20.

TRIGEMINAL NERVE

Trigeminal Nerve
Trigeminal nerve is the 5th cranial nerve. It is a mixed nerve containing both the motor
and sensory fibres but predominantly it is sensory. Trigeminal nerve is the nerve of first brachial
arch. It comprises three branches, two of which are purely sensory and third, the largest branch
is mixed nerve. Its sensory ganglion (largest in the body) is located within the cranial cavity.

Nuclear Columns
Ö General somatic afferent column: This column has three nuclei. These are:
○ Spinal nucleus of Vthnerve: Fibres conveying pain and temperature sensations from most of
the face area relay here.
○ Principle sensory nucleus of Vth nerve: Fibres carrying touch and pressure relay in this
nucleus.
○ Mesencephalic nucleus: This nucleus extends in the midbrain. It receives proprioceptive
impulses from muscles of mastication, temporomandibular joint and teeth.
Ö Branchial efferent column: The nucleus of Vth nerve is situated at the level of upper pons.

Sensory Components of Vth Nerve

Gasserian ganglion or semilunar ganglion
Ö It lies at the apex of petrous temporal bone in a dural cave, the Meckel’s cave. Sensations of

Trigeminal Nerve 151

 pain, temperature, touch and pressure from skin of face, mucous membrane of nose, most of
the tongue, paranasal air sinuses travel along this axons. Their cell bodies lie in the Vth ganglion
or semilunar ganglion.
Ö The central processes of Vth ganglion form sensory root. Ascending fibres end in superior
sensory nucleus. Descending fibres end in the spinal nucleus of Vth nerve.
Ö Pain and temperature reach spinal nucleus. Touch and pressure sensations go to superior
sensory nucleus.
Spinal nucleus:
✓ Ophthalmic nerve fibres - inferior part.
✓ Maxillary nerve fibres - middle part.
✓ Mandibular nerve fibres - upper part.

Motor Component for the Muscles

Ö The motor nucleus receives impulses from the right and left cerebral hemispheres, red nucleus
and mesencephalic nucleus.
Ö Fibres of motor root supply four muscles of mastication (temporalis, masseter, lateral pterygoid
and medial pterygoid) and four other muscles which are tensor veli palatini, tensor tympani,
mylohyoid and anterior belly of digastric.
Branches of Trigeminal Nerve
Ö Trigeminal nerve comprise three branches—ophthalmic (V1),maxillary(V2) and mandibular(V3).
Trigeminal Nerve 16
2
 Ophthalmic Nerve
Ö The ophthalmic nerve (purely sensory) arises from the anterolateral aspect of the
ganglion and enters the lateral wall of the cavernous sinus where it lies below the trochlear
nerve. In the cavernous sinus, it divides into three branches: nasociliary, lacrimal, and frontal.
All these branches enter the orbit through the superior orbital fissure.
Frontal
Ö Supratrochlear: Upper eyelid, conjunctiva and lower part of forehead.
Ö Supraorbital: Frontal air sinus, upper eyelid, forehead and scalp till vertex.
Nasociliary
Ö Long ciliary: Sensory to eyeball.
Ö Branch to ciliary ganglion.
Ö Posterior ethmoidal: Sphenoidal air sinus, posterior ethmoidal air sinuses.
Ö Anterior ethmoidal:
○ Middle and anterior ethmoidal sinuses
○ Medial internal nasal c. Lateral internal nasal
○ External nasal: Skin of ala of vestibule and tip of nose.
Ö Infratrochlear: Both eyelids, side of nose, lacrimal sac.
Lacrimal
Ö Lateral part of upper eyelid; conveys secretomotor fibres from zygomatic nerve to lacrimal
gland.

Trigeminal Nerve 173

 Maxillary Nerve
Ö The maxillary nerve (purely sensory) arises from the ganglion and enters the lateral wall of the
cavernous sinus where it occupies the lowest position and leaves the cavernous sinus to enter
the pterygopalatine fossa through the foramen rotundum.

Trigeminal Nerve 18
4
 In Middle Cranial Fossa
Ö Meningeal branch
In Pterygopalatine Fossa
Ö Ganglionic branches
Ö Zygomatic: (sensory) a. Zygomaticotemporal b. Zygomaticofacial
Ö Posterior superior alveolar
In Infraorbital Canal
Ö Middle superior alveolar
Ö Anterior superior alveolar
On Face
Ö Infraorbital (Sensory)
○ Palpebral
○ Labial
○ Nasal

Trigeminal Nerve 195

 Mandibular Nerve
Ö The mandibular nerve (the largest division) arises from the trigeminal ganglion and
immediately enters the infratemporal fossa through the foramen ovale. The motor root of the
trigeminal nerve after emerging from the pons passes forward and laterally deep to the sensory
root and trigeminal ganglion and enters the infratemporal fossa through the foramen ovale.
Trunk
Ö Meningeal Branch
Ö Nerve to medial pterygoid supplies:
○ Tensor veli palatini
○ Tensor tympani
○ Medial pterygoid.
Ö Meningeal Branch or Nervus Spinosus enters the skull through the foramen spinosum with the
middle meningeal artery and supplies the dura mater of the middle cranial fossa.
Ö Nerve to Medial Pterygoid arises close to the otic ganglion and supplies the medial pterygoid
from its deep surface. This nerve gives a motor root to the otic ganglion.
From Anterior Division
(Motor)
Ö Deep temporal
Ö Lateral pterygoid
Ö Masseteric
Ö Buccal—skin of cheek (sensory)
○ Deep Temporal Nerves two nerves—anterior and posterior. They pass between the skull and
the lateral pterygoid, and enter the deep surface of the temporalis.
○ Nerve to Lateral Pterygoid enters the deep surface of the muscle.
○ Masseteric Nerve emerges at the upper border of the lateral pterygoid just in front of the
temporomandibular joint and supplies the temporomandibular joint.
From Posterior Division
Ö Auriculotemporal
○ Auricular
○ Superficial temporal
○ Articular to temporomandibular joint
○ Secretomotor to parotid gland.
Ö Lingual—general sensation from anterior two-thirds of tongue.
Ö Inferior alveolar—lower teeth, mental for skin of chin and nerve to mylohyoid which also supplies:
Trigeminal Nerve 20
6
 a. Mylohyoid b. Anterior belly of digastric.
○ Auriculotemporal Nerve arises by two roots which run backwards, encircle the middle
meningeal artery, and unite to form a single trunk .The auricular part of the nerve supplies
the skin of the tragus; and the upper parts of the pinna, the external acoustic meatus and the
tympanic membrane. The temporal part supplies the skin of the temple. Auriculotemporal
nerve also supplies the parotid gland and the temporomandibular joint.
○ Lingual Nerve one of the two terminal branches of the posterior division of the mandibular
nerve. It is sensory to the anterior two-thirds of the tongue and to the floor of the mouth.
Lingual nerve begins 1 cm below the skull. About 2 cm below skull, it is joined by chorda
tympani nerve at an acute angle. Then it lies in contact with mandible medial to 3rd molar
tooth. Finally, it lies on surface of hyoglossus and genioglossus to reach the tongue.
○ Inferior Alveolar Nerve : larger terminal branch of the posterior division of the mandibular
nerve .It enters the mandibular foramen and runs in the mandibular canal. It is accompanied
by the inferior alveolar artery.
Branches
✓ The mylohyoid branch contains all the motor fibres of the posterior division. It arises just
before the inferior alveolar nerve and enters the mandibular foramen.
✓ While running in the mandibular canal the inferior alveolar nerve gives branches that supply
the lower teeth and gums.
✓ The mental nerve emerges at the mental foramen and supplies the skin of the chin, and the
skin and mucous membrane of the lower lip.
✓ Its incisive branch supplies the labial aspect of gums of canine and incisor teeth.

Trigeminal Nerve 217

 Distribution of mandibular division of trigeminal nerve.

Clinical Anatomy
✓ Trigeminal neuralgia (Tic douloureux): It is a clinical condition which presents as a paroxysmal
episodes of severe pain of sudden onset and short duration in the area of distribution of one
or more of the three divisions of the trigeminal nerve.
✓ Ophthalmic nerve injury: There is loss of corneal blink reflex. This reflex is mediated by V1
which is afferent pathway and VIIth nerve which subserves as efferent pathway.
✓ Maxillary nerve injury: There is loss of sneeze reflex. This branch is the afferent path of
sneeze reflex.
✓ Mandibular nerve injury: There is loss of jaw jerk reflex.
✓ Flaccid paralysis of muscles of mastication in injury of mandibular nerve leading to decrease
strength for biting.

Trigeminal Nerve 22
8
 Summary of Trigeminal Nerve

Ophthalamic Upper third of the face including eyeball, conjunctivae, nasal cavity,
(sensory) lacrimal gland, scalp up to vertex. Ophthalamic nerve also forms the
afferent limb of corneal reflex.

Maxilary Middle third of the face including most of nasal cavity, upper teeth and
(sensory) gums, maxillary sinus, mucous membrane of pharynx, palate, duramater
of middle cranial fossa. Maxillary nerve conveys secretomotor fibres to
the lacrimal gland and the glands of palate, nose, and oral cavity.

Mandibular Sensory: Lower third of the face (except the small area over the angle of
(mixed) mandible)including part of auricle,temple
Motor: Muscles of mastication, mylohyoid, anterior belly of digastric
tensor palati and tensor tympani. Mandibular nerve forms both the limbs
of masticatory reflex.

Trigeminal Nerve 23
9