Trigeminal Pain Pathway Quiz
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Questions and Answers

Which of the following is NOT a characteristic of the trigeminal pain pathway?

  • It involves three orders of neurons.
  • The pathway is responsible for conveying pain signals from the face.
  • It is a direct, single synapse pathway for pain transmission. (correct)
  • The first-order neurons synapse on the spinal nucleus of CN V.

Where does the decussation of the trigeminothalamic tract occur?

  • Midbrain
  • Medulla (correct)
  • Thalamus
  • Pons

Which of the following nuclei is NOT involved in the trigeminal pain pathway?

  • Main sensory nucleus of V
  • Spinal nucleus of CN V
  • Ventral posterolateral nucleus (VPL) of the thalamus (correct)
  • Ventral posteromedial nucleus (VPM) of the thalamus

Which of the following correctly identifies the order of the neurons involved in the trigeminal pain pathway?

<p>Trigeminal ganglion - Spinal nucleus of CN V - Thalamus - Somatosensory cortex (D)</p> Signup and view all the answers

What is the function of the trigeminothalamic tract?

<p>To convey pain signals from the face to the thalamus (C)</p> Signup and view all the answers

Where does the third-order neuron synapse on the somatosensory cortex?

<p>Postcentral gyrus (D)</p> Signup and view all the answers

What is the role of the trigeminal ganglion in the trigeminal pain pathway?

<p>It houses the cell bodies of the first-order neurons. (D)</p> Signup and view all the answers

Which of the following statements about the trigeminal pain pathway is TRUE?

<p>It is a complex pathway with multiple synapses and nuclei. (C)</p> Signup and view all the answers

Which cranial nerve is responsible for the innervation of the lacrimal gland?

<p>CN VII (Facial) (C)</p> Signup and view all the answers

Where do the preganglionic parasympathetic fibers of the facial nerve (CN VII) synapse?

<p>Submandibular ganglion (B)</p> Signup and view all the answers

What nerve carries the postganglionic parasympathetic fibers to the submandibular and sublingual glands?

<p>Lingual nerve (D)</p> Signup and view all the answers

Which cranial nerve is responsible for the innervation of the parotid gland?

<p>CN IX (Glossopharyngeal) (A)</p> Signup and view all the answers

Where do the preganglionic parasympathetic fibers of the glossopharyngeal nerve (CN IX) synapse?

<p>Otic ganglion (A)</p> Signup and view all the answers

What nerve carries the postganglionic parasympathetic fibers to the parotid gland?

<p>Auriculotemporal nerve (D)</p> Signup and view all the answers

Which of the following signs and symptoms in the case study could be indicative of a lesion to the facial nerve (CN VII)?

<p>Deviation of the chin to the right (B), Hyperacusis (D)</p> Signup and view all the answers

The deviation of the uvula to the left in the case study is likely due to a lesion of which cranial nerve?

<p>CN X (Vagus) (B)</p> Signup and view all the answers

Which condition is NOT associated with damage to the trigeminal nerve motor neurons?

<p>Herpes zoster (C)</p> Signup and view all the answers

Which sensory modality is NOT conveyed by cutaneous receptors?

<p>Memory (A)</p> Signup and view all the answers

What type of receptor is primarily involved in proprioception within the trigeminal system?

<p>Muscle spindle receptors (B)</p> Signup and view all the answers

Which of the following is a function associated with trigeminal nerve damage?

<p>Difficulty with mastication (D)</p> Signup and view all the answers

Which nerve pathway best describes the perception of orofacial pain?

<p>Trigeminal sensory pathways (A)</p> Signup and view all the answers

Which of the following is NOT a type of cutaneous sensory modality related to the trigeminal system?

<p>Muscle strength (B)</p> Signup and view all the answers

Which condition can lead to ipsilateral loss of muscle function due to trigeminal nerve damage?

<p>Base of skull trauma (B)</p> Signup and view all the answers

Which type of trigeminal nuclei primarily processes touch sensations?

<p>Primary sensory nuclei (C)</p> Signup and view all the answers

Which division of the trigeminal nerve is responsible for the sensory innervation of the lower eyelid and its conjunctiva?

<p>Maxillary Division (V2) (A)</p> Signup and view all the answers

What is the primary motor function of the mandibular division of the trigeminal nerve?

<p>Motor to the muscles of mastication (A)</p> Signup and view all the answers

Which foramen does the mandibular division of the trigeminal nerve pass through?

<p>Foramen ovale (C)</p> Signup and view all the answers

Which area is innervated by the maxillary division of the trigeminal nerve?

<p>Inferior posterior portion of the nasal cavity (D)</p> Signup and view all the answers

What type of sensation is primarily provided by all three divisions of CN V?

<p>General sensation (C)</p> Signup and view all the answers

Which muscle is NOT innervated by the mandibular division of the trigeminal nerve?

<p>Buccinator muscle (D)</p> Signup and view all the answers

Which of the following is a sensory function of the ophthalmic division of the trigeminal nerve?

<p>Sensory to the forehead (C)</p> Signup and view all the answers

Which part of the trigeminal nerve's course is considered intracranial?

<p>Pons (D)</p> Signup and view all the answers

What is the primary cranial nerve involved in the afferent limb of the jaw jerk reflex?

<p>CN V (A)</p> Signup and view all the answers

A normal jaw jerk reflex indicates integrity of which cranial nerve?

<p>CN V (C)</p> Signup and view all the answers

What does the presence of clonus in the jaw jerk reflex suggest?

<p>Upper motor neuron lesion (B)</p> Signup and view all the answers

If a patient has an absent jaw jerk reflex, what could this indicate?

<p>Lower motor neuron lesion (D)</p> Signup and view all the answers

What is the significance of the jaw jerk reflex being inconclusive during testing?

<p>It may not provide clear information about CN V. (C)</p> Signup and view all the answers

What muscle movement is primarily tested by the jaw jerk reflex?

<p>Closure of the jaw (D)</p> Signup and view all the answers

In the jaw jerk reflex test, tapping the chin should normally lead to what response?

<p>Jaw closing (B)</p> Signup and view all the answers

Which cranial nerve mediates the efferent limb of the jaw jerk reflex?

<p>CN V (C)</p> Signup and view all the answers

What is the significance of the "forehead sparing" phenomenon in patients with intracranial lesions?

<p>It highlights that the upper motor neurons responsible for facial movements are not fully affected. (C)</p> Signup and view all the answers

A patient presents with loss of sensation in the lower jaw and impaired jaw movement. Which cranial nerve is likely affected?

<p>Trigeminal Nerve (CN V) (D)</p> Signup and view all the answers

Which division of the trigeminal nerve is responsible for sensory innervation of the upper teeth?

<p>Maxillary (C)</p> Signup and view all the answers

The trigeminal nerve plays a role in parasympathetic pathways. Which of the following is NOT a function of the trigeminal nerve in the parasympathetic nervous system?

<p>Pupillary constriction (C)</p> Signup and view all the answers

Which of the following is the BEST description of the facial nerve's role in the parasympathetic nervous system?

<p>It influences lacrimation and salivation. (A)</p> Signup and view all the answers

What is the primary function of the trigeminal nerve?

<p>Sensory innervation of the face and head. (C)</p> Signup and view all the answers

A patient presents with unilateral facial weakness, drooping of the eyelid, and difficulty in swallowing. Which cranial nerve is most likely affected?

<p>Facial Nerve (CN VII) (C)</p> Signup and view all the answers

Which of the following accurately describes the course of the facial nerve?

<p>It exits the brainstem and traverses the temporal bone through the internal auditory canal, exiting through the stylomastoid foramen, then branching to innervate the face. (D)</p> Signup and view all the answers

Flashcards

What is the trigeminal nerve?

The trigeminal nerve is a mixed nerve, responsible for sensation in the face, motor function of chewing muscles, and some parasympathetic functions.

What are the branches of the trigeminal nerve?

The trigeminal nerve has three branches: the ophthalmic, maxillary, and mandibular nerves. Each branch has specific sensory and motor functions.

What are the trigeminal nerve nuclei?

The trigeminal nerve nuclei are clusters of neurons responsible for different functions. The sensory nuclei receive input from the face, while the motor nuclei control chewing muscles.

How does the trigeminal nerve relate to the parasympathetic system?

The trigeminal nerve plays a role in parasympathetic pathways, controlling things like lacrimation (tear production) and salivation.

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What happens when the trigeminal nerve is damaged?

Lesions in the trigeminal nerve can affect sensory and motor functions, leading to pain, numbness, weakness, or paralysis.

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What are the facial nerve nuclei and what do they do?

Facial nerve nuclei control facial expressions and are located in the brainstem. They receive input from the motor cortex.

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What is the facial nerve and what are its functions?

The facial nerve carries motor, sensory, and parasympathetic fibers. It controls facial expressions, taste sensations, and tear production.

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What happens when the facial nerve is damaged?

Lesions affecting the facial nerve can cause paralysis of facial muscles, affecting expressions and sometimes taste. 'Forehead sparing' refers to an upper motor neuron lesion where the forehead muscles are unaffected.

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Where does the trigeminal nerve (CN V) travel?

The trigeminal nerve (CN V) travels within the brainstem (CNS) before exiting to the foramina. These foramina are the superior orbital fissure, foramen rotundum, and foramen ovale.

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What are the three branches of the trigeminal nerve?

The trigeminal nerve (CN V) has three branches: ophthalmic (V1), maxillary (V2), and mandibular (V3).

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What are the primary functions of the trigeminal nerve (CN V)?

The trigeminal nerve's primary functions are sensory and motor, but it's mostly sensory. It's responsible for carrying general sensation from the face, including touch, temperature, and pain.

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What muscles does the trigeminal nerve (CN V) innervate?

The trigeminal nerve (CN V) provides motor innervation to the muscles of mastication, which are responsible for chewing.

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What does the ophthalmic division (V1) of the trigeminal nerve innervate?

The ophthalmic division (V1) of the trigeminal nerve is responsible for sensation in the forehead, upper eyelid, and the conjunctiva.

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What does the maxillary division (V2) of the trigeminal nerve innervate?

The maxillary division (V2) of the trigeminal nerve is responsible for sensation in the cheek, lower eyelid, upper lip, and upper teeth.

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What does the mandibular division (V3) of the trigeminal nerve innervate?

The mandibular division (V3) of the trigeminal nerve is responsible for sensation in the lower jaw, lower lip, lower teeth, and some of the tongue.

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What makes the motor component of the trigeminal nerve (CN V) unique?

The motor component of the trigeminal nerve (CN V) is complicated. It's responsible for controlling the muscles of mastication and some suprahyoid muscles.

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Trigeminal Nerve Lower Motor Neuron Lesions

Lower motor neuron lesions of the trigeminal nerve cause ipsilateral loss of muscle function. This is evident in issues like mastication, where the jaw deviates to the affected side, and muscle atrophy.

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Trigeminal Nerve Sensory Function

The trigeminal nerve supplies sensory information from the face, including touch, pressure, vibration, pain, and temperature. It also carries proprioceptive information.

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Trigeminal Nerve Motor Nucleus

The trigeminal nerve's motor nucleus controls the muscles of mastication, which are responsible for chewing.

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Mesencephalic Nucleus of Trigeminal Nerve

The mesencephalic nucleus is a unique sensory nucleus of the trigeminal nerve that is responsible for proprioception of the muscles of mastication. This means it helps the brain know where the jaw is in space.

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Sensory Trigeminal Pathways

Sensory information from the face travels through several pathways, including the primary, secondary, and tertiary pathways.

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Trigeminal Nerve Damage

The trigeminal nerve can be affected by a number of things, including tumors, lesions, herpes zoster (shingles), trauma to the craniofacial region, and peripheral nerve branches.

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Sensory Modalities of Trigeminal Nerve

The trigeminal nerve carries sensory modalities such as proprioception, touch, pressure, vibration, pain, and temperature.

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Trigeminal Nerve - Sensory Function

The trigeminal nerve is responsible for conveying sensory information from the face, including touch, pressure, vibration, pain, and temperature. It also carries proprioceptive information about the muscles involved in mastication.

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1st order neurons

The first order neurons of the trigeminal pain pathway receive sensory information from receptors in the face, head, and mouth.

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2nd order neurons

The second order neurons travel from the spinal nucleus of CN V to the thalamus via the trigeminothalamic tract.

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3rd order neurons

The third order neurons project from the thalamus to the somatosensory cortex, allowing us to perceive and localize pain.

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Spinal nucleus of CN V

The spinal nucleus of CN V is a collection of neurons in the brainstem that receives sensory information from the face and head. It plays a crucial role in processing and transmitting pain signals.

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Trigeminothalamic tract

The trigeminothalamic tract is a bundle of nerve fibers that carries pain signals from the spinal nucleus of CN V to the thalamus. It is crucial for transmitting pain information to the brain.

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Thalamus

The thalamus acts as a relay station for sensory information, including pain. It receives signals from the trigeminothalamic tract and sends them to the somatosensory cortex.

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Primary somatosensory cortex

The primary somatosensory cortex located in the postcentral gyrus is the part of the brain that receives and interprets sensory information, including pain. It allows us to perceive and localize pain.

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VPM

The VPM (ventral posterior medial) nucleus of the thalamus is responsible for relaying sensory information, including pain, from the face and head to the somatosensory cortex.

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What parasympathetic functions does cranial nerve VII control?

The cranial nerve VII (facial nerve) carries parasympathetic fibers that control lacrimal gland (tear production), submandibular gland, and sublingual gland (salivation).

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Where do the preganglionic parasympathetic fibers of CN VII travel?

The preganglionic parasympathetic fibers travel within the chorda tympani branch of the facial nerve (CN VII).

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Where do the preganglionic fibers of CN VII synapse?

The preganglionic parasympathetic fibers synapse in the submandibular ganglion.

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How do the postganglionic parasympathetic fibers reach the target glands?

The postganglionic parasympathetic fibers hitchhike on the lingual nerve (from CN V) to reach the target glands.

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What parasympathetic function does cranial nerve IX control?

The cranial nerve IX (glossopharyngeal nerve) carries parasympathetic fibers that control the parotid gland (saliva production).

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Where do the preganglionic parasympathetic fibers of CN IX travel?

The preganglionic parasympathetic fibers of CN IX travel within the lesser petrosal nerve.

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Where do the preganglionic fibers of CN IX synapse?

The preganglionic parasympathetic fibers synapse in the otic ganglion.

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How do the postganglionic parasympathetic fibers reach the parotid gland?

The postganglionic parasympathetic fibers hitchhike on the auriculotemporal nerve (from CN V) to reach the parotid gland.

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Jaw Jerk Reflex

A reflex test that assesses the integrity of the trigeminal nerve (CN V) by tapping on the chin with the mouth slightly open. A normal response involves contraction of the muscles of mastication, closing the jaw.

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Jaw Clonus

A rhythmic, oscillatory contraction of the jaw muscles, typically indicative of an upper motor neuron lesion affecting the trigeminal nerve.

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Efferent Limb of Jaw Jerk Reflex

The pathway responsible for carrying signals from the brain to the muscles involved in chewing. It is part of the trigeminal nerve.

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Afferent Limb of Jaw Jerk Reflex

The pathway responsible for carrying sensory information from the face to the brain, particularly regarding touch and pressure, within the jaw jerk reflex.

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Mesencephalic Nucleus

The trigeminal nerve's nucleus located in the midbrain. It plays a critical role in transmitting sensory information from the face to the brain, particularly for the jaw jerk reflex.

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Trigeminal Motor Nucleus

The trigeminal nerve's nucleus located in the brainstem. It controls motor function of the muscles involved in chewing, including the jaw jerk reflex.

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Hyperactive Jaw Jerk Reflex

An overactive, exaggerated jaw jerk reflex often associated with a lesion affecting the upper motor neurons that control the trigeminal nerve.

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Absent Jaw Jerk Reflex

The absence of a jaw jerk reflex, which can indicate a lower motor neuron lesion affecting the trigeminal nerve.

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Study Notes

Trigeminal Nerve (CN V)

  • Trigeminal nerve is a cranial nerve (CN V)
  • It's responsible for sensory and motor functions
  • It has three divisions: ophthalmic, maxillary, and mandibular
  • It has two branches

Trigeminal Nerve Pathways

  • Sensory pathways: transmit pain, touch, temperature, and pressure sensations.
  • Motor pathway: controls muscles involved in chewing (mastication).
  • The upper motor neurons originate in the motor cortex and project to the trigeminal motor nucleus in the pons.

Trigeminal Nuclei

  • Trigeminal motor nucleus: located in the pons
  • It is the lower motor neuron of the trigeminal nerve
  • It receives upper motor neuron input from the motor cortex
  • It controls muscles used for chewing

Cranial Nerve VII (Facial Nerve)

  • Functions: motor and sensory
  • Motor: controls muscles of facial expressions
  • Sensory: taste from the anterior two-thirds of the tongue, sensations within some parts of the face and ear.
  • Nuclei: located in the pons

Sensory and Motor Functions - Trigeminal Nerve (CN V)

  • Sensory: general sensation (touch, pain, temperature) from the face, head, and mouth.
  • Motor: somatic motor control of muscles of mastication, as well as some other muscles involved.
  • Divisions: Ophthalmic (V1), Maxillary (V2), Mandibular (V3), each has different regions innervated

UMN (Upper Motor Neuron) Pathways

  • Originate in the motor cortex
  • Project to the cranial nerve nuclei in the brainstem
  • Descending pathways to different cranial nerves through the internal capsule to the pons
  • There are pathways for left and right motor control in the pons affecting the facial muscles from the left and right sides of the motor cortex.

CN VII Motor Pathway

  • The motor pathway of CN VII is complex.
  • UMN originate in the motor cortex
  • The axons project to the bilateral (both right and left) facial motor nerve nuclei bilaterally in the pons.
  • A unilateral lesion in the UMN of one side only affects one side of the face.
  • A lesion in the pons itself (supranuclear) may spare movement of the forehead and upper eyelids.

Clinical Considerations - Trigeminal Nerve

  • Damage to the corticobulbar pathway (UMN) will not always produce symptoms.
  • Damage to the LMNs may lead to weakness, loss of function, or other impairments depending on location.
  • The trigeminal nerve has bilateral innervation, unilateral damage does not eliminate all function.

Trigeminal Nerve Sensory Nuclei

  • Trigeminal sensory nuclei: located in several parts of the brainstem, including the midbrain, pons, and medulla oblongata; these nuclei receive afferent fibers from trigeminal ganglion; they play important roles in the perception of pain, touch, temperature, and other sensory stimuli from the face; each sensory nucleus plays unique roles dependent on the type of input

Cutaneous Receptors

  • Different cutaneous receptors relay sensations via separate pathways (depending on the modality)
  • Modalities perceived: proprioreception, touch, pressure, vibration, pain, temperature

Trigeminal Sensory Pathways

  • Sensory receptors transmit various sensory information to the brain.
  • Sensory pathway relays include the principal sensory nucleus, mesencephalic nucleus and spinal trigeminal nucleus.
  • Pathway details are related to the type(s) of sensation perceived from the diverse locations of the face, cranium and other parts of the mouth/head

Pathway for Perception of Orofacial Pain

  • First-order neurons relay from peripheral receptors/nociceptors in the face and other structures including the mouth and other locations in the head.
  • Second-order neurons transmit pain signals into spinal trigeminal nucleus.
  • Third-order neurons transmit the sensory information to the thalamus.
  • Pain eventually is perceived in postcentral gyrus.

Thalamocortical Projections

  • Neurons in the VPM send axons into the posterior limb of the internal capsule to the somatosensory cortex in the postcentral gyrus
  • The face's sensory information is processed in the most lateral part of the postcentral gyrus; this is where pain is perceived.

Parasympathetic Supply to Head and Neck

  • The trigeminal nerve does not have intrinsic parasympathetic fibers
  • Parasympathetic functions related to the head and neck are mostly handled by other cranial nerves.
  • Parasympathetic innervation in this region projects from other cranial nerves, and some post-ganglionic pathways utilise the trigeminal nerve trunk to reach their target organs.

Case Studies (Trigeminal Nerve)

  • Various case studies detailed different clinical results and potential causes.
  • Several case examples show potential complications from dental procedures and their potential to cause various facial, mouth and nerve-related problems.

Jaw Jerk Reflex

  • This reflex involves tapping (in a particular spot on the chin) that elicits contractions of muscles involved in chewing.
  • Afferent and efferent limbs are mediated by CN V.

Jaw Clonus

  • Characterized as rhythmic/oscillatory contractions of the jaw muscles.

Corneal Reflex

  • Both eyes close in response to touch of either cornea
  • Afferent limb (sensory) is CN V₁)
  • Efferent limb (motor) is CN VII (orbicularis oculi muscle). This action is ipsilateral (involves the same side of the head).

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Test your knowledge on the trigeminal pain pathway with this quiz. You will answer questions about the characteristics of the pathway, the role of various nuclei, and the functions of different cranial nerves involved. Perfect for students delving into neuroanatomy and physiology!

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