H&na: Trigeminal Nerve

Front 1

Name the branches that the ophthalmic nerve breaks up into after exiting the trigeminal ganglion.

Back 1

1) Meningeal branch -> tentorium cerebelli

2) Lacrimal nerve

3) Frontal nerve

4) Nasociliary nerve

Front 2

Lacrimal nerve:

1) What is it a branch of?
2) Where does it pass?
3) What does it pick up? What nerve does it communicate with?
4) What modality does it supply?

Back 2

1) Ophthalmic nerve
2) Lateral wall of orbit
3) Hitchhiking postsynaptic secretory fibers from pterygopalatine ganglion, delivers them to lacrimal gland. Communicates with zygomatic nerve.
4) Sensory from lateral aspect of upper lid, conjunctiva

Front 3

Frontal nerve:

1) What is it a branch of?
2) Where does it pass?
3) What does it branch into

Back 3

1) Ophthalmic nerve
2) Forward below the orbital roof
3) Supraorbital and supratrochlear

Front 4

Branches of the frontal nerve:

1) What are they?
2) What does the supraorbital branch into, where do they exit, and what do they supply?
3) What does the supratrochlear nerve share fibers with? What does it supply?

Back 4

1) Supraorbital and medial supratrochlear
2) Supraorbital branches into medial and lateral - exit orbit via supraorbital foramen - sensory for upper eyelid, frontal sinus
3) Infratrochlear nerve - sensory for skin of roof of nose, upper eyelid, medial portion of forehead

Front 5

1) Ethmoidal nerves come off what branch of the ophthalmic? What do they supply?

Back 5

1) Nasociliary - sensory from mucosa of nasal cavity, ethmoidal air cells, skin of distal potion of nose

Front 6

1) The oculomotor nerve (CN III) that enters orbit with ophthalmic nerves contain what modalities?

2) Where do these fibers synapse?

3) Postganglionic fibers from the ciliary ganglion travel through what nerves?

Back 6

1) 1. Somatic motor fibers (motor to turn eyeball). 2. visceral motor fibers (parasympathetic innervation to constrict pupil, accomodate lens of eye)

2. Ciliary ganglion

3. Travel through short ciliary nerves -> constrictor pupillae (constrict pupil), ciliary muscles of eye (keep eyeball round)

Front 7

What kind of fibers from the carotid artery move onto the ophthalmic nerve? Where do they travel?

Back 7

Postganglionic sympathetic fibers -> short and long ciliary nerves.

Other sympathetic fibers travel through separate sympathetic root -> short ciliary nerves only. Synapse on smooth muscle in blood vessels, travel to dilator pupillae.

Front 8

Ciliary nerves:

1) Branch of what main nerve?
2) What modality do they provide, and from where?

Back 8

1) Nasociliary branch
2) Eyeball in general, cornea

Front 9

Describe all the somatic sensory pathways in the opthalmic nerve (what branches they're coming from, what part of the face they're bringing sensory from)

Back 9

1) Lacrimal nerve - sensory from upper part of eyelid, conjunctiva

2) Supraorbital nerve - medial + lateral branches sensory from upper part of eyelid, maxillary sinus

3) Supratrochlear nerve (communicates with infratrochlear) - sensory from medial part of forehead, upper eyelid, skin of roof of nose

4) Long ciliary nerves - sensory from eyeball in general, cornea

5) Ethmoidal nerves - sensory from ethmoidal air cells, mucosa of nasal cavity, skin of distal portion of nose

Front 10

Describe all the parasympathetic motor pathways in the ophthalmic nerve.

Back 10

Oculomotor nerve -> ciliary ganglion -> short ciliary nerves to constrictor pupillae, ciliary muscles of eye

Front 11

Describe all the sympathetic motor pathways in the ophthalmic nerve.

Back 11

Postsynaptic fibers from superior cervical ganglion -> internal carotid plexus -> short and long ciliary nervecs -> dilator pupillae and smooth muscle in blood vessels

Front 12

What does the maxillary nerve supply?

Back 12

Sensory from face, lower eyelid, mucous membranes of cheek, nose, paranasal sinuses, gums and teeth of upper jaw

Front 13

What bony landmarks does the maxillary nerve pass through?

Back 13

Foramen rotundum, inferior orbital fissure

Front 14

What does the maxillary nerve branch into in the pterygopalatine fossa?

Back 14

1) Zygomatic nerve
2) Infraorbital nerve
3) Posterior superior alveolar nerve

Front 15

Zygomatic nerve:

1) Branch of what nerve?
2) What does it branch into?
3) What does each of these branches supply?

Back 15

1) Maxillary nerve
2) Zygomaticotemporal branch, zygomaticofacial branch
3) Zygomaticotemporal branch - sensory from skin over temple

Zygomaticofacial branch - sensory from skin on faical surface of zygomatic bone

Front 16

Posterior superior alveolar nerve:

1) Branch of what nerve?
2) When does it branch off?
3) What does it supply sensation from?

Back 16

1) Maxillary nerve
2) Before inferior orbital fissure
3) Supplies sensation from roots of maxillary molars.

Front 17

Middle superior alveolar nerve:

1) Branch of what nerve?
2) When does it branch off?
3) Supplies sensory to?

Back 17

1) Infraorbital nerve
2) After inferior orbital fissure, before infraorbital foramen
3) Premolars, MB root of first molar

Front 18

Anterior superior alveolar nerve:

1) Branch of what nerve?
2) When does it branch off?
3) Supplies sensory to?

Back 18

1) Infraorbital nerve (maxillary)
2) After inferior orbital fissure, before the infraorbital foramen
3) Canine and incisors, mucous membrane on floor of nose

Front 19

What bony landmarks does the maxillary nerve travel through?

Back 19

Foramen rotundum, inferior orbital fissure, inferior orbital foramen

Front 20

What bony landmarks does the ophthalmic nerve travel through?

Back 20

Superior orbital fissure, supraorbital foramen

Front 21

1) What does the pterygopalatine ganglion hang from?

2) What system is it part of?

3) What does it interact with directly?

Back 21

1) Maxillary nerve, via two roots

2) Parasympathetic nervous system

3) Nerve of pterygoid canal (Vidian canal)

Front 22

Pterygoid canal:

1) What is it made up of, and what are they carrying?
2) What does this canal interact with?

Back 22

1) Merging of two nerves:

a) Greater petrosal nerve - CN VII, preganglionic PS fibers, synapse in pterygopalatine ganglion, go to lacrimal and mucous glands. Also taste from palate.

b) Deep petrosal nerve - postganglionic sympathetic fibers from internal carotid plexus of sympathetic fibers, goes to blood vessels and mucous glands

Front 23

What branches off the pterygopalatine ganglion, and what does it supply? (5)

Back 23

1. Pharyngeal branch - sensory/autonomic fibers to mucous membranes of the nasopharynx and sphenoidal sinus

2. Lesser palatine nerves (lesser palatine canals) - sensory/autonomic fibers to mucous membranes of soft palate, adjacent portions of tonsils

3. Greater palatine nerve (exit ganglion in sep. or joint root with lesser, descend in greater palatine canal) -> branches to mucosa covering inferior concha of nasal cavity, sensory, parasympathetic fibers, taste fibers to soft/hard palates. Extends to area of incisor teeth.

4. Superior posterior nasal nerves - sensory/autonomic fibers to posterior ethmoidal sinuses, area of two upper nasal conchae

5. Nasopalatine nerve - communicates with terminal fibers of greater palatine nerve - supplies mucosa of anterior aspect of hard palate

Front 24

What are the branches off the mandibular nerve before it splits into the anterior and posterior trunk?

Back 24

1) Meningeal branch (nervus spinosus)

3) Motor branches to tensor veli palatini
4) Motor branches to tensor tympani muscles
5) Motor to medial pterygoid muscle

Front 25

What are the branches of the posterior trunk of the mandibular nerve?

Back 25

1) Lingual nerve
2) Auriculotemporal nerve
3) Inferior alveolar nerve

Front 26

What are the functions associated with the auriculotemporal nerve?

Back 26

PS innervation of parotid gland, sensory from TMJ, sensory for skin of lateral aspect of auricle, skin on lateral aspect of head.

Front 27

Postganglionic sympathetic fibers from the internal carotid plexus travel where on the mandibular nerve?

Back 27

On middle meningeal artery -> auriculotemporal nerve -> parotid gland

Front 28

Infraorbital nerve:

1) Branch of what nerve?
2) What does it branch into?

Back 28

1) Maxillary
2) Middle superior alveolar nerve, anterior superior alveolar nerve

Front 29

What bony landmarks does the maxillary nerve travel through?

Back 29

Foramen rotundum, then inferior orbital fissure, infraorbital foramen (infraorbital nerve)

Front 30

After exiting the infraorbital foramen, what does the infraorbital nerve divide into?

Back 30

Branches that supply sensory to upper lip, skin over cheek, lateral aspect of nose and lower eyelid

Front 31

Describe all the general sensory pathways in the maxillary nerve.

Back 31

1) Zygomatic nerve -> zygomaticofacial, zygomaticotemporal

2) Pterygopalatine ganglion -> lesser palatine and greater palatine nerves

3) Posterior superior alveolar nerve

4) Middle alveolar nerve

5) Anterior alveolar nerve

6) Palpebral, nasal, superior labial nerve

Front 32

Describe the pathway of taste in the maxillary nerve.

Back 32

Carried from lesser palatine (soft palate) and greater palatine (soft and hard palates) to pterygopalatine ganglion.

Front 33

Describe the sympathetic motor pathways the maxillary nerve.

Back 33

Postganglionic fibers from pterygopalatine ganglion (lesser/greater palatine nerve, lateral/medial posterior superior nasal nerves, pharyngeal branches, nasopalatine nerve) travel through maxillary nerve -> zygomatic nerve -> a) directly to lacrimal nerve or b) zygomatic nerve -> zyngomaticotemporal nerve -> lacrimal nerve -> lacrimal gland to stimulate lacrimal secretions.

Front 34

Describe the parasympathetic motor systems in the maxillary nerve.

Back 34

Greater petrosal nerve carries preganglionic parasympathetic motor from facial nerve synapses in pterygopalatine ganglion, travels to stimulate lacrimal gland.

Lesser, greater palatine nerves carry PS nerves to soft/soft and hard palate, respectively.

Zygomatic nerve carries parasympathetic fibers to lacrimal nerve

Front 35

Mandibular nerve:

1) What are the nerves that branch off after gaining access to the infratemporal fossa?

2) What are the branches of the posterior trunk?

Back 35

1) Nervus spinosus
2) Motor to tensor veli palatini
3) Motor to tensor tympani
4) Motor to medial pterygoid muscle

2) Auriculotemporal nerve, inferior alveolar nerve, lingual nerve

Front 36

Nervus spinosus:

1) Branch of what nerve?
2) What bony landmark does it pass through?
3) What does it supply?

Back 36

1) Mandibular
2) Foramen spinosum
3) Sensory to meninges

Front 37

Auriculotemporal nerve:

1) Branch of what nerve?
2) What major structures does it pass across/through?
3) Functions?

Back 37

1) Posterior trunk of mandibular nerve
2) Neck of ligament, TMJ, THROUGH parotid gland, zygoma, earlobe
3) Parasympathetic innervation of the parotid gland, sensory from TMJ, sensory from skin on lateral aspect of auricle, skin on lateral aspect of the head

Front 38

How do fibers from the postganglionic sympathetic fibers from the internal carotid plexus travel to the auriculotemporal nerve? Where are they traveling to?

Back 38

Postganglionic sympathetic fibers from internal carotid plexus -> middle meningeal artery -> auriculotemporal nerve -> parotid gland

Front 39

Parotid gland:

1) What innervates it parasympathetically?

2) What innervates it sympathetically?

Back 39

1) Postganglionic parasympathetic fibers on the auriculotemporal nerve

2) Postganglionic sympathetic fibers from INTERNAL CAROTID PLEXUS -> middle meningeal artery -> auriculotemporal nerve

Front 40

Lingual nerve:

1) What modality does the lingual nerve carry?

2) What structures in the oral cavity does it supply?
2) What do postganglionic sympathetic fibers exit from, and how do they interact with the lingual nerve?

Back 40

1) Sensory

2) Exit from plexus on the facial artery, join with the terminal portion of the lingual nerve to supply salivary glands associated with nerve.

3) Mucous membranes of the floor and side of the mouth

Front 41

Chorda tympani:

1) Branch of?
2) What runs within the chorda tympani?
3) What ganglion does it run to? What do postganglionic parasympathetic fibers run to?

Back 41

1) CN VII
2) a) Parasympathetic preganglionic fibers that run to submandibular ganglion, b) taste fibers carrying taste from anterior 2/3 of the tongue
3) Submandibular ganglion that hangs from lingual nerve - postgang run to submandibular gland, sublingual, salivary glands in the tongue

Front 42

How can the lingual nerve be injured?

What must be evaluated for possible injury if you hurt the lingual nerve?

Back 42

1) Mandibular block/lingual nerve injection
2) Relaxing incision placed posterior to first or second bicuspid
3) Lingual nerve stretched/injured if lingual flap of tissue covering 3rd molar is not freed up prior to elevating the tooth
4) Injured during elevation of posterior molars if elevator slips
5) Using disk/slip

Submandibular duct

Front 43

Inferior alveolar nerve:

1) Branch of which nerve?
2) What bony landmark does it pass through?
3) What does it give off before it passes through the bony landmark?
4) What does it carry?
5) What second bony landmark does it pass through, and what nerve does it become then?

Back 43

1) Mandibular
2) Mandibular foramen
3) Mylohyoid nerve
4) Sensory fibers to teeth of mandible, sensory from buccal gingiva (incisors, canines, premolars)
5) Mental foramen, mental nerve

Front 44

Mylohyoid nerve:

1) Branch of what nerve?
2) What does it carry?

Back 44

1) Mandibular (inferior alveolar nerve)
2) Motor to mylohyoid and anterior digastric muscles

Front 45

1) What modality are branches of the anterior trunk of the mandibular nerve associated with?

2) What branches does the anterior branch of the mandibular nerve give off?

Back 45

1) Branchial motor

2) Posterior and anterior deep temporal nerve, nerve of the masseter, branch that supplies lateral pterygoid muscle

Front 46

Nerve to the masseter:

1) What is it an offshoot of?
2) What merges with it?

Back 46

1) Anterior trunk of mandibular nerve
2) Sensory fibers merge with it, sensation from TMJ travel in it

Front 47

All branches of the mandibular nerve are motor branches EXCEPT:

Back 47

Buccal nerve - sensory nerve that carries sensation from mucous membranes of cheek, possible sensation from lower premolar/first molar, gingiva from buccal gingiva in mandibular molars

Front 48

What innervates buccal gingiva over maxillary:

1) Central/lateral incisors, canines
2) Labial and buccal gingiva over premolars
3) Labial and buccal gingiva over 1st, 2nd, 3rd molars

Back 48

1) branches of anterior superior alveolar nerve/labial branches of infraorbital nerve
2) branches of middle superior alveolar nerve
3) branches of posterior superior alveolar nerve

Front 49

What innervates lingual gingiva over:

1) Maxillary incisors and canine
2) Maxillary premolars and molars

Back 49

1) Nasopalatine nerve
2) Greater palatine nerve

Front 50

What innervates the buccal gingiva over:

1) Mandibular incisors, canines, and premolars
2) Mandibular molars

What innervates lingual gingiva in the mandible?

Back 50

1) Inferior alveolar nerve
2) Gingival branches of buccal branch of mandibular nerve

Gingival branches of the lingual nerve

Front 51

What innervates:

1) Maxillary central incisors, lateral incisors, and canines?
2) First and second premolars and mesiobuccal root of first molar
3) Remainder of first molar, second molar, third molar
4) Mandibular teeth

Back 51

1) Anterior superior alveolar nerve
2) Middle superior alveolar nerve
3) Posterior superior alveolar nerve
4) All mandibular teeth = inferior alveolar nerve

Front 52

What two modalities does CN V carry when it exits the brain?

Back 52

Somatic sensory and branchial motor.

Front 53

When you anesthetize the mandibular molar, you're anesthetizing the lingual nerve and you lose taste. What is going on?

Back 53

Taste fibers hop onto the lingual nerve later - when CN V leaves, it's only carrying somatic sensory and branchial motor.

Front 54

Why can you do a direct injection to the posterior superior alveolar nerves, but not the middle/anterior superior alveolar nerves?

Back 54

Posterior superior alveolar nerve sits on top of maxilla, middle/anterior are buried underneath the maxillary sinus. No direct access, need to use infiltration to catch end of nerves when they get near the cheek.

Front 55

What goes through the incisive foramen?

Back 55

Nasopalatine nerve - supplies mucosa on anterior aspect of plate, communicates with greater palatine nerve.

Front 56

What is the palatovaginal canal? What does it connect?

Back 56

Tube in the head that sends fibers to pharynx and palate. Connects pterygopalatine fossa with nasal cavity (deep petrosal nerves sending fibers down)

Front 57

What carries taste from the anterior 2/3 of the tongue? What carries taste from the palate?

How does this relate to CNV?

Back 57

Chorda tympani, greater petrosal nerve.

Chorda tympani joins lingual nerve in infratemporal fossa.

Front 58

What is Bell's Palsy?

Sometimes person can't form tears. What happened?

Back 58

Where person loses movement unilaterally.

Possible harm to facial nerve before greater petrosal nerve.

Front 59

What muscle lies around the mandibular nerve? What muscle does the mandibular nerve sit on top of?

Back 59

Lateral pterygoid (mandibular nerve is deep to it). Sits on medial pterygoid.

Front 60

What is the first thing you can cut when you slice into the floor of the mouth?

Back 60

Submandibular duct.

Front 61

What muscles does the mandibular nerve bring branchial motor to?

Back 61

temporalis,
Masseter, lateral pterygoid, medial pterygoid,
Anterior digastric, mylohyoid, tensor veli palatini,
Tensor tympani.

Front 62

1) What ganglion is hanging off the auriculotemporal nerve? What CN is it associated with?

2) What ganglion is hanging off the lingual nerve?

Back 62

1) Otic ganglion - CN 9

2) Submandibular ganglion - CN 7

Front 63

Describe the pathway of the auriculotemporal nerve.

Back 63

Auricolotemporal nerve - Sensory from anterior meninges out the foramen spinosum to nervus spinosus, into infratemporal fossa, in mandibular nerve, back up to foramen ovale, to the brainstem and to the brain.

Front 64

Describe the pathway of how taste from the anterior 2/3 of the tongue gets in.

Back 64

Goes up lingual nerve, into the chorda tympani, then from there it goes into the facial nerve, brainstem solitary nucleus.

Front 65

Vast majority of sensory from the mandible comes from which nerve?

Back 65

Inferior alveolar.

Front 66

Sympathetic fibers run on what?

Back 66

Arteries

Front 67

Describe the pathway of the auriculotemporal nerve.

Back 67

Auricolotemporal nerve - Sensory from anterior meninges out the foramen spinosum to nervus spinosus, into infratemporal fossa, in mandibular nerve, back up to foramen ovale, to the brainstem and to the brain.

Front 68

Describe the pathway of how taste from the anterior 2/3 of the tongue gets in.

Back 68

Goes up lingual nerve, into the chorda tympani, then from there it goes into the facial nerve, brainstem solitary nucleus.

Front 69

Vast majority of sensory from the mandible comes from which nerve?

Back 69

Inferior alveolar.

Front 70

Sympathetic fibers run on what?

Back 70

Arteries

Front 71

Name what nuclei the parasympathetic fibers from CN 3, 7, and 9 originate and where they run to.

Back 71

Edinger Westphal -> oculomotor nerve -> ciliary ganglion (hanging from ophthalmic nerve) -> short ciliary nerve -> constrictor pupillae and ciliary muscles

Superior salivatory nucleus: Facial nerve

Greater petrosal nerve -> pterygopalatine ganglion (hanging from maxillary nerve) -> mucous glands, lacrimal glands

-> chorda tympani -> submandibular ganglion (hanging from mandibular nerve) -> hitchhike on lingual nerve to submandibular glands, sublingual glands, smaller salivary glands

Inferior salivatory nucleus -> GLOSSOPHARYNGEAL (lesser petrosal nerve) -> otic ganglion -> hitchhike on auriculotemporal parotid salivatory gland

Front 72

What is being carried on the middle meningeal artery and what does it hop onto?

Back 72

Postganglionic sympathetic fibers that hop onto auriculotemporal nerve

Front 73

Cranial arteritis:

1) Symptom?
2) What arteries can it involve?
3) What is usually the first artery affected?

Back 73

1) Severe unilateral pain- can be bilateral

2) Lingual, superficial temporal, vertebral, ophthalmic, posterior ciliary

3) Temporal

Front 74

Acoustic neuroma:

1) What is happening?
2) Where does it grow?

Back 74

1) Tumor grows in internal acoustic meatus
2) Grows inward, compresses CN VII and CN VIII, then V

Front 75

Trigeminal neuralgia can be caused by what 4 things?

Back 75

1) Compression of trigeminal ganglion by surrounding vessels

2) Compression of superior petrosal vein

3) Compression of ganglion/stem by aberrant branches of middle meningeal artery

4) Compression by superior cerebellar artery

Front 76

Describe how the lacrimal gland is powered, starting from the brainstem

Back 76

Superior salivatory nucleus -> greater petrosal (CN VII) -> pterygopalatine ganglion -> zygomatic nerve -> lacrimal gland

or zygomaticotemporal nerve -> lacrimal gland

Front 77

Trigeminal neuralgia is mostly associated with which branches of the trigeminal?

Back 77

V2 and V3