Nervus-trigeminus-EM-II-2018.pdf

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1. Trigeminalnerve
trigeminalneuralgia
Dr. Gábor GERBER
EM II

2. Trigeminalnerve
Largestcranialnerve
Sensoryinnervation:
face, oraland nasalcavity, paranasal
sinuses, orbit, duramater, TMJ
Motor innervation:
musclesof firstpharyngealarch

3. Nucleiof thetrigeminalnerve
nucleusof spinaltrigeminaltract
protopathic
motor nucleusof V. nerve
specialvisceromotoror
branchialmotor
mesencephalicnucleus
proprioceptive
principal(pontine) sensorynucleus
epicritic
diencephalon
mesencephalon
pons
medullaoblongata

4. brainstem,
cisternal (pontocerebellar),
Meckel´s cave,
(Gasserian or semilunar ganglion)
cavernous sinus,
skull base
peripheral branches
Segments of trigeminal nereve

5. Somatotopicorganisation
Sölderlines

6. Mesencephalicnucleus:
pseudounipolarneurons
Trigeminalganglion
Motor root(Radix motoria)
Sensoryroot(Radix sensoria)
Kovách

7. General sensoryinnervation:
skinof thescalpand frontal region,
part of nasalcavity, and paranasalsinuses,
eye,
duramater (anteriorand tentorialregion)
lacrimalgland
Ophthalmicnerve(V/1)

8. •frontal nerve(superior orbital fissure outside thetendinous ring)
osupraorbital nerve(supraorbital notch)
osupratrochlear nerve(supratrochlear notch)
olacrimal nerve(superior orbital fissure outside the tendinous ring)
oCommunicating branch to zygomatic nerve
•nasociliarynerve(superior orbital fissure though the tendinous ring)
oanterior ethmoidal nerve(anterior ethmoidal foramenthen thecribriform plate)
(ant. meningeal, ant. nasal, ext. nasal)
oposterior ethmoidal nerve(posterior ethmoidal foramen)
oinfratrochlearnerve
olong ciliary nerves
osmall communicating branchto theciliary ganglion (n.III), short ciliary nerves
Branches of ophthalmic nerve (V/1)
tentorial branch

9. General sensory innervation:
face, scalp,
nose, palate, teeth,
maxillary sinuses
dura mater,
salivary glands and lacrimal gland
Maxillarynerve(V/2)

10. •meningeal
•zygomatic nerve(inferior orbital fissure)
ozygomaticotemporal nerve(zygomaticotemporal foramen)
ozygomaticofacial nerve(zygomaticofacial foramen)
•infraorbital nerve(inferior orbital fissure theninfraorbital foramen)
oposterior superior alveolar nerve(pterygomaxillary fissure)
omiddle superior alveolar nerve
oanterior superior alveolar nerve
Branchesof maxillarynerve(V/2)
inferior palpebral branch
external nasal branch
superior labial branch
n.VII

11. •nasopalatine nerve(sphenopalatine foramen)
•posterior superior nasal nerves(sphenopalatine foramen)
•greater palatine nerve(greater palatine foramen)
olateral posterior inferior nasal nerve
•lesser palatine nerve(lesser palatine foramen)
•pharyngeal nerve(palatovaginal canal)
Branchesof maxillarynerve(V/2)
palatinenerve
palatovaginalcanal

12. General sensory innervation:
face, scalp
tongue (2/3), teeth,
dura mater,
salivary glands
motor innervation:
muscles of mastication, tensor tympani, tensor veli
palatini, mylohyoid, ant. belly of digastric
Mandibularnerve(V/3)

13. •trunk
•meningeal
•medialpterygoidnerve
•anteriordivision
(4 branches,allmotorexceptone)
odeeptemporalnerves
olateralpterygoidnerves
omassetericnerve
obuccalnerve
•posteriordivision
(3 branches, allsensoryexceptone)
oauriculotemporalnerve(TMJ)
olingualnerve
oinferioralveolarnerve
▪incisivenerve
▪mentalnerve
▪mylohyoidnerve
Branchesof mandibularnerve(V/3)

14. Innervationof
duramater

15. Masseterreflex
(jawjerk, monosynaptic)
Cornealreflex
(polysynaptic)
Reflexes(n.V. afferents)
tearing (n.VII)
salivary(n.VII, n.IX)
sneezing(n.X)
vomiting(n.X)

16. „Guest” fiberstotrigeminalnerve
GVM
(sup. and inf. salivarynucl.
n.VII and n IX)
SVS
(solitarinucl. N. VII)

17. Herpeszoster

18. Trigeminal neuralgia:
excruciating pain in the area of distribution of trigeminal nerve

19. Trigeminal neuralgia: nervecompression

20. Trigeminal neuralgia: vascular compression
Vajda

21. John Y.K. Lee,
Microvascular
decompression
(MVD) surgery
This procedure was
pioneered by
Peter Jannetta, MD

22. Thankyoufor
yourattention
Dr. Gábor GERBER