18/10/2012
CN V: trigeminal
o Largest cranial nerve
o Emerges from pons and goes thru middle cranial fossa
o Forms huge semilunar/trigeminal sensory ganglion (medial side of middle cranial fossa) and divides into 3 pieces
o Primary somatic sensory nerve of head; also a motor nerve of first pharyngeal arch
o Labeling scheme: CN V1, 2, 3
o CN V1 = ophthalmic, entirely sensory
o Goes to superior orbital fissure to join CN III and IV to go to back of orbit
o Supplies cornea, conjunctiva, eyeball, lacrimal gland, forehead, nose, upper eyelid, frontal and ethmoid sinuses
o Emerges in forehead from frontalis
o Branches
Lacrimal: small, lateral
• provides somatic sensory to lacrimal gland, adjacent eyelid and conjuncitva (doesn’t control secretions)
Frontal (supraorbital, supratrochlear): both travel to upper medial corner of eye through foramen
• Terminal branches on forehead: sensory
Nasociliary
• Under levator palpebrae superioris and superior re**us
• Four branches
o Suspends ciliary ganglion with sensory root: see above
Fibers are considered part of short ciliary nerves
Short ciliary
• Parasympathetic
• To back of eyeball, pierce sclera and travel on eyeball
• May contain some sympathetic fibers
o Long ciliary nerves:
Follows same course as short ciliary
Sensory to eye
Primary carrier of sympathetics to ciliary body, iris
• dilate muscles
Side note: sympathetics travel in sympathetic trunk into neck where there are 3 cervical ganglion
• superior cerv. Ganglion
o base of skull, above of carotids
o where sympathetics of head will synapse
o fibers form plexuses around internal and external carotid
o fibers can come up with internal carotid and contribute to CNs
o Ethmoidal and nasal: from ethmoidal and sphenoidal sinuses, nasal cavity and front and tip of nose
pierces medial wall of orbit
Supplies mucosa
Pierces forward to supply nasal cavity: nasal nerves
o Infratrochlear: from superomedial corner of orbit below trochlea
Just sensory
o CN V2 =maxillary, entirely sensory
o Goes thru foramen rotundum (a round hole behind the medial angle of the superior orbital fissure, that goes forward in skull)
o Takes a bent course to go to floor of orbit; travels the infraorbital fissure and thru infraorbital canal and out the infraorbital foramen
o Sensory innervation of cheek; sensory for everything from floor of orbit to roof of mouth
Upper jaw, maxillary sinus, nasal cavity, middle of face, middle ear cavity, auditory tube and dura
o Branches
Supends pteryogopalantine ganglion (CN VII)
• To reach ganglion, travels vertically along pteryogomaxillary canal
• Fibers pass thru then go medially along nasal cavity to palate
Zygomatic: from cheek
• Sends sensory thru lateral wall of orbit onto cheek
Nasal branches: from mucous membranes of nasal sinuses
Palatine branches (lesser, greater, nasopalatine)
• Fibers pass through pteryogpalatine ganglion
• Descend through palatine canal and exit respective foramen
• Sensory nerves to palate
nasopalatine nerve
• supplies nasal septum
• goes to front of palate and exits out opening behind upper incisors (incisor foramen)
• sensory to front of palate
Superior alveolar branches from upper teeth, gums, maxillary sinus
• Maxillary sinus: hollow cavity from floor of orbit to roof of mouth; lined with mucosa
infraorbital: terminal branch
sensory between orbit and mouth
meningeal: from middle and anterior cranial fossae
• given off before exiting foramen rotundum
• supplies dura around area
pharyngeal: passes thru ganglion
• from middle ear cavity and auditory tube
• upper part of pharynx (back of throat)
• connection to middle ear
o CN V3= mandibular, sensory and motor
o Largest division
o Exits skull thru foramen ovale (postero lateral from foramen rotundum; oval opening); exits at lower jaw
o Supplies sensory to lower jaw (tongue, lower teeth, chin, cheek, floor of mouth, anterior 2/3 of tongue, tympanic membrane, salivary glands)
o Also supplies motor innervation for mastication
Branchiomotor: associated with first branchial/pharyngeal arch
Striated muscles are supplied
Branches to muscles of mastication
• Temporalis, masseter, medial and lateral pterygoids
Branches to floor of mouth: mylohyoid, digastric (anterior belly), tensor veli palatine (tenses roof of palate) and tensor tympani (tenses ear drum)
o Branches after motor branches
Buccal
• Sensory from cheek, internal and external
• Pierces buccinator to mucus membranes and skin
Auriculotemporal
• Sensory from external acoustic meatus and tympanic membrane, temporal region and temperomandibular junction
• Suspends otic ganglion (CN IX)
Lingual
• Sensory for anterior 2/3 of tongue, floor mouth, mandibular gums
• Joined by piece of chorda tympani of facial nerve
• Suspends submandibular ganglion (CN VII)
Inferior alveolar
• Sensory from lower jaw, gums, lips and teeth
• Dental, mental nerves
Meningeal
• Accompanies middle meningeal artery (enters back into skull thru foramen spinosum: immediately adjacent to foramen ovale)
• Sensory for dura mater of middle cranial fossa