seminar

1. Good Morning

2. TRIGEMINAL NERVE
Presented by:-
Dr. Shruti Mishra
MDS 1st year
Dept. of conservative and Endodontics

3. GUIDED BY:-
• Dr. Gopal Tawani (Reader and Guide)
• Dr. Manoj Chandak (Professor and HOD)
• Dr. Pradnya Nikhade (Professor)
• Dr. Ajay Saxena (Professor)
• Dr. Anuja Ikhar (Reader)
• Dr. Neelam Chandwani (Reader)
• Dr. Aditya Patel (Reader)

4. CONTENTS
• Introduction.
• Trigeminal Ganglion.
• Origin & Attachments of the Trigeminal Nerve
• Branches of the Trigeminal Nerve.
Course.
Branches.
Innervations.
• Applied Anatomy.
• Summary

5. SPECIFIC LEARNING OBJECTIVES
S/N Learning
Objectives
Domain Level Criteria
1. Intracranial
course
Cognitive Must know All
2. Trigeminal
ganglion
Cognitive Must know All
3. Origin and
attachments of
the trigeminal
nerve
Cognitive Must know All
4. Branches of the
nerve
Cognitive Must know All
5. Course and
innervations
Cognitive Must know All
6. Applied
anatomy
Cognitive Must know All

6. INTRODUCTION
• The word ‘Trigemina’ meaning ‘Threefold’ gives the V Cranial Nerve
its name – The Trigeminal or Trifacial Nerve as it forms 3 divisions:-
1. The Opthalmic(sensory)
2. The Maxillary(sensory) &
3. The Mandibular nerve(Sensory,motor).
• It is the largest of all the Cranial Nerves, & of mixed variety having a
large sensory root & a small motor root.
• As major general sensory nerves of face, it transmits afferent
impulses from Touch, Temperature & Pain receptors.

7. Figure showing
inferior view of
the brain
showing cranial
nerves and the
organs and
tissue they
innervate

8. • It is composed of a small motor root and a considerably larger
(tripartite) sensory root.
• The motor root supplies the muscles of mastication and other muscles
in the region.
• The three branches of sensory root supply the skin of the entire face
and the mucous membrane of the cranial viscera and oral cavity,
except for the pharynx and base of the tongue.

9. ORIGIN
• Cell bodies of sensory neurons of all
three divisions are located in the
large Trigeminal (or Semilunar or
Gasserian or Gasser's) Ganglion.
• The mandibular division also
contains motor fibers that innervate
the muscles of mastication.
Gaserrian ganglion

10. TRIGEMINAL / SEMILUNAR / GASSERIAN
GANGLION
• In 1765, Anton Balthasar Raymund Hirsch, described the Gasserian
ganglion, naming it in honor of his professor “Gasser’ a Professor of
Anatomy at the University of Vienna.
• It is the sensory ganglion of the Vth cranial nerve.
• The ganglion is Flat, Crescentric Or Semilunar in shape, measuring
1 x 2 cms with its convexity directed anterolaterally.
• The three divisions of the trigeminal nerve emerge from this
convexity.

11. Situation & Meningeal Relations :
• The ganglion lies at a depth of 4.5 – 5 cms from the lateral aspect of
head, at the posterior extremity of the Zygomatic arch.
• It occupies a special space of dura mater, called the Trigeminal (or
Meckel’s) Cave covering the trigeminal impression on the anterior
surface of the petrous temporal bone near its apex.
Clinical Significance :
• After recovery from a primary herpes infection, the virus is not
cleared from the body, but rather lies dormant in a non-replicating
state within the trigeminal ganglion. Thus, herpes zoster may follow
from Chickenpox.

12. Opthamlmic nerve V1
Maxillary nerve V2
Mandibular nerve
V3
Trigeminal ganglion
Trigeminal nerve
Trigeminal Nerve in the
interior of the base of the
cranium

13. Sensory root
Mouth of
Meckel’s cave
Trigeminal
ganglion
Greater pertrosal nerve
Lesser petrosal nerve Mandibular
nerve
Maxillary
nerve
Opthalmic
nerve
Lacrimal
nerve
Frontal
nerve
Supraorbital
nerve
Supratroch
lear nerve
Trigeminal
nerve in the
Middle
Cranial
Fossa

14. ORIGIN & ATTACHMENT
• The Trigeminal nerve is attached
to the lateral part of the pons by
its 2 roots, motor & sensory to its
4 nuclei :
1. Principle sensory nucleus.
2. Mesencephalic nucleus.
3. Motor nucleus.
4. Spinal nucleus.
pons
Trigeminal
ganglion

15. SPINAL NUCLEUS
• Takes pain and temperature sensations from most of the face area
which relay here.
• The crossed fibres are called trigeminal lemniscus which go to
ventroposterior nucleus of thalamus for another relay, to finally
terminate in lower part of postcentral gyrus.

16. SUPERIOR SENSORY NUCLEUS
• Fibres carrying touch and pressure relay in this nucleus.
• Remaining path is same as that of the spinal nucleus.

17. MESENCEPHALIC NUCLEUS
• This nucleus extends from pons till the midbrain.
• Receives proprioceptive impulses from muscles of mastication,
temporomandibular joint and teeth.

19. Pons
Hypoglossal nerve
Sensory root
Motor root
Vagus nerve
Superficial
origin of
trigeminal nerve

20. SENSORY COMPONENTS OF V NERVE
• Sensations of pain, temperature, touch and pressure from skin of face,
mucous membrane of nose, most of the tongue, paranasal air sinuses
travel along axons.
• Their cell bodies lie in the V ganglion.
• This ganglion is similar to the spinal ganglia of other nerves.
• It lies at the apex of petrous temporal bone in a dural cave, the
Meckel’s cave.
• Peripheral processes form the three nerves.

21. Sensory Root :
• The large sensory root (portio major) arise from the
Semilunar (Gasserian) ganglion & enters the
brainstem via the side of the Pons.
• The ganglion with its unipolar neurons forms
Central & Peripheral processes.
• The peripheral branches form the opthalmic,
maxillary & mandibular divisions of the nerve while
the central branches are the sensory roots of the
trigeminal nerve
V1
V2
V3

22. • The central processes of V ganglion form sensory root.
• Some fibres ascend and other descend.
• Ascending fibres end in superior sensory nucleus.
• Descending fibres end in the spinal nucleus of V nerve.

23. • Pain and temperature reach spinal nucleus.
• Touch and pressure sensations go to superior sensory nucleus.
• Opthalmic nerve fibres end in the inferior part, maxillary nerve fibres
end in the middle part and mandibular nerve fibres terminate in the
upper part of the spinal nucleus.

24. MOTOR COMPONENT
• The motor nucleus receives impulses from the right and left cerebral
hemispheres, red nucleus and mesencephalic nucleus.
• Fibres of motor root supply four muscles of mastication and four other
muscles.
• It supplies the following muscles : - Muscles of mastication:-
1. Mylohyoid.
2. Ant belly of the diagastric.
3. Tensor tympani.
4. Tensor veli palatini

25. • The small motor root (portio minor) arises separately from the sensory root,
originating in the motor nucleus located in the upper pons and medulla
oblongata. Its fibers, forming a small nerve root travels anteriorly along
with, but entirely separate from, the larger sensory root to the region of
trigeminal ganglion. Here the nerve passes latero-inferior direction under
the ganglion towards the foramen ovale, through which it leaves the
MIDDLE CRANIAL FOSSA along the mandibular nerve. Just after leaving
the skull, the motor root unites with the sensory root of the mandibular
division to form a single trunk.

26. BRANCHES OF THE TRIGEMINAL NERVE
• The Trigeminal Nerve forms three divisions :
1) The Opthalmic
2) The Maxillary &
3) The Mandibular Nerves.
• All of the three are chiefly sensory in nature but the mandibular
division also contains motor fibres that innervate the muscles of
mastication.

27. The general pathway of the trigeminal nerve and its
motor and sensory roots and three divisions

28. Various branches of trigeminal nerve

29. OPTHALMIC NERVE (V1)
• Ist branch of trigeminal nerve.
• Sensory in nature.
• Smallest branch(2.5cms long)
SUPPLIES :-
1.Eyeball
2.Conjuctiva
3.Lacrimal Gland
4.Parts of the mucous membrane of the nose and Paranasal Sinuses
5.Skin of the forehead, eyelid and nose.
Just before the ophthalmic nerve passes through the superior orbital fissure it divides into its three main
branches:
a. Frontal
b. Lacrimal and
c. Naso-cilliary nerves

30. COURSE
• It courses anteriorly in the lateral wall of the cavernous sinus to the medial
part of the superior orbital fissure through which it enters the orbit.
• It also gives off communication branches to the Oculomotor, Trochlear and
Abducent cranial nerves. As the ophthalmic division passes forward from the
cavernous sinus, it divides into three branch’s: Lacrimal, Frontal and
Nasociliary Nerves.

32. • The internal branch, the nasociliary nerve , follows the medial border
of the orbital roof, releases branches to the nasal cavity, and ends on
the skin at the root of the nose.
• The intermediate branch, the frontal nerve , courses straight
anteriorly to reach the skin of the forehead.
• Finally the external branch, the lacrimal nerve, runs anteriorly and
laterally along the border of roof the orbit toward the lacrimal gland
and to the skin at the outer corner of the eye.

33. • Branches :
a) Lacrimal nerve
b) Frontal nerve
• Supraorbital
• Supratrochlear
c) Nasocilliary nerve
1) Branches in the Orbit
- Long root of ciliary ganglion
- Long ciliary nerve
- Posterior ethmoidal
- Anterior ethmoidal
-Internal nasal branches
-External nasal branches

34. 2) Branches arising in the nasal cavity
3) Terminal branches of the opthalmic division on the face.

35. I) LACRIMAL NERVE
• Smallest of the three branches.
• It passes into the orbit at the lateral angle of the superior orbital fissure &
then courses in an anterolateral direction to reach the lacrimal gland.
Innervation :
a) Skin of the upper eyelid and lateral part of the eyebrow region
b) Conjunctiva of the lateral part of the upper eyelid.

36. II) FRONTAL NERVE
• The largest of the three branches, & appears to be a direct continuation of
the ophthalmic division.
It enters the orbit by way of the superior orbital fissure. At about the middle of
the orbit, the frontal nerve divides into two branches:
1) Supraorbital nerve :
• Larger branch of the frontal nerve.
• It passes forward and leaves the orbit through the supraorbital foramen
Innervation :-
a) Medial part of the upper eyelid & the lower medial part of the forehead.
b) Conjunctiva of the upper eyelid.

37. 2) Supratrochlear nerve
• The smallest branch of the frontal nerve.
• It passes toward the upper medial angle of the orbit.
Innervation :
a) Skin of the Upper Eyelid and the skin of the forehead and
scalp as far back as the vertex of the skull.
b) Lining of the frontal sinus.

38. III ) NASOCILIARY NERVE
• It is the third main branch of the ophthalmic division. It enters the
orbit through the Superior Orbital Fissure.
• Its branches are divided into those arising in the orbit, in the nasal
cavity, and on the face.
Innervation :-
a. Long ciliary branch :
-Sensory from the eyeball and ciliary ganglion.
b. Infratrochlear nerve :
-Upper and lower eyelid and from the side of the nose.
-Conjunctiva and the lacrimal sac.
c. Ethmoid branches : Sensory from the lining of the frontal & sphenoid
sinus and of the anterior & posterior ethmoid cells.

39. d. Internal branches : Sensory from the anterior portion of the septum and
lateral walls of the nasal cavity.
e. External nasal branch : Sensory from the tip of the nose.
A) Branches in the orbit :
1. Long root of the ciliary ganglion: The long, or sensory, root arises from the
nasociliary nerve. It contains sensory fibers, which pass through the
ganglion without synapsing and continue on to the eyeball by means of the
short ciliary nerves.
2. Long ciliary nerves: There are usually two or three long ciliary nerves
branching from the nasociliary nerve. They are distributed to the iris &
cornea.

40. 3. Posterior ethmoid nerve : It enters the posterior ethmoid canal to be
distributed to the mucous membrane lining the posterior ethmoidal cells
and the sphenoid sinus.
4. Anterior ethmoid nerve : It continues anteriorly along the medial wall of
the orbit. In the upper part of the nasal cavity, the ethmoid nerve divides
into two sets of anterior nasal branches:
a) Internal nasal branches : In turn, divide in the upper anterior part of
the nasal cavity into two divisions :
- Medial or septal branches. - Lateral branches.
b) External nasal branches : At the border between the lower edge of the
nasal bone and the upper edge of the lateral nasal cartilage, the external
nasal branch passes externally.

41. B. Branches arising in the nasal cavity:-
• The branches of the nasociliary nerve that arise in the nasal cavity
supply the mucous membrane lining the cavity.
C. Terminal branches of the ophthalmic division on the face:-
• These branches course below the trochlear nerve to supply sensory
fibers to the skin of the medial parts of both eyelids, lacrimal sac, &
the lacrimal caruncle.
• These fibers supply the skin over the side of the bridge of nose.

42. Main branches of ophthalmic nerve

43. MAXILLARY NERVE (V2)
• The maxillary nerve is entirely sensory in function.
Intracranial course :
• It originates at the middle of the semilunar ganglion & continues forward in
the lower part of the cavernous sinus.
Extracranial course :
• It then passes to the Foramen Rotundum, through which it leaves the
cranial fossa and enters the Pterygopalatine Fossa. It enters the Inferior
Orbital Fissure to pass into the orbital cavity. Here it turns laterally in a
groove on the orbital surface of the maxilla, called the infraorbital groove.

44. BRANCHES

45. Maxillary nerve
(V2)
Cranial cavity
Pterygopalatine
fossa
Infraorbital
canal
Face /
Terminal
branches
Meningeal Pterygopalatine
Zygomatic
Posterior
superior
alveolar
Middle
superior
alveolar
Anterior
superior
alveolar
Palpebral
Nasal
Superior labial

47. BRANCHES GIVEN IN THE PTERYGO PALATINE FOSSA
Pterygopalatine
nerve
Zygomatic
nerve
Posterior
superior
alveolar nerve
Orbital
Nasal
Pharyngeal
Palatine
Greater
palatine
Lesser
palatine
Nasopalatine
nerve Zygomaticotemporal
Zygomaticofacial

48. I) Branches given off in the middle cranial fossa :
• In the middle cranial fossa a small branch, the middle meningeal nerve,
passes with the middle meningeal artery and its branches to supply the dura
with sensory fibers.
• Innervation : It sends a sensory branch to the dura.

49. PTERYGOPALATINE NERVE
• Enters the ganglion after a course of
only 2-3 mm.
• No synapse formation with the cells of
the ganglion.
• The superior posterior nasal branches
are given off :-
1. Lateral nasal
• Supplies upper and middle conchae.
2. Medial branch (nasopalatine)
• Branches of the septal mucosa passes
through the incisive canal to reach the
oral cavity.

50. NASOPALATINE NERVE
• Exchanges fibers with anterior
superior alveolar nerves and
consequently may participate in the
innervation of central incisor.
• In the nasopalatine canal, the rt. And
lt. palatine nerves approach each
other and enter the oral cavity
through the unpaired incisive
foramen.
• Supply a small anterior area of the
palatine mucosa behind the incisor
teeth , from one canine to another.

51. MAIN PART OF THE PTERYGOPALATINE
NERVE
• Continues below the pterygopalatine
ganglion.
• Passes through the pterygopalatine fossa
and canal.
• Palatine nerves
• Before reaching the lower oral end of the
pterygopalatine canal, palatine nerve
divides into one larger and one or two
smaller branch.
Larger branch smaller branch

52. Palatine
nerves
Larger
branch
(anterior
palatine
nerve)
Enters oral cavity
through the major
palatine foramen.
Splits into
numerous
branches that
spread fan wise
• Anterior
• Lateral
• Medial
Smaller
branch
Middle and posterior
palatine nerves
emerge through the
lesser palatine
foramen and supply
the tonsil and the
soft palate with
sensory twigs

53. INFRAORBITAL NERVE
• Intermediate branch.
• Passes through the pterygomaxillary fissure.
• Reaches infratemporal fossa.
• Leaves immediately through the inferior
orbital fissure.
• Enters the orbit to run in the infraorbital
groove.
• The groove is roofed to form the infraorbital
canal, which leads the nerve to the infraorbital
foramen to the superficial structures of face.

54. BRANCHES OF INFRAORBITAL NERVE
• Superior alveolar nerves.
• Posterior superior alveolar nerve.
• Middle superior alveolar nerve.

55. SUPERIOR ALVEOLAR NERVES
• Supplies upper teeth, their periodontal
membrane and gingivae on the outer
surface of the jaw.
• In the base of the alveolar process the
SAN exchange fibers and form a loose
plexus – superior dental plexus.
• Two terminal sets of branches:-
1. Dental nerves:- innervates the roots
of the superior teeth by entering the
apical foramen and branches in the
dental pulp.
2. Interdental/ inter radicular nerves:-
supplies b/w two adjacent teeth,
supplies PDL. They end in the PDL
at the furcation of roots.

56. • Terminal branches :-
• They spread fanwise:-
1) Palpebral branches :- turns
upward into the eyelid.
2) Nose :- supply the lateral
slope of the nose and nasal
wing.
3) Upper lip :- 3 or 4 superior
labial branches enter the lip
between its muscles and mucous
membrane.

57. ZYGOMATIC NERVE
• Division occurs either before or while
the infraorbital nerve passes through
the inferior orbital fissure.
• In the orbit, it follows the lateral edge of
the orbital floor anteriorly and laterally.
• Sends upward branch to the lacrimal
nerve.
• Enters the zygomatic foramen and
reaches the zygomatic bone.
zygomatico- zygomaticotemporal
facial

59. MANDIBULAR NERVE (V3)
• This is the largest of the three divisions of the trigeminal nerve.
• It has both sensory and motor fibres.(Mixed nerve)
• It is the nerve of first branchial arch and supplies all structures derived from the
first branchial arch.
• Otic and submandibular ganglia are associated with this nerve.

60. COURSE AND RELATIONS
• Mandibular nerve begins in the middle
cranial fossa through a large sensory root
and a small motor root.
• The sensory root arises from the lateral
part of the trigeminal ganglion, and
leaves the cranial cavity through the
foramen ovale.
• The motor root lies deep to the trigeminal
ganglion and to the sensory root.
• It also passes through the foramen ovale
to join the sensory root just below the
foramen thus forming the main trunk.

61. • The main trunk lies in the
infratemporal fossa, on the tensor
veli palatine, deep to the lateral
pterygoid.
• After a short course, the main trunk
divides into a small anterior trunk
and a large posterior trunk.

63. BRANCHES
From the main trunk:-
a) Meningeal branch
b) Nerve to medial pterygoid
From the anterior trunk.
a) A sensory branch, the buccal
nerve.
b) Motor branches, the masseteric
nerve and deep temporal nerves
and the nerve to the lateral
pterygoid.
From the posterior trunk:
a) Auriculotemporal nerve
b) Lingual nerve
c) Inferior alveolar nerve

64. Meningeal branch or nervus spinosus:-
• It enters the skull through the foramen spinosum
with the middle meningeal artery and supplies
the dura mater of the middle cranial fossa.
Nerve to medial pterygoid:-
• It arises close to the otic ganglion and supplies
medial pterygoid from its deep surface.
• This nerve gives a motor root to the otic ganglion
which does not relay and supplies the tensor veli
palatine, and the tensor tympani muscles.
Buccal Nerve:-
• It is the only sensory branch of the anterior
division of the mandibular nerve.

65. • It passes between the
two heads of the
lateral pterygoid , runs
downwards and
forwards , and supplies
the skin of cheek,
mucous membrane
related to the
buccinator.
• It also supplies the
labial aspect of the
gums of molar and
premolar teeth.

66. Masseteric nerve :-
• It emerges at the upper border of the
lateral pterygoid muscle just in front of
the temporomandibular joint, passes
laterally through the mandibular notch
in company with the masseteric
vessels, and enters the deep surface of
the masseter.
• It also supplies the temporomandibular
joint.

67. Deep temporal nerves:-
• These are 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:-
• Nerve to the lateral pterygoid enters the
deep surface of the muscle.
Auriculotemporal nerve:-
• It 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 upper parts of
the pinna, the external acoustic meatus
and the tympanic membrane.

68. • The temporal part supplies the
skin of the temple.
• In addition, the
auriculotemporal nerve also
supplies the parotid gland and
the temporomandibular joint.

69. Lingual nerve:-
• One of the two terminal branches of the
posterior division of the mandibular nerve.
• Sensory to the anterior two thirds of the tongue
and to the floor of the mouth.
• The fibres of chorda tympani which is
secretomotor to the submandibular and
sublingual salivary glands and gustatory to the
anterior two thirds of the tongue , are also
distributed through the lingual nerve.
Course :-
• Begins 1 cm below the skull .
• At 2 cm below the skull, it is joined by chorda
tympani nerve at an acute angle, then it lies in
contact with mandible medial to third molar
tooth.
• Finally it lies on surface of hyoglossus and
genioglossus to reach the tongue.

70. Inferior alveolar nerve:-
• It is the largest terminal branch of the
posterior division of the mandibular nerve.
• Runs vertically downwards lateral to the
medial pterygoid and to the
sphenomandibular ligament.
• It enters the mandibular foramen and runs
in the mandibular canal.
• It is accompanied by the inferior alveolar
artery.
• Branches :- mylohyoid branch, branches
that supply the lower teeth and gums,
mental nerve.

71. BRANCHES OF THE MANDIBULAR NERVE
(CN V3)
Muscular Sensory Other
Temporalis and masseter Meningeal
Auriculotemporal
Taste
Medial and lateral pterygoid Inferior alveolar Secretory
Tensor veli palatine and
tensor tympani
Lingual Articular
Mylohyoid and digastric Buccal

73. APPLIED ASPECT
• Trigeminal Neuralgia:-
• Sudden,lancinating,usually unilateral,
severe brief stabbing recurrent pain in the
distribution of one or more branches of Vth
cranial nerve.
Etiology :-
• Most cases are idiopathic.
• Compression of nerve in root entry zone.
• Uncommonly by nerve demyelination n
post herpetic neuralgia

74. CLINICAL CHARACTERISTICS
• Incidence – 4 in 100000 person.
• Age – late middle age (5th or 6th decade)
• Female predilection.
• Division of trigeminal nerve involvement.
• V3 most commonly involved followed by V2.
• V1 is rarely involved
• Predilection for right side is noted (60%).

75. • Diagnostic criteria for Trigeminal neuralgia ( by: Sweet in
1987)
• The pain is paroxysmal.
• The pain may be provoked by light touch to the face (Trigger
zone).
• The pain is confined to trigeminal distribution.
• The pain is unilateral.

76. HISTORY AND SOCIETY
• Trigeminal neuralgia was first described by physician John
Fothergill and treated surgically by John Murray Carnochan,
both of whom were graduates of the University of Edinburgh
Medical School.
• Historically TN has been called "suicide disease" due to
studies by Dr Harvey Cushing which demonstrated 0.6%
mortality involving 123 cases of TN during 1896 and 1912.
• Salman Khan, one of India's biggest film stars, was diagnosed
with TN in 2011, resulting in tremendous media coverage in
the country and abroad. He underwent surgery in the US.

77. TREATMENT
• Drug therapy with carbamazepine
1. Initial treatment of choice.
2. 100 mg single daily dose and increased gradually by 100 mg daily
every 1 or 2 days until substantial pain relief.
• If carbamazepine is not well tolerated then phenytoin 300 mg to 400
mg daily.
• Baclofen 5 mg to 10 mg TID either alone or in combination with
carbamazepine or phenytoin.

78. • Surgical therapy
-Peripheral neurectomy
-Radiofrequency thermal Rhizotomy
• Injection of glycerol
• Microvascular Decompression

79. FREY’S SYNDROME
• Clinical manifestation:
Sweating, flushing, sense of
warmth in the temporal area
during eating
• Etiology:-
• Damage to auriculotemporal
nerve
• Due to trauma or parotitis.

80. a) Topical agents: anticholinergic preparation commercial
antiperspirants like scopolamine and glycopyrolate.
b) Injection of botulinum A toxin.
c) Surgical procedures: Auriculotemporal nerve section.

81. 2. Damage to the nasociliary branch can produce loss of the protective
corneal reflex with serious consequences to the eye.
3. The motor part of the mandibular nerve is tested clinically by asking
the patient to clench hisher teeth and then feeling for the
contracting masseter and temporalis muscles on the two sides.
4. If one Masseter is paralysed, the jaw deviates to the paralysed side,
on opening the mouth by the action of normal lateral Pterygoid of
the Opposite side. The activity of the Pterygoid muscle is tested by
asking the patient to move the chin from side to side.

82. 5. Lingual nerve lies in contact with the mandible, medial to
the third molar tooth. In extraction of malposed "wisdom
tooth" care must be taken not to injure the lingual nerve.
6. Post-herpetic neuralgia: This unfortunate sequela occurs
most frequently in elderly patients as a result of scarring
of nerve.

83. 7. Trotter's syndrome - Carcinoma of the nasopharynx often
producing trigeminal neuralgia like pain in the mandible,
tongue & side of the head along with the middle ear
deafness.
8. Wallenberg syndrome : Also called the lateral medullary
syndrome, a stroke causes loss of pain / temperature
sensation from one side of the face and the other side of
the body.

84. CONCLUSION
• An understanding of the management of pain in dentistry requires
thorough knowledge of the fifth cranial nerve.
• The right and left trigeminal nerves provide, among other functions,
an overwhelming majority of sensory innervation from teeth, bone and
soft tissues of the oral cavity.

85. TAKE HOME MESSAGE
• Disorders of Trigeminal nerve are not rare. Knowing about it will
help in formulating appropriate diagnosis and treatment.
• Nerve blocks given for carrying various dental procedures involves the
various branches of Trigeminal nerve, Hence to avoid any
complications ,one needs to have a knowledge about the course and
branches of the nerve .

86. REFERENCES
• BD Chaurasia’s Human Anatomy – 4th edition
• Textbook of Anatomy – I.B Singh -4th edition
• Grays Anatomy
• Atlas of Anatomy- Joseph J. Warner
• Sicher and DuBRUL’s Oral Anatomy 8th edition.
• Essentials of medical pharmacology- K.D tripathi 6th edition.
• Handbook of local anaesthesia by stanley malamed

87. Thank you !