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The Trigeminal Nerve

The trigeminal nerve is the fifth cranial nerve and has three well-defined divisions: the ophthalmic branch, maxillary branch, and mandibular branch. Their fibers contain various types of nervous tissue (e.g. sensory or motoric) running through selected branches.

The branches of the trigeminal nerve innervate a large area including the whole forehead, face, lateral regions of the head and the most upper part of the neck.

Recommended video: Cranial nerves
Overview of the 12 cranial nerves.

Nuclei

The nuclei of the trigeminal nerve are located in the brainstem and the upper part of the spinal cord.

Mesencephalic nucleus of trigeminal

The mesencephalic nucleus of trigeminal nerve is found in the lateral region of the periaqueductal grey matter in the midbrain. It contains the first neurons responsible for the proprioception of the jaw and intraocular muscles, temporomandibular joints, the teeth and the upper and lower jaw.

mesencephalic nuclei of the trigeminal nerve - sagittal view

Mesencephalic nuclei of the trigeminal nerve - sagittal view

Principal (sensory) nucleus

The principal nucleus of trigeminal nerve is located in the dorsolateral pontine tegmentum. Its main task is the tactile sensation.

Principal nucleus of the trigeminal nerve - sagittal view

Principal nucleus of the trigeminal nerve - sagittal view

Spinal trigeminal nucleus

The spinal nucleus of trigeminal nerve is a long, sensory nucleus stretching from the pons down into the upper three segments of the spinal cord's dorsal horn. It is primarily concerned with the pain and temperature sensation.

Nucleus of spinal tract of the trigeminal_nerve - Medulla oblongata Level decussatio pyramidum, H&E stain

Nucleus of spinal tract of the trigeminal_nerve - Medulla oblongata Level decussatio pyramidum, H&E stain

Branches

The Ophthalmic Branch

This first branch of the trigeminal nerve is responsible for the innervation the forehead, the nose and the ophthalmic regions of the face. It exits the skull through the superior orbital fissure in the bony orbit. Both the ophthalmic branch and the maxillary branch of the trigeminal nerve supply the nasal cartilage with terminal branches.

Ophthalmic nerve - lateral view

Ophthalmic nerve - lateral view

The Maxillary Branch

The second branch provides nervous receptors for the face from below the eye to the upper jaw. One important nerve branching off the maxillary nerve is the superior alveolar nerve which supplies the upper teeth within the oral cavity.

Maxillary nerve - lateral view

Maxillary nerve - lateral view

The Mandibular Branch

The third branch of the trigeminal nerve covers the sensation of the lowest part of the face, the lower jaw and the floor of the oral cavity. Furthermore, it supplies all jaw muscles with motoric branches including the muscles of mastication. One important branch innervating the tongue is the lingual nerve.

Mandibular nerve - lateral view

Mandibular nerve - lateral view

Trigeminal neuralgia (trigeminal nerve pain) - Symptoms and Causes

Trigeminal neuralgia is one of the pathological presentations involving the trigeminal nerve. It is described as a severe pain in the face with a sudden and erratic onset. The pain is chronic and progressive (gradually getting worse with time). There are three different types of trigeminal neuralgia:

  1. Typical (or idiopathic): the most common one where no cause can be found.
  2. Atypical.
  3. Symptomatic: occurs secondary to other conditions, e.g. multiple sclerosis, tumors, post-infectious or post-traumatic.

Therapy options include anticonvulsants and augmentative surgery however in most cases there is no cure.

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Show references

References:

  • Frank H. Netter, Atlas der Anatomie, 5th Edition (Bilingual Edition: English and German), Saunders, chapter 1, table 121.
  • Vishram Singh: Textbook of Clinical Neuroanatomy, Elsevier (2004), p.124-127
  • National Health Service: Trigeminal neuralgia (http://www.nhs.uk/Conditions/Trigeminal-neuralgia/Pages/Introduction.aspx)

Author:

  • Dr. Alexandra Sieroslawska

Illustrators:

  • Mesencephalic nuclei of the trigeminal nerve - sagittal view - Paul Kim
  • Principal nucleus of the trigeminal nerve - sagittal view - Paul Kim
  • Ophthalmic nerve - lateral view - Yousun Koh 
  • Maxillary nerve - lateral view - Yousun Koh 
  • Mandibular nerve - lateral view - Paul Kim
© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are protected by German and international copyright laws. All rights reserved.

Related Atlas Images

Mandibular nerve

Ophthalmic nerve

Maxillary nerve

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