Anatomy
Review
Main Structures Involved:
Facial Bones of the Skull:
-Maxilla, Mandible, and Palatine bones
Cranial Nerve V—Trigeminal nerve:
V2-Maxillary branch of the Trigeminal nerve
V3-Mandibular branch of the Trigeminal nerve
Cranial Nerves
 Emerge from the inferior
surface of the brain
 All pass through the
foramina (window like
opening) of the skull to
innervate structures in
the head, neck, and
facial region
Cranial Nerves (12 pairs)




IIIIIIIV-
Olfactory
Optic
Oculomotor
Trochlear
 V- Trigeminal







VI- Abducent
VII- Facial
VIII-Vestibulocochlear
IX- Glossopharyngeal
X- Vagus
XI- Accessory
XII- Hypoglossal
Trigeminal Nerve - V
Trigeminal Nerve
Largest cranial nerve/Most Important
 Short trunk from brain
with 2 roots
 Afferent /Sensory Root
[larger]
 Has trigeminal ganglion
 Opthalmic V1
 Maxillary V2
 Mandibular V3
 Motor /Efferent root
[smaller]
 Muscles of mastication
 Parasympathetic to salivary
glands
Cranial Nerve V (Trigeminal)
 3 Divisions/branches
• V1 entirely afferent
• V2 entirely afferent
• V3 mixed, both
afferent and efferent
Foramen of the Trigeminal Nerve
V-1 Ophthalmic Division
 Enters the eye through the Superior orbital fissure
 Sensation to conjuctiva, cornea, eyeball, orbit, forehead,
ethmoid sinus, frontal sinus, dura mater of brain
V-2 Maxillary Division
 Enters the skull through the
Foramen Rotundum
Afferent (Sensory) nerve
for:
 Maxilla and overlying
skin and dental plexus
 Maxillary sinuses
 Nasal cavity
 Palate
 Nasopharynx
 Part of dura mater
V2 Branches:
Infraorbital Nerve
 Sensation for upper lip,
medial cheek, lower eyelid
and side of the nose
 Passes through infraorbital
sulcus (groove in floor of
orbit) becomes:
 Infraorbital canal which
terminates at:
 Infraorbital foramen
V2 Branches:
Anterior Superior Alveolar (ASA)
 Sensation for Maxillary
centrals, laterals, canines,
and associated tissues
 Originates in pulp tissues
of teeth at apical foramen
 Joins the infraorbital nerve
along anterior wall of
maxillary sinus
 May cross over midline.
V2 Branches:
Middle Superior Alveolar (MSA)
 Sensation for Maxillary




premolars and mesiobuccal
root of the 1st molar, and buccal
gingiva.
Originates in pulp tissues of
teeth at apical foramen
Joins the infraorbital nerve
along lateral wall of maxillary
sinus
Not present on all patients.
Communicates with ASA and
PSA nerves.
V2 Branches:
Posterior Superior Alveolar (PSA)
 Sensation for Maxillary 1st
(except MB root), 2nd, 3rd
molars, buccal gingiva, and
maxillary sinus.
 Originates in pulp tissues of
teeth at apical foramen
 Joins the infraorbital nerve
along lateral wall of maxillary
sinus
 Communicates with ASA and
MSA nerves.
V2 Branches:
Greater Palatine Nerve
 Posterior hard palate and posterior lingual gingiva
 Enters Greater palatine foramen near 2-3rd molar
V2 Branches:
Lesser Palatine Nerve
 Soft Palate and palatine tonsillar tissues
 Enters lesser palatine foramen near pterygoid process
V2 Branches:
Nasopalatine Nerve
 Mucosa of anterior hard palate and lingual gingiva of maxillary teeth
 Enters incisive foramen beneath incisive papilla
 Travels along nasal septum
 Communicates with GP nerve lingual to the maxillary canines
V-3 Mandibular Division
 Enters the skull through the
Foramen Ovale in Sphenoid bone
 Largest of three divisions
 Sensory root to:
 Cheek
 External ear and scalp
 Tongue
 Submand/Sublingual salivary glands
 Floor of the mouth
 Mandibular dental plexus
 Motor root to:
 Muscles of Mastication
 Palatal muscles
V3 Branches:
Buccal Nerve
 Skin of cheek
 Buccal mucosa
 Buccal gingiva of mandibular
posterior teeth
Located on surface of
buccinator muscle
V3 Branches:
Lingual Nerve
 Lateral surface of the
tongue
 Slightly medial to
Inferior alveolar nerve
 Sensory for body of the
tongue, floor of the
mouth, and lingual
gingiva of mandibular
teeth
V3 Branches:
Mental Nerve
 Sensory for chin, lower lip,
and labial mucosa of
mandibular pre-molars,
and anterior teeth
 Merges with the incisive
nerve to form the IA nerve
 Enters the mental foramen
on the anterior surface of
the mandible near 1st and
2nd premolar apices
V3 Branches:
Incisive Nerve
 Sensory for mandibular
premolars and anterior
teeth pulp tissue
 Merges with the mental
nerve to form the IA nerve
 May crossover midline
 Enters the mental foramen
on the anterior surface of
the mandible near 1st and
2nd premolar apices
V3 Branches:
Inferior Alveolar Nerve
 Sensory for mandibular teeth
 Formed from merger of the
mental and incisive nerves
 Exits the mandibular
foramen on the lingual
surface of the ramus
V3 Branches:
Mylohyoid Nerve
 Efferent (motor) for
mylohyoid muscle and
anterior belly of digastric
muscle
 May serve as a afferent
nerve for mandibular 1st
molar if IA nerve block
failure