Trigeminal Nerve - Maxillary Branch (V2) PDF

Trigeminal Nerve – Maxillary Branch (V2) Gulshana Choudhury Module: Oral and Dental Sciences GDC Learning Outcomes 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their application to patient management Intended Learning Outcomes Describe th...

Trigeminal Nerve – Maxillary Branch (V2) Gulshana Choudhury Module: Oral and Dental Sciences GDC Learning Outcomes 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and 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 relevance of the maxillary branch of the trigeminal nerve to dentistry Why do I need to know this?  Acland's Video Atlas of Human Anatomy Resources Anatomy.tv Teach me Anatomy  Maxillary nerve - 14 terminal branches Innervates; Skin, lower eyelid, cheeks, maxillary sinus, nasal cavity and upper 5th paired cranial nerve lip and upper teeth and associated gingivae. Derivatives 1st pharyngeal arch Trigeminal Nerve The largest cranial nerve Knowledge of this nerve is very important for dental professionals 3 Divisions Ophthalmic (V1) Maxillary (V2) Mandibular (V3)  Only branch of trigeminal branch with motor fibres is mandibular branch - Innervates muscles of mastication,parasympathetic&sensory Nerve Roots Each nerve is a short trunk composed of two closely adapted roots : 1. Motor root ( thinner) 2. Sensory root ( thicker) The trigeminal nerves function in sensing facial touch, pain and temperature, as well as controlling muscles used for chewing The trigeminal nerve should be distinguished from the facial nerve (cranial nerve VII), which controls all other facial movements Facial nerve - innervates muscles of facial expression What is supplied? Sensory (afferent) roots Motor( efferent) roots supply: supply: 1. Muscles of mastication 1. Maxillary dentition Masseter 2. Mandibular dentition Temporalis 3. Skin of face and head Medial pterygoid 4. Oral mucosa Lateral pterygoid 5. Nasal mucosa Anterior belly of digastric 6. Air sinuses 2. Mylohyoid 7. Meninges 4. Tensor tympani 5. Tensor veli palatini Brain origin Trigeminal nerve - Extends from midbrain to medulla Arises from the pons Nuclei: One motor nucleus Middle cranial fossa - sensory root expands into trigeminal ganglion 3 sensory nuclei - located in trigeminal cave Ganglion - collection of neurons outside CNS Pathway from skull From the middle cranial fossa, the 3 branches exit at: 1. Ophthalmic enters orbit through the superior orbital fissure (SOF) 2. Maxillary leaves via foramen rotundum (FR) into pterypopalatine fossa, then through infra-orbital canal to the infra-orbital foramen 3. Mandibular leaves via foramen ovale (FO)  - Ophthalmic, maxillary and mandibular The three divisions of the trigeminal nerve come together in an area called the Gasserion ganglion Within the brain stem, the signals travelling through the trigeminal nerve reach specialised clusters of neurones called the trigeminal nerve nucleus Trigeminal nerve (cranial nerve V) in the cranium | Acland's Video Atlas of Human Anatomy Ophthalmic Nerve (V1) First division of the sensory root of the Trigeminal nerve Nerve carries information to the brain via the superior orbital fissure of the sphenoid bone The superior orbital fissure is also traversed by cranial nerves II, IV and VI Ophthalmic Nerve (V1) Smallest division which serves as an afferent nerve to the: Sensory Conjunctiva Cornea Eyeball Orbit Forehead Ethmoidal and frontal sinuses Portions of the dura mater Branches of Ophthalmic Nerve Lacrimal nerve Frontal nerve Nasociliary nerve Sensory information to lacrimal gland Supplies conjunctiva and Supra-orbital nerve Sensory branches to ciliary skin covering lateral part Supratrochlear nerve ganglian of upper eyelid Supply mucous membrane - Long ciliary nerves responsible for tear lining frontal sinus, skin & - Posterior ethmoidal nerve productionand conjunctiva covering the - Anterior ethmoidal nerve upper eyelid & skin over the - Infratrochlear nerve forehead & scalp Ophthalmic nerve (cranial nerve V1) | Acland's Video Atlas of Human Anatomy  Connects infratemporal fossa with pterygopalatine fossa Transmits to neurovascular structures; posterior superior alveolar nerve - branch of maxillary exists through fissure and into infratemporal fossa Pterygo-maxillary fissure Lies between posterior surface of maxilla & pterygoid process of sphenoid bone It fills the triangular gap between lower ends of medial & lateral pterygoid plates Pterygomaxillary fissure (C) leads into it Entered by foramen rotundum & maxillary nerve Orientation to maxillary and mandibular nerves (cranial nerves V2, V3) | Acland's Video Atlas of Human Anatomy Maxillary Nerve (V2) The Maxillary branch exits via the foramen rotundum and passes into the upper part of the pterygopalatine fossa where it divides into: 1. Zygomatic 2. Infraorbital 3. Posterior Superior Alveolar 4. Pterygopalatine Maxillary Nerve (V2) Only sensory fibres Nerve of maxillary process on embryonic face Supplies: Maxillary teeth and supporting structures Hard and soft palate Maxillary sinus Much of nasal cavity Skin overlying middle part of face Infra-orbital Nerve The terminal branch of the maxillary nerve Enters orbit at inferior orbital fissure (2) & runs in infra orbital groove Leaves orbit at infra-orbital foramen (4) to run onto the face Branches: 1. Middle superior alveolar nerve 2. Anterior superior alveolar nerve 3. Terminal branches – palpebral, nasal & labial Terminal branches Arise at infra-orbital foramen Palpebral nerve supply skin of lower eyelid Nasal nerve supply skin of side of nose Labial nerve supply skin & oral mucosa of upper lip, labial gingivae of anterior maxillary teeth & skin of cheek Skin overlying the body of the maxilla After the infraorbital nerve emerges onto the face through the infra orbital foramen, it divides into three terminal branches Posterior Superior Alveolar Nerve (C) Sensation to maxillary teeth Leaves pterygopalatine fossa through pterygomaxillary fissure Runs onto tuberosity of maxilla & sends branch to supply buccal gingivae of maxillary molars Pierces bone to supply maxillary sinus & maxillary molar teeth (3rd, 2nd & palatal & disto-buccal root of 1st ) Middle & Anterior Superior Alveolar Nerves (G) Arise from infra-orbital nerve in the orbit Middle supplies the maxillary premolars & the mesio-buccal root of the first maxillary molar Anterior supplies the maxillary incisors & canine Pterygopalatine Nerves 1. Greater Palatine 2. Lesser Palatine 3. Nasopalatine Greater Palatine Nerve Passes through greater palatine canal & onto hard palate at the greater palatine foramen (4) Gives off nasal branches in canal → mucosa of lateral wall of nasal fossa On palate, it supplies much of mucosa of the hard palate & palatal gingivae, except round incisive papilla  Restorative treatment on more than 2 tooth Can be less traumatic for patient Greater palatine block Lesser Palatine Nerve Passes through greater palatine canal to lesser palatine foramen (5) Supplies soft palate Sensory sensation Nasopalatine Nerve Enters nasal cavity through sphenopalatine foramen Supplies part of nasal septum Passes through incisive canal on hard palate Supplies oral mucosa around incisive papilla Zygomatic Nerve Travels anteriorly to enter orbit via inferior orbital fissure Divides into: Zygomaticotemporal nerve Sensory innervation to temple Zygomaticofacial nerve Emerges on the face through zygomaticofacial foramen, perforating orbicularis oculi & innervates skin on the prominence of the cheeks Maxillary nerve (cranial nerve V2) | Acland's Video Atlas of Human Anatomy Summary The trigeminal nerve is the 5th and largest cranial nerve The trigeminal nerve has three divisions; ophthalmic, maxillary and mandibular The ophthalmic nerve enters orbit through the superior orbital fissure (SOF) The maxillary nerve leaves via foramen rotundum (FR) The maxillary nerve supplies the maxillary teeth and supporting structures, hard and soft palate, maxillary sinus and skin overlying middle part of face https://app.sli.do/event/5tK3dJmSTbUD1sjvhsZiGc References https://teachmeanatomy.info/head/cranial-nerves/trigeminal-nerve/ https://www.anatomy.tv/titles https://aclandanatomy.com/ Norton, N.S. and Netter, F.H. (2017) Netter's head and neck anatomy for Dentistry. Elsevier (Chapter 8 and 21) Liebgott, B. (2018) The anatomical basis of Dentistry. PHILADELPHIA (U.A.): SAUNDERS.