Dr.

Nazim Nasir

Department of Anatomy

Jawahar Lal Nehru

Medical College A.M.U.,
Aligarh

INDIA
 Definition
The fifth vertebrate
peripheral nerve that
emerges from within the
skull. It is sensory from
the head, but motor to
the jaw muscles.

L. trigerninus, three-

fold. Trigeminal nerve
has three divisions. It
was described by
Fallopius and again by
Meckel in 1748. The
name trigeminal was
 Functio
The sensory
n
function of the
trigeminal nerve is
to provide the
tactile,
proprioceptive, and
nociceptive
afference of the
face and mouth.

The motor function

activates the
muscles of the
mastication, the
 Peripheral Anatomy
The trigeminal nerve exits from the anterolateral
surface of the pons as a large sensory root and a
small motor root. These roots continue forward out
of the posterior cranial fossa and into the middle
cranial fossa by passing over the medial tip of the
petrous part of the temporal bone.

In the middle cranial fossa the sensory root

expands into the trigeminal ganglion. The
ganglion is in a depression (the trigeminal
depression) on the anterior surface of the petrous
part of the temporal bone, in a dural cave (the
trigeminal cave). The motor root is below and
completely separate from the sensory root at this
point.
 General
Consideration
Arising from the anterior border of the
trigeminal ganglion are the three terminal
divisions of the trigeminal nerve, which in
descending order are:
Ophthalmic (V1), Maxillary (V2), and
Mandibular (V3)
Fibers run from the face to the pons via the
superior orbital fissure (V1), the foramen
rotundum (V2), and the foramen ovale (V3)
Conveys sensory impulses from various areas
of the face (V1) and (V2), and supplies motor
fibers (V3) for mastication
 Various
Components
Sensory
component

Branchial Motor
component

Visceral motor
component
 SENSORY COMPONENT
Ophthalamic
division

Maxillary division

Mandibular division
 Division
Enters the middle
cranial fossa through the
superior orbital fissure
and courses within the
lateral wall of the
cavernous sinus on its
way to the trigeminal
ganglion.
Branches of the
ophthalmic nerve (V1)
{frontal nerve,
nasociliary nerve, and
lacrimal nerve}
convey sensory
information from the
 Division
Enters the middle cranial
fossa through foramen
rotundum and may or
may not pass through
the cavernous sinus en
route to the trigeminal
ganglion.
Branches of the
maxillary nerve (V2)
{zygomatic nerve and
infraorbital
nerve}convey sensory
information from the
lower eyelids, zygomae,
 division
Enters the middle cranial
fossa through foramen
ovale, coursing directly
into the trigeminal
ganglion
Branches of the
mandibular nerve (V3)
{buccal nerve, lingual
nerve, inferior alveolar
nerve, and
auriculotemporal
nerve}convey sensory
information from the
lateral scalp, skin anterior
to the ears, lower cheeks,
BRANCHIAL MOTOR COMPONENT
Consists of lower motor neurons whose cell bodies
are located in the motor nucleus of the trigeminal
nerve in the brainstem.

These nerves exit the mid-lateral aspect of the

pons, course within the trigeminal nerve, pass
through the trigeminal ganglion, and within the
mandibular nerve before branching.

The muscles innervated-

temporalis, masseter, medial and lateral
pterygoids, tensor veli palatini, tensor
tympani, anterior belly of diagastric and
VISCERAL MOTOR COMPONENT
Visceral motor nerves are not a true component of
the trigeminal nerve, but “hitchhike” .

Vidian nerve (a.k.a. nerve of the pterygoid canal)

emerges from the pterygoid canal carrying pre-
ganglionic fibers to the pterygopalatine
ganglion. After synapse, post-ganglionic fibers exit
the ganglion and hitchhike along trigeminal nerve
branches en route to the lacrimal gland and minor
salivary glands of the palate and mouth.
Chorda tympani exits the skull through the
petrotympanic fissure, courses extracranially to join
the lingual nerve. It carries pre-ganglionic fibers
to the submandibular ganglion which "hangs"
from the lingual nerve. After synapse, post-
ganglionic fibers exit the ganglion to innervate the
submandibular gland and sublingual gland.

The lesser petrosal nerve after exiting the skull

through or near the foramen ovale, carries pre-
ganglionic fibers to the otic ganglion. After
synapse, post-ganglionic fibers exit the ganglion,
hitchhiking along the auriculotemporal nerve to
 Nuclei
The sensory trigeminal nerve nuclei are the
largest of the cranial nerve nuclei, and extend
through whole of the brainstem.

The nucleus is divided into three parts, from

rostral to caudal (top to bottom in humans):

The mesencephalic nucleus

The chief sensory nucleus (or "pontine
nucleus" or "main sensory nucleus" or
"primary nucleus")
The spinal trigeminal nucleus
The
mesencephalic
nucleus is
involved with
proprioception.
Neurons of this
nucleus are
pseudounipolar
cells receiving
proprioceptive
information from
the jaw, and
sending
projections to the
motor trigeminal
The principal sensory nucleus (or chief sensory
nucleus) receives information about discriminative
sensation and light touch of the face as well as
conscious proprioception of the jaw.

The spinal trigeminal nucleus is a nucleus in the

medulla that receives information about deep/crude
touch, pain, and temperature from the ipsilateral face.
The facial, glossopharyngeal, and vagus nerves
also convey pain information from their areas to the
spinal trigeminal nucleus.
s
#3 – Muscle Afferents

#1 – Large Afferents

#2 – Small Afferents
Motor Trigeminal Pathway -
Efferents
1. Origin – Motor neurons of trigeminal motor
nucleus.
2. Course – Exit via trigeminal nerve
3. Laterality – Uncrossed.
4. Topographical Organization – Organized by
muscle group.
5. Destination – Muscles of mastication.
6. Function – Voluntary movement of the jaw;
mastication.
7. Dysfunction – Paralysis of the jaw
 Part 1--Trigeminal
Large Primary Afferents
RECEPTOR TYPE FIBER GROUP FIBER NAME MODALITY

Cutaneous and subcutaneous

mechanoreceptors Touch

Meissner's corpuscle Aβ RA Stroking, fluttering

Merkel disk receptor Aβ SAI Pressure, texture

Pacinian corpuscle Aβ PC Vibration

Ruffini ending Aα,β SAIl Skin stretch

Hair follicle Aβ Gl,G2 Stroking, fluttering

Hair-down Aβ D Light stroking

Field Aβ F Skin stretch

Trigeminal
Large Primary Afferents
Origin - Trigeminal ganglion, Aβ and Aδ
fibers
Course – Trigeminal nerve, enter at pons
Laterality - Uncrossed
Topographical Organization - yes
Destination – Principal sensory nucleus of
trigeminal
Function – fine touch, vibration, two-point
discrimination, proprioception
Dysfunction – loss of above senses on half
of face.
Trigeminal Lemniscus
1. Origin – Principal sensory nucleus of
trigeminal (nV)
2. Course – Trigeminal lemniscus
3. Laterality – Mostly crossed; bilateral
projections for oral cavity receptive fields.
4. Topographical Organization - yes
5. Destination – Ventroposterior Medial nuc.
(VPM) of thalamus
6. Function – Vibration, proprioception, fine
touch, two-point discrimination
7. Dysfunction – loss of sensation mostly
contralateral face.
Thalamocortical Pathway
1. Origin - VPM
2. Course – Posterior limb of internal capsule
3. Laterality - Uncrossed
4. Topographical Organization – yes; head area
5. Destination – Primary somatosensory cortex,
areas 1, 2, 3
6. Function – Fine touch, vibration,
proprioception
7. Dysfunction – Loss of somatic sensations
 Part 2--Small Trigeminal
Primary Afferent Pathway
FIBER FIBER
RECEPTOR GROUP NAME MODALITY
THERMAL RECEPTORS TEMPERATURE
Cool receptors Aδ III Skin cooling (25°C)
Warm receptors C IV Skin warming
Heat Nociceptor Aδ III Hot temp
Cold Nociceptors C IV Cold temp
NOCICEPTORS PAIN
Mechanical Aδ III Sharp pain
Thermal-mechanical Aδ III Burning pain
Thermal-mechanical C IV Freezing pain
Polymodal C IV slow, burning pain
Chemoreceptors C IV Insect venom,
histamine
Small Trigeminal Primary
Afferent Pathway
Origin - Nociceptors, small trigeminal
ganglion cells; Aδ and C fibers.
Course - Enter trigeminal nerve; descend in
spinal trigeminal tract.
Laterality – Uncrossed.
Topographical Organization – Yes. Separate
dermatomes are distributed in segments;
most oral are rostral
Destination - Spinal trigeminal nucleus.
Function - Pain and temperature sensation
Dysfunction – Numbness, loss of temp sense
5

1
Trigeminal Lemniscus, part 2
Pain and Temp Pathway
1. Origin – Neurons of spinal trigeminal
nucleus.
2. Course – Axons cross in spinal cord or
medulla and join the trigeminal lemniscus.
3. Laterality - Crossed
4. Topographical Organization - Yes
5. Destination – VPM in thalamus
6. Function - Information from A-delta fibers
on fast pain, temp, and innocuous stimuli.
7. Dysfunction – Numbness on opposite face
Spino-Reticular Pathway
1. Origin – Neurons of spinal trigeminal nucleus.
2. Course – Same as trigeminal lemniscus
3. Laterality – Mostly crossed
4. Topographical Organization - Poor
5. Destination – Reticular formation of medulla
6. Function – slow pain
7. Dysfunction – partial analgesia
Thalamocortical Pathway
 Same as for the large afferent pathway.
 Both go the head and face area of S1.
 Part 3 – Mesencephalic
Trigeminal Afferents
RECEPTOR TYPE FIBER GROUP FIBER NAME MODALITY

Muscle and skeletal mechanoreceptors Limb proprioception

Muscle spindle primary Aα la Muscle length and speed

Muscle spindle secondary Aβ II Muscle stretch

Golgi tendon organ Aα Ib Muscle contraction

Joint capsule mechanoreceptors Aβ II Joint angle

Stretch sensitive free endings Aδ III Excess stretch or force

Mesencephalic Trigeminal
Afferents
1. Origin – Ganglion cells in mesencephalon; sensory
endings from muscle spindles and golgi tendon
organs.
2. Course – Enter trigeminal nerve; ascend in
mesencephalic division to midbrain near inferior
colliculus where cell bodies are located. Fibers then
descend back to pons.
3. Laterality – Uncrossed.
4. Topographical Organization – Organized by muscle
group.
5. Destination – Motor nucleus of trigeminal nerve.
6. Function – Muscle stretch and tension;
proprioception. Substrate for jaw stretch reflex –
myotatic jaw-jerk reflex.
 Clinical
Consideration
Wallenberg Syndrome
(Lateral Medullary Syndrome)
In the medulla, the ascending spinothalamic
tract (which carries pain/temperature information
from the opposite side of the body) is adjacent to
the descending spinal tract of the fifth nerve
(which carries pain/temperature information from
the same side of the face). A stroke that cuts off the
blood supply to this area (e.g., a clot in the
posterior inferior cerebellar artery) destroys both
tracts simultaneously. The result is loss of
pain/temperature sensation (but not touch/position
 Trigeminal Neuralgia
Trigeminal neuralgia (TN), also known as “tic
douloureux” (pronounced “tick-doo-la-roo”), is a
condition affecting the trigeminal nerve or fifth
cranial nerve
 characterized by sudden attacks of pain to the
face, commonly described as sudden, severe,
electric-shock-like, or stabbing.
Because sufferers of TN may contort their face in
pain or become noticeably still during an attack, the
disease has sometimes been confused with a
seizure disorder, hence the term “tic douloureux”
which means “twitching pain.”
 A patient’s description of the pain and a
 Peripheral lesions-----
craniofacial trauma, basilar skull features,
dental trauma, maxillary sinusitis, primary or
metastatic tumors, aneurysm of the internal
carotid artery, cavernous sinus thrombosis,
stilbamidine, trichlorethylene, lupus,
scleroderma, Sjøgren's syndrome, sarcoidosis,
probably amyloidosis, and a fairly common
idiopathic benign sensory neuropathy. Horner's
syndrome can be produced by lesions of the
nasociliary nerve as it runs with the ophthalmic
division.

Lesions of the ganglion: herpes zoster infection,

primary and metastatic tumors.

Trigeminal root lesions: adjacent tumors and

vascular malformations, especially acoustic
 Refrences
 http://anatomyatlases.org/MicroscopicAnatomy/Appendices/Appendix5.shtml
 http://www.nature.com/nrm/journal/v3/n4/glossary/nrm783_glossary.html
 Grays Anatomy
 Snells Neuroanatomy
 Grants Anatomy
 http://en.wikipedia.org/wiki/Trigeminal_nerve
 http://medinfo.ufl.edu/year1/trigem/text.html
 Pocket Atlas of Human Anatomy 4th edition
 http://images.google.co.in/images?hl=en&q=trigeminal+pics&um=1&ie=U
TF-
8&ei=kyjKSbyrNJT27AO0yaytAg&sa=X&oi=image_result_group&resnum=1
&ct=title
 http://www.google.co.in/imgres?imgurl=http://www.dalcross.com/staging/_i
mages/trigeminal.JPG&imgrefurl=http://www.dalcross.com/trigeminal_neur
algia.php&h=578&w=550&sz=70&tbnid=EZaF9XlIF137dM::&tbnh=134&tb
nw=128&prev=/images%3Fq%3Dtrigeminal%2Bpics&hl=en&usg=__kvKsX
C_rl0dZorPt6qpCqT4IDdA=&ei=kyjKSbyrNJT27AO0yaytAg&sa=X&oi=imag
e_result&resnum=2&ct=image&cd=1
 http://www.google.co.in/imgres?imgurl=http://upload.wikimedia.org/wikipe
dia/commons/9/99/Gray778_Trigeminal.png&imgrefurl=http://commons.wi
 http://images.google.co.in/imgres?imgurl=http://wpcontent.answers.com/w
ikipedia/en/thumb/e/e3/Gray696_Trigeminal.png/300px-
Gray696_Trigeminal.png&imgrefurl=http://www.answers.com/topic/trigemi
nal-
nerve&usg=__fenDtfRA3gaI08q6fuhFFSzcTwo=&h=539&w=300&sz=109&
hl=en&start=10&sig2=-
A5FGxaBoSqBwdvbznCbNg&um=1&tbnid=yDDxms2I2Pkt2M:&tbnh=132&t
bnw=73&prev=/images%3Fq%3Dtrigeminal%2Btracts%2Bpics%26hl%3De
n%26sa%3DX%26um%3D1&ei=_JnDSfLSHMOSkAWNysTXDA

 http://www.google.co.in/imgres?imgurl=http://www.stjosephsatlanta.org/ga
mma_knife_center/images/gamma_knife_trigeminal_neuralgia_profile.jpg&i
mgrefurl=http://www.stjosephsatlanta.org/gamma_knife_center/trigeminal.
html&h=327&w=300&sz=128&tbnid=hpZGcBjS1e0M2M::&tbnh=118&tbn
w=108&prev=/images%3Fq%3Dtrigeminal%2Bpics&hl=en&usg=__gAs9-
794jt-
B4vt3SSeXIgy0I6o=&ei=kyjKSbyrNJT27AO0yaytAg&sa=X&oi=image_result
&resnum=1&ct=image&cd=1

 http://www.google.co.in/imgres?imgurl=http://zingerone.foodsci.cornell.ed
u/trigeminal/trigeminal-figure.png&imgrefurl=http://nikas-
culinaria.com/2006/07/09/molecular-gastronomy-101-part-2-
%25E2%2580%2593-the-nose-and-
receptors/&h=523&w=379&sz=56&tbnid=Vvh_s28IAjlFeM::&tbnh=131&tb
 http://images.google.co.in/imgres?imgurl=http://www.ncbi.nlm.nih.gov/boo
kshelf/picrender.fcgi%3Fbook%3Dcm%26part%3DA1882%26blobname%3
Dch61f2.jpg&imgrefurl=http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi%3Fb
ook%3Dcm%26part%3DA1882&usg=__wKG_QNUDpHapRzzbYrd2FR-
hkjo=&h=558&w=482&sz=140&hl=en&start=9&sig2=JvPvZqC8XNFHeZlV
mZawxA&um=1&tbnid=G7kwKMBbvltUkM:&tbnh=133&tbnw=115&prev=/
images%3Fq%3Dtrigeminal%2Btracts%2Bpics%26hl%3Den%26sa%3DX%
26um%3D1&ei=_JnDSfLSHMOSkAWNysTXDA
 http://www.ajnr.org/cgi/content-nw/full/20/6/1119/F3
 http://images.google.co.in/images?hl=en&um=1&q=trigeminal+nuclei+diag

 http://www.google.co.in/imgres?imgurl=http://wpcontent.answers.com/wiki
pedia/en/thumb/e/e3/Gray696_Trigeminal.png/300px-
Gray696_Trigeminal.png&imgrefurl=http://www.answers.com/topic/trigemi
nal-
nerve&h=539&w=300&sz=108&tbnid=yDDxms2I2Pkt2M::&tbnh=132&tbn
w=73&prev=/images%3Fq%3Dtrigeminal%2Bnuclei%2Bdiagram&hl=en&u
sg=__WE6860WS0L99KYD696GFCCOJcqk=&ei=oy_KSYzzMoiO6gOZ5rm9A
g&sa=X&oi=image_result&resnum=3&ct=image&cd=1
 http://www.google.co.in/imgres?imgurl=http://instruct.uwo.ca/anatomy/53
0/trignuc.gif&imgrefurl=http://instruct.uwo.ca/anatomy/530/530notes.htm
&h=379&w=499&sz=72&tbnid=NZaUHJ1_-
CbF0M::&tbnh=99&tbnw=130&prev=/images%3Fq%3Dtrigeminal%2Bnucl
ei%2Bdiagram&hl=en&usg=__9eZMutXE6L3gnl5wgNojn6WYvlE=&ei=oy_K