental professionals. This quiz covers its anatomy, function, and significance in patient management. Enhance your understanding of cranial nerves and their applications in dentistry.