The document discusses the trigeminal nerve, which is the 5th cranial nerve. It has three main branches - the ophthalmic, maxillary, and mandibular nerves. Each branch innervates different parts of the face and has its own set of branches. The trigeminal ganglion contains the cell bodies of the sensory fibers of the trigeminal nerve. Common disturbances of the trigeminal nerve include trigeminal neuralgia, which causes sudden, severe facial pain, and trigeminal nerve injuries. The document provides detailed information on the anatomy and branches of the trigeminal nerve.
3. NERVOUS SYSTEM
Central nervous system
Peripheral nervous
system
Brain and spinal cord
Autonomic and somatic
nervous system
I
N
T
R
O
D
U
C
T
I
O
N
B.D. Chaurasia 4th edition
3www.indiandentalacademy.com
4. Structure of nerve
Axon
Fasciculi
Nerve fibre
Nerve
Endoneurium
Perineurium
Epineurium
I
N
T
R
O
D
U
C
T
I
O
N
Peter. L. Williams, grays anatomy, 38th edition,1995
4www.indiandentalacademy.com
5. C
R
A
N
I
A
L
N
E
R
V
E
S
Motor nerves: III IV VI XI
XII
Sensory nerves I II VIII
Mixed nerves V VII IX X
Associated with
parasympathetic ganglion
III VII IX X
Peter. L. Williams, grays anatomy, 38th edition,1995 5www.indiandentalacademy.com
8. T
R
I
G
E
M
I
N
A
L
N
E
R
V
E
Trigeminal nerve
Tres meaning three and
geminus meaning twin Largest cranial nerve
Mixed nerve
Sensory to greater part of
the scalp, teeth and the
oral and nasal cavity
Motor supply is to
muscles of mastication
and extraocular muscles
5th cranial nerve
Cunningham’s manual of practical anatomy, volume 3,
3rd edition 8www.indiandentalacademy.com
9. T
R
I
G
E
M
I
N
A
L
N
E
R
V
E
MOTOR ROOT SENSORY ROOT
TWO ROOTS
Within pons and medulla
oblongata
Semilunar gangalion
Foramen ovale along with
mandibular nerve
MOTOR ROOT
Muscles of mastication
Mylohyoid
Anterior belly of digastric
Tensor tympani
Tensor veli palatine
Cunningham’s manual of practical anatomy, volume 3,
3rd edition
9www.indiandentalacademy.com
10. T
R
I
G
E
M
I
N
A
L
N
E
R
V
E
SENSORY ROOT
Fibres arise in trigeminal
ganglion
Opthalmic nerve
Leaving from concave
surface of ganglion
Cunningham’s manual of practical anatomy, volume 3,
3rd edition 10
Maxillary nerve
Mandibular nerve
www.indiandentalacademy.com
11. B
R
A
N
C
H
E
S
Main divisions
Opthalmic
Wholly Sensory division
Superior and smallest
division
Leaves cranium through
Superior orbital fissure
3 branches
Lacrimal
Frontal
Nasocilliary
Cunningham’s manual of practical anatomy, volume 3,
3rd edition 11www.indiandentalacademy.com
14. O
P
T
H
A
L
M
I
C
N
E
R
V
E
Frontal nerve
Largest branch
Skin of forhead and scalp
Mucous membrane of
frontal sinus and
pericranium
Enter orbit through
superior orbital fissure
Supraorbital branch Supratochlear branch
Upper eyelid
Lower part of forhead
Peter. L. Williams, grays anatomy, 38th edition,1995
14www.indiandentalacademy.com
15. O
P
T
H
A
L
M
I
C
N
E
R
V
E
Nasocilliary nerve
Branches in orbit
In nasal cavity
Supply mucous
membrane of nose
Branches in nasal cavity
Long ciliary nerve
Supply iris , cornea
Posterior ethmoi nerve
Posterior
ethmoid,sphenoidal air
cells
Anterior ethmoidal nerve
Anterior ethmoid, frontal
paranasal
Nasal conchae, anterior
nasal wall
Tip and ala of nose
On face supply lacrimal
gland. Both eyelids and
skin over nasal bridge
Branches on face
B.D. Chaurasia 4th edition
15www.indiandentalacademy.com
16. M
A
X
I
L
L
A
R
Y
N
E
R
V
E
Maxillary nerve
Wholly sensoryBegins at trigeminal
ganglion
Enter orbit through
inferior orbital fissure
and appears on face
through infra orbital
foramen
Leaves through foramen
rotundum
Peter. L. Williams, grays anatomy, 38th edition,1995
16www.indiandentalacademy.com
19. M
A
N
D
I
B
U
L
A
R
N
E
R
V
E
Largest division
Large sensory root, small
motor root
Mandibular nerve
Motor root medial to
sensory
Main trunk 2-3mm
Small anterior and large
posterior branch
B.D. Chaurasia 4th edition
19www.indiandentalacademy.com
21. M
A
N
D
I
B
U
L
A
R
N
E
R
V
E
Meningeal branch
Nerve to medial
pterygoid
Branches of undivided
nerve
Enter skull through
foramen spinosum
Supply dura of middle
and anterior cranial fossa
Slender branch
Supply deep part of
muscle
Also tensor tympani and
tensor velli palati muscle
B.D. Chaurasia 4th edition
21www.indiandentalacademy.com
22. M
A
N
D
I
B
U
L
A
R
N
E
R
V
E
Buccal nerve
Anterior division
Passes between two
heads of lateral pterygoid
Emerge under ramus and
anterior border of
masseter
Supply skin over anterior
part of buccinator and
mucous membrane lining
buccal surface of gums
B.D. Chaurasia 4th edition
22www.indiandentalacademy.com
23. M
A
N
D
I
B
U
L
A
R
N
E
R
V
E
Massetric nerve Passes through
mandibular notch
Deep temporal nerve
Nerve to lateral pterygoid
Supply masseter muscle
Passes above upper head
of lateral pterygoid
Turn above infratemporal
crest and sink into
temporalis
2 branches supplying
each muscle head
B.D. Chaurasia 4th edition
23www.indiandentalacademy.com
25. M
A
N
D
I
B
U
L
A
R
N
E
R
V
E
Lingual nerve
Lies between ramus and
medial pterygoid.
Antriomedial to inferior
alveolar nerve
Base of tongue behind 3rd
molar
Medial to submandibular
duct
Peter. L. Williams, grays anatomy, 38th edition,1995
25www.indiandentalacademy.com
26. M
A
N
D
I
B
U
L
A
R
N
E
R
V
E
Carries sensation from
Anterior two third of the
tongue
Oral mucosa on the floor
of the oral cavity
Lingual gingiva associated
with lower teeth
Peter. L. Williams, grays anatomy, 38th edition,1995
26www.indiandentalacademy.com
27. M
A
N
D
I
B
U
L
A
R
N
E
R
V
E
Inferior alveolar nerve
Large terminal branch of
posterior division
Originates deep to the
lateral pterygoid muscle
in association with
lingual nerve
Passes between
sphenomandibular
ligament and ramus
B.D. Chaurasia 4th edition
27www.indiandentalacademy.com
28. M
A
N
D
I
B
U
L
A
R
N
E
R
V
E
Inferior alveolar nerve
Mylohyoid branch which
supply mylohyoid muscle
Enter the mandibular
foramen
Branches into mental
nerve and incisive nerve
Peter. L. Williams, grays anatomy, 38th edition,1995
28www.indiandentalacademy.com
31. g
a
n
g
l
i
o
n
Ciliary ganglion
Sensory root
Sympathetic root Plexus around opthalmic
artery
Nasocilliary nerve
Parasympathetic root Occulomotor nerve
Peter. L. Williams, grays anatomy, 38th edition,1995
31www.indiandentalacademy.com
32. g
a
n
g
l
i
o
n
Only structurally related
to maxillary nerve
Sphenopalatine/Pterygopalatine
gangalion
B.D. Chaurasia 4th edition
32
Sensory root
Sympathetic root
Plexus around internal
carotid artery
Maxillary nerve
Secrotomotor root Greater petrosal nerve
www.indiandentalacademy.com
35. g
a
n
g
l
i
o
n
Otic ganglion
B.D. Chaurasia 4th edition
35
Sensory root
Sympathetic root
Plexus around middle
meningeal artery
Auriculotemporal nerve
Secrotomotor root Lesser petrosal nerve
www.indiandentalacademy.com
36. g
a
n
g
l
i
o
n
Submandibular ganglion
Lies superficial to
hyoglossus muscle in
submandibular region
Topographically – lingual
branch of mandibular
nerve
Fumctionally – Facial
nerve
Peter. L. Williams, grays anatomy, 38th edition,1995
36www.indiandentalacademy.com
41. D
I
S
T
U
R
B
A
N
C
E
S
A
S
S
O
C
I
A
T
E
D
Treatment
Peripheral neurectomy Alcohol injection into
peripheral nerve area
Injection of boiling water
into ganglion
Surgical sectioning of
trigeminal sensory root
Cranial nerve functional anatomy, Stanley Monkhouse 41
Microsurgical
decompression of
trigeminal root
www.indiandentalacademy.com
46. D
I
S
T
U
R
B
A
N
C
E
S
A
S
S
O
C
I
A
T
E
D
Auriculotemporal
syndrome
Frey syndrome
Due to reinnervation of
sweat glands by
parasympathetic salivary
fibres
Mainly after some
surgical operation like
removal of parotid gland
Sweating and flushing of
the involved side during
eating
Cranial nerve functional anatomy, Stanley Monkhouse 46www.indiandentalacademy.com
47. N
E
R
V
E
B
L
O
C
K
S
Posterior superior
alveolar nerve block
Tuberosity
block/zygomatic block
Pulp of maxillary 3rd
molar, 2nd and 1st molar
(except MB root of 1st
molar), buccal
periosteum and bone
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201347www.indiandentalacademy.com
48. N
E
R
V
E
B
L
O
C
K
S
Middle superior alveolar
nerve block
Pulps of maxillary 1st and
2nd premolar, MB root of
1st molar, buccal
periosteum and bone
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201348www.indiandentalacademy.com
49. N
E
R
V
E
B
L
O
C
K
S
Anterior superior
alveolar nerve block
Infraorbital nerve block
Pulp of maxillary central
incisor to the canine.
In 72% of cases pulp of
maxillary premolars and
MB root of 1st molar.
Buccal periosteum and
bone of these teeth.
Lower eyelid, lateral
aspect of nose, upper lip.
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201349www.indiandentalacademy.com
50. N
E
R
V
E
B
L
O
C
K
S
Greater palatine nerve
block
Anterior palatine nerve
block
Posterior portion of hard
palate and overlying
tissues, anteriorly till the
1st PM and medially till
the midline.
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201350www.indiandentalacademy.com
51. N
E
R
V
E
B
L
O
C
K
S
Nasopalatine nerve block
Incisive nerve block
Anterior portion of hard
palate and overlying
tissues, mesial from the
right 1st PM to the mesial
of the left 1st PM.
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201351www.indiandentalacademy.com
52. N
E
R
V
E
B
L
O
C
K
S
Maxillary nerve block
Second division block/V2
nerve block
Pulpal anaesthesia of
maxillary teeth on the
side of the block.
Buccal periodontium and
bone overlying these
teeth.
Soft tissue and bone of
the hard palate and part
of the soft palate medial
to midline.
Skin of lower eyelid, side
of nose, cheek and upper
lip.
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201352www.indiandentalacademy.com
53. N
E
R
V
E
B
L
O
C
K
S
Inferior alveolar nerve
block
Mandibular block
Mandibular teeth to the
midline.
Body of the mandible,
inferior portion of ramus.
Buccal mucoperiosteum,
mucous membrane
anterior to mental
foramen.
Anterior 2/3rd of tongue
and floor of oral cavity.
Lingual soft tissues and
periosteum.
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201353www.indiandentalacademy.com
54. N
E
R
V
E
B
L
O
C
K
S
Mandibular nerve bolck
3rd division nerve
block/Gow Gates
technique
Mandibular teeth to the
midline.
Body of the mandible,
inferior portion of ramus.
Buccal mucoperiosteum,
mucous membrane on
the side of injection.
Anterior 2/3rd of tongue
and floor of oral cavity.
Lingual soft tissues and
periosteum.
Skin over zygoma and
temporal region.
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201354www.indiandentalacademy.com
55. N
E
R
V
E
B
L
O
C
K
S
Vazirani akinosi tecnique
Closed mouth
mandibular nerve block
Mandibular teeth to the
midline.
Body of the mandible,
inferior portion of ramus.
Buccal mucoperiosteum,
mucous membrane
anterior to mental
foramen.
Anterior 2/3rd of tongue
and floor of oral cavity.
Lingual soft tissues and
periosteum.
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201355www.indiandentalacademy.com
56. N
E
R
V
E
B
L
O
C
K
S
Incisive nerve block
Buccal mucous
membrane anterior to
mental foramen till
midline.
Lower lips.
Pulp of premolars,
canines and incisors.
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;201356www.indiandentalacademy.com
57. C
L
I
N
I
C
A
L
E
X
A
M
I
N
A
T
I
O
N
Clinical examination of
trigeminal nerve
Use sterile sharp item on
forehead, cheek and jaw.
Sensory function
Motor function
While cleching of teeth,
firmnes of masseter will
be felt on both sides
Trigeminal Nerve Injuries. Michael Miloro;2013 57www.indiandentalacademy.com
63. REFERENCES:
B.D. Chaurasia 4th edition
Cunningham’s manual of practical anatomy, volume 3,
3rd edition
Tubbs RS, Loukas M, May WR, Cohen-Gadol AA. A variation of the infraorbital
nerve: its potential clinical consequence especially in the treatment of
trigeminal neuralgia: case report. Neurosurgery. 2010 Sep; 67
Malamad SF. Handbook of local anesthesia. 6th ed. Missouri: Elsevier;2013
Peter. L. Williams, grays anatomy, 38th edition,1995
Trigeminal Nerve Injuries. Michael Miloro;2013
Cranial nerve functional anatomy, Stanley Monkhouse
63www.indiandentalacademy.com