Trigeminal Nerve Cranial Nerve V

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The trigeminal nerve forms two primary ARPs on the face, and their locations are easily defined. Nevertheless, the trigeminal nerve is one of the most complicated peripheral nerves. A comprehensive description of its anatomic and functional physiologic features is helpful for understanding its relationship to facial pathologic processes.

The trigeminal nerve provides sensory innervation to the face. It also has a small branchial motor root, which travels with the mandibular division and is responsible for controlling the muscles of mastication and some other smaller muscles. It should be distinguished from the facial nerve, which controls the muscles of facial expression.

The trigeminal nerve exits the brainstem from the ventrolateral pons and enters a small fossa just posterior and inferolateral to the cavernous sinus called Meckel's cave. The trigeminal ganglion lies in Meckel's cave and is a sensory ganglion. The ophthalmic division (V1) travels through the inferior part of the cavernous sinus to exit the skull through the superior orbital fissure, where an ARP is formed (H23). The maxillary division (V2) exits via the foramen rotundum and penetrates the inferior orbital foramen, where another ARP is formed. The mandibular division (V3) exits via the foramen ovale and courses to the face through the mental foramen, where the third ARP of the trigeminal sensory nerve is located. The sensory territories of the three branches are shown in Figure 8-4. The trigeminal nerve also conveys touch and pain sensation for the nasal sinuses, the inside of the nose and mouth, and the anterior two thirds of the tongue.

The trigeminal nuclei receive general somatic sensory inputs from the nerve's own input and from other cranial nerves. Smaller inputs from the facial nerve (VII), glossopharyngeal nerve (IX), and vagus nerve (X) convey sensation for part of the external ear.

The trigeminal nuclear complex runs from the midbrain to the upper cervical spinal cord and contains three nuclei: the mesencephalic, main sensory,

Median

Common palmar digital nerves

Proper palmar digital nerves

Musculocutaneous nerve, lateral cutaneous nerve of forearm

Radial nerve, inferior lateral /cutaneous nerve of arm

Palmar branch

Radial nerve, superficial branch

Axillary nerve, superior lateral cutaneous nerve of arm

Proper palmar Ulnarl digital nerves nerve Common palmar digital nerves

Radial nerve, superficial branch

Medial cutaneous [Anterior branch nerve of forearm Posterior branch

Radial nerve, inferior lateral /cutaneous nerve of arm

Axillary nerve, superior lateral cutaneous nerve of arm

Medial cutaneous [Anterior branch nerve of forearm Posterior branch

Supraclavicular nerves Anterior pectoral cutaneous branches Intercostal

Lateral pectoral cutaneous branches

Intercostobrachial nerve Medial cutaneous nerve of arm nerve

Axillary nerve, superior lateral cutaneous nerve of arm

Posterior cutaneous nerve of arm

Inferior lateral cutaneous nerve of arm Posterior cutaneous

Supraclavicular nerves nerve of forearm Musculocutaneous nerve, lateral

Thoracic nerves, posterior cutaneous branches

Axillary nerve, superior lateral cutaneous nerve of arm

Inferior lateral cutaneous nerve of arm Posterior cutaneous

Supraclavicular nerves nerve of forearm Musculocutaneous nerve, lateral

Thoracic nerves, posterior cutaneous branches

Radial nerve, posterior cutaneous nerve of arm

Medial cutaneous nerve of arm

Figure 8-11 Cutaneous nerves of the upper limb. A, Anterior view. B, Posterior view.

Radial nerve

Radial nerve, posterior cutaneous nerve of arm

Medial cutaneous nerve of arm

┬╗Superficial branch

Communicating branch with ulnar nerve Dorsal digital branches

Median nerve, proper palmar digital nerves

Proper palmar digital nerves Dorsal digital Ulnar nerve branches Dorsal branch Medial cutaneous nerve of forearm

Radial nerve

Figure 8-11 Cutaneous nerves of the upper limb. A, Anterior view. B, Posterior view.

and spinal trigeminal nuclei. The mesencephalic nucleus is the only one in which primary sensory neurons lie within the central nervous system instead of in a peripheral ganglion. This nucleus conveys proprioceptive input from the muscles of mastication and probably from the tongue and extraocular muscles. The other two nuclei serve as major sensory systems for fine and touch, pressure, pain, and temperature.

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