Professional Documents
Culture Documents
- Dr. Gnanasagar
Contents
Trigeminal Nerve Maxillary bone Mandibular bone Muscles of mastication
Trigeminal nerve
Largest cranial nerve Composed of 1 small motor root 1 large sensory root.
3 branches supply the skin of the ENTIRE FACE & Oral mucosa EXCEPT the pharynx & base of the tongue
Motor root
Originate within the pons & medulla oblongata Unites with the sensory root of mandibular division to form a single nerve trunk, just after their exit from the skull Supply 1. Muscles of mastication, 2. Mylohyoid, 3. Anterior belly of digastric, 4. Tensor tympani, 5. Tensor veli palatini
Sensory root
Comprise the major portion of the trigeminal (semilunar or gasserian) ganglion Ophthalmic division (V1) travels in the lateral wall of the cavernous sinus medial part of the superior orbital fissure enters the orbit Maxillary division (V2) Exits the cranium through F. rotundum Enters the upper part of pterygopalatine fossa Mandibular division (V3) Exits the skull with motor root through F. ovale Enters the infratemporal fossa
Frontal
largest - 2 branches
Nasociliary
1. Long ciliary iris, cornea 2. Short ciliary sensory to ciliary ganglion 3. Infratrochlear lacrimal sac & caruncle 4. Anterior ethmoidal - mucosa of the
anterior part of the nasal septum lateral wall of the nasal cavity
5. Posterior ethmoidal - ethmoidal and sphenoidal sinuses 6. External nasal - skin over nasal tip & ala.
2. Supraorbital
-
Lacrimal - lateral part of the upper eyelid & - adjacent area of skin
Maxillary division
Purely sensory Give branches in 4 places : Within the cranium 1 branch In pterygopalatine fossa - 3 branches In the Infraorbital canal - 2 branches On the face - 3 branches
Maxillary Division
Within the cranium Middle meningeal nerve In pterygopalatine fossa
1. Zygomatic nerve 2 branches 2. Pterygopalatine nerve - 4 branches 3. Posterior superior alveolar nerve - 2 branches
On the face
1. Inferior palpebral branches 2. External nasal branches 3. Superior labial branches
Maxillary division
Within the cranium
Middle meningeal - sensory to duramater
In pterygopalatine fossa 1. Zygomatic nerve - enter orbit thro inferior orbital fissure & divides into i. zygomaticotemporal
- skin on the side of the forehead
ii. zygomaticofacial
- skin on the prominence of the cheek
2. Pterygopalatine nerve
1. Orbital branch - orbital periosteum 2. Nasal branch - mucosa of the superior & middle conchae, lining of the posterior ethmoidal sinuses posterior part of nasal septum Nasopalatine nerve - ant part of nasal septum & floor of the nose & palatal mucosa in the region of the premaxilla (canines to central incisors)
3. Palatine branch i. Greater palatine nerve - sensory to the palatal soft tissues & bone anterior to the first premolar ii. Lesser palatine nerve - mucosa over the soft palate
4. Pharyngeal branch - mucosa of the nasopharynx posterior to the auditory (eustachian) tube.
In the Infraorbital canal Here max nerve is called infraorbital nerve, 1. Middle superior alveolar (MSA) nerve 2 maxillary PM mesiobuccal root of the 1st molar PDL, buccal mucosa, bone in PM region 2. Anterior superior alveolar (ASA) nerve central & lateral incisors and the canine PDL, buccal bone, and mucous membranes of these teeth
Dental Plexus
Individual roots of all teeth, bone & PDL in both Mx+Md are innervated by the terminal branches of larger nerves in that region. These nerve networks are termed the dental plexus. Superior dental plexus for maxilla. Inferior dental plexus for mandible.
3 types of nerves emerge from these plexuses & are accompanied by a corresponding artery 1. Dental nerves, 2. Interdental branches 3. Interradicular
Dental nerve enters the tooth through the apical foramen, supplying the pulp Interdental br.- provide sensory innervation to the PDL of adjacent teeth, the interdental papillae and buccal gingiva. Interradicular br.- provide sensory supply to the PDL of adjacent roots. Terminate in the PDL @ furcations.
On the face: 3 branches 1. Inferior palpebral branches - the skin of the lower eyelid 2. External nasal branches - skin on the lateral aspect of the nose 3. Superior labial branches -skin and mucous membranes of the upper lip
Mandibular Nerve
Give off branches in 3 areas: From undivided nerve trunk 2 br. Anterior division branches 4 br. Posterior division branches 3 br.
From the main trunk:1. Nervus spinosus (meningeal branch of the mandibular nerve)
duramater mastoid air cells
Anterior division branches: 1. Nerve to masseter 2. Nerve to temporalis 3. Nerve to lateral pterygoid 4. Buccal or long buccal or buccinator nerve
- Crosses in front of anterior border of ramus @ the occlusal level opposite to the md II or III molar - Enters cheek through the buccinator muscle - Supply buccal gingiva of the md molars & the mucobuccal fold in that region
Buccal nerve
Posterior division branches: 1. Auriculotemporal nerve TMJ 2. Lingual nerve run anteromedial to Infr. Alv Nerve, general sensation for anterior 2/3rd of tongue mucosa of the floor of the mouth lingual gingiva enters mandibular canal thro md foramen Along with inferior alveolar artery & vein Supply pulp & buccal PD tissues of md Ms
Auriculotemporal nerve
ii.
Mental nerve buccal mucosa anterior to mental foramen till the midline & skin of the lower lip & chin of that side.
4. Mylohyoid nerve
-
branches from the inferior alveolar nerve before it enters the mandibular canal, a mixed nerve motor to the mylohyoid muscle & anterior belly of the digastric, sensory to the skin on the inferior & anterior surfaces of the mental protuberance & mandibular incisors.
Lingual nerve
Maxillary bone
Porous cancellous bone permits infiltration anesthesia In many areas, bone over the apices of the maxillary teeth either is paper-thin / absent (dehiscence). Posterior superior alveolar nerves & blood vessels enter the infratemporal surface of the maxilla through several alveolar canals. The maxillary tuberosity is a rounded eminence posterior to the III molar.
Maxillary nerve passes on the superior surface of the maxilla in a groove, directed laterally and slightly superiorly, continuous with the infraorbital groove. The palatal processes of the maxilla are thick horizontal projections that form a large portion of the floor of the nose and the roof of the mouth Makes the anterior three fourths of the hard palate
Mandibular bone
Bone is Thicker on the external surface of the mandible. Thinner along the labial alveolar processes in the anterior region (incisors) permitting infiltration anesthesia. Mental foramen is in the region of the 2nd premolar on each side, midway between the upper & lower borders of the body. The mental nerve, artery & vein exit the mandibular canal through this.
Coronoid notch on the anterior border of ramus represents a landmark tor determining the height of needle penetration for inferior alveolar nerve block.
The ramus at the level of the mandibular foramen is thicker in its anterior region than posteriorly. This is of clinical importance during the inferior alveolar nerve block. The thickness of soft tissues between needle penetration and the bone of the ramus at the level of the mandibular foramen averages about 20 to 25 mm
Muscles of mastication
Muscle Masseter Origin 1. Zygomatic process of maxilla 2. Medial & infr surface of zyg bone Temporal fossa Attachment Action 1. Angle of md 1. Closes mandible, 2. Ramus 2. Clenches teeth 3. Latl surface of coronoid process 1. Coronoid process 1. Closes mandible, 2. Anterior border 2. Clenches teeth of ramus 1. Medial surface of ramus 2. Angle of mandible 1. Elevate the mandible 2. Side to side jaw movement
Temporalis
Medial Pterygoid
1. Medial surface of latl pterygoid plate 2. Palatine bone & maxillary tuberosity
Lateral Pterygoid
Superior head disc 1. Open jaw Supr head lat side 2. Protrudes md of TMJ of gr wing of sphenoid 3. Moves mandible Infr head lat side of Inferior head sidewards neck of condyle latl pterygoid plate
Muscles of mastication
Temporalis
Masseter
Medial pterygoid
Lateral pterygoid
Summary