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Cranial Nerves 9Th & 10Th
Cranial Nerves 9th & 10th Neuroanatomy block-Anatomy-Lecture 8 Editing file Objectives At the end of the lecture, students should be able to: ● Define the deep origin of both Glossopharyngeal and Vagus Nerves. ● Locate the exit of each nerve from the brain stem. ● Describe the course and distribution of each nerve . ● List the branches of both nerves. Color guide ● Only in boys slides in Green ● Only in girls slides in Purple ● important in Red ● Notes in Grey Glossopharyngeal (IX) 9th Cranial Nerve ● it's mixed nerve, a Sensory nerve with preganglionic parasympathetic and few motor fibers ● It has no real nucleus to itself. Instead it shares nuclei with VII (facial) and X (vagus). Superficial attachment Course ● It arises from the ventral aspect of the 1. It Passes forwards between medulla by a linear series of small Internal jugular vein and rootlets, in groove between olive and External carotid artery. inferior cerebellar peduncle. ● It leaves the cranial cavity by passing 2. Lies Deep to Styloid process. through the jugular foramen in company with the Vagus , and the Accessory 3. Passes between external and nerves and the Internal jugular vein. internal carotid arteries at the posterior border of Stylopharyngeus then lateral to it. 4. It reaches the pharynx by passing between middle and inferior constrictors, deep to Hyoglossus, where it breaks into terminal branches. 3 Glossopharyngeal (IX) 9th Cranial Nerve Ganglia & Communications ● Small with no branches. Superior Ganglion ● It is connected to the Superior Cervical sympathetic ganglion. ● Large and carries general sensations from pharynx, soft palate and tonsil. Inferior ● ganglion It is connected to Auricular Branch of Vagus. -
Maxillary Nerve-Mediated Postseptoplasty Nasal Allodynia: a Case Report
E CASE REPORT Maxillary Nerve-Mediated Postseptoplasty Nasal Allodynia: A Case Report Shikha Sharma, MD, PhD,* Wilson Ly, MD, PharmD,* and Xiaobing Yu, MD*† Endoscopic nasal septoplasty is a commonly performed otolaryngology procedure, not known to cause persistent postsurgical pain or hypersensitivity. Here, we discuss a unique case of persis- tent nasal pain that developed after a primary endoscopic septoplasty, which then progressed to marked mechanical and thermal allodynia following a revision septoplasty. Pain symptoms were found to be mediated by the maxillary division of the trigeminal nerve and resolved after percuta- neous radiofrequency ablation (RFA) of bilateral maxillary nerves. To the best of our knowledge, this is the first report of maxillary nerve–mediated nasal allodynia after septoplasty. (A&A Practice. 2020;14:e01356.) GLOSSARY CT = computed tomography; FR = foramen rotundum; HIPAA = Health Insurance Portability and Accountability Act; ION = infraorbital nerve; LPP = lateral pterygoid plate; MRI = magnetic reso- nance imaging; RFA = radiofrequency ablation; SPG = sphenopalatine ganglion; US = ultrasound ndoscopic nasal septoplasty is a common otolaryn- septoplasty for chronic nasal obstruction with resection of gology procedure with rare incidence of postsurgical the cartilage inferiorly and posteriorly in 2010. Before this Ecomplications. Minor complications include epistaxis, surgery, the patient only occasionally experienced mild septal hematoma, septal perforation, cerebrospinal fluid leak, headaches. However, his postoperative course was compli- and persistent obstruction.1 Numbness or hypoesthesia of the cated by significant pain requiring high-dose opioids. After anterior palate, secondary to injury to the nasopalatine nerve, discharge, patient continued to have persistent deep, “ach- has been reported, but is usually rare and temporary, resolv- ing” nasal pain which radiated toward bilateral forehead ing over weeks to months.2 Acute postoperative pain is also and incisors. -
Neurophysiological Aspects of the Trigeminal Sensory System: an Update
Rev. Neurosci. 2018; 29(2): 115–123 Frederic Van der Cruyssen* and Constantinus Politis Neurophysiological aspects of the trigeminal sensory system: an update https://doi.org/10.1515/revneuro-2017-0044 Keywords: infraorbital; mandibular; neurophysiology; Received June 21, 2017; accepted July 20, 2017; previously published ophthalmic nerve; oral somatosensory functioning; online November 8, 2017 trigeminal sensory system. Abstract: The trigeminal system is one of the most complex cranial nerve systems of the human body. Research on it has vastly grown in recent years and concentrated more and more on molecular mechanisms and pathophysiology, Introduction but thorough reviews on this topic are lacking, certainly Knowledge about physiological aspects of the trigeminal on the normal physiology of the trigeminal sensory system. system today is largely based on animal models (Akerman Here we review the current literature on neurophysiology and Goadsby, 2015; Herta et al., 2017), cadaver studies of the trigeminal nerve from peripheral receptors up to its (Ezure et al., 2001; Williams et al., 2003) or extrapola- central projections toward the somatosensory cortex. We tions from peripheral nerve functioning. Human studies focus on the most recent scientific discoveries and describe are frequently limited to pathophysiology and lack proper historical relevant research to substantiate further. One study designs (Tanaka and Zhao, 2016; Goadsby et al., chapter on new insights of the pathophysiology of pain 2017). Neurophysiological research in this area is difficult at the level of the trigeminal system is added. A database due to the invasive character of most neurophysiological search of Medline, Embase and Cochrane was conducted tests, the small caliber of fibers, high density of receptors, with the search terms ‘animal study’, ‘neurophysiology’, cross-connections between different cranial nerves, dif- ‘trigeminal’, ‘oral’ and ‘sensory’. -
The Mandibular Nerve - Vc Or VIII by Prof
The Mandibular Nerve - Vc or VIII by Prof. Dr. Imran Qureshi The Mandibular nerve is the third and largest division of the trigeminal nerve. It is a mixed nerve. Its sensory root emerges from the posterior region of the semilunar ganglion and is joined by the motor root of the trigeminal nerve. These two nerve bundles leave the cranial cavity through the foramen ovale and unite immediately to form the trunk of the mixed mandibular nerve that passes into the infratemporal fossa. Here, it runs anterior to the middle meningeal artery and is sandwiched between the superior head of the lateral pterygoid and tensor veli palatini muscles. After a short course during which a meningeal branch to the dura mater, and the nerve to part of the medial pterygoid muscle (and the tensor tympani and tensor veli palatini muscles) are given off, the mandibular trunk divides into a smaller anterior and a larger posterior division. The anterior division receives most of the fibres from the motor root and distributes them to the other muscles of mastication i.e. the lateral pterygoid, medial pterygoid, temporalis and masseter muscles. The nerve to masseter and two deep temporal nerves (anterior and posterior) pass laterally above the medial pterygoid. The nerve to the masseter continues outward through the mandibular notch, while the deep temporal nerves turn upward deep to temporalis for its supply. The sensory fibres that it receives are distributed as the buccal nerve. The 1 | P a g e buccal nerve passes between the medial and lateral pterygoids and passes downward and forward to emerge from under cover of the masseter with the buccal artery. -
Morphometry and Morphology of Foramen Petrosum in Indian Population
Basic Sciences of Medicine 2020, 9(1): 8-9 DOI: 10.5923/j.medicine.20200901.02 Morphometry and Morphology of Foramen Petrosum in Indian Population Rajani Singh1,*, Nand Kishore Gupta1, Raj Kumar2 1Department of Anatomy, Uttar Pradesh University of Medical Sciences Saifai 206130 Etawah UP India 2Department of Neurosugery Uttar Pradesh University of Medical Sciences Saifai 206130 Etawah UP India Abstract Greater wing of sphenoid contains three constant foramina, Foramen ovale, foramen rotundum and foramen spinosum. The presence of foramen Vesalius and foramen petrosum are inconsistent. Normally foramen ovale transmits mandibular nerve, accessory meningeal artery, lesser petrosal nerve and emissary vein. When foramen petrosum is present, lesser petrosal nerve passes through petrosal foramen instead of foramen ovale. Lesser petrosal nerve distribute postganglionic fibers from otic ganglion to parotid gland. In absence of knowledge of petrosal foramen transmitting lesser petrosal nerve, the clinician may damage the nerve during skull base surgery creating complications like hyperemia of face and profuse salivation from the parotid gland (following atropine administration), lacrimation (crocodile tears syndrome) and mucus nasal secretion. Considering clinical implications associated with petrosal foramen, the study was carried out. The aim of the study is to determine the prevalence of petrosal foramen in Indian Population and to bring out associated clinical significance. The study was conducted in the department of Anatomy UPUMS Saifai Etawah Indian. 30 half skulls were observed for the presence of petrosal foramina and morphometry was also done. Literature search was carried out, our findings were compared with previous work and associated clinical implications were bought out. Keywords Petrosal foramen, Lesser petrosal nerve, Foramen ovale patients. -
Clinical Anatomy of the Trigeminal Nerve
Clinical Anatomy of Trigeminal through the superior orbital fissure Nerve and courses within the lateral wall of the cavernous sinus on its way The trigeminal nerve is the fifth of to the trigeminal ganglion. the twelve cranial nerves. Often Ophthalmic Nerve is formed by the referred to as "the great sensory union of the frontal nerve, nerve of the head and neck", it is nasociliary nerve, and lacrimal named for its three major sensory nerve. Branches of the ophthalmic branches. The ophthalmic nerve nerve convey sensory information (V1), maxillary nerve (V2), and from the skin of the forehead, mandibular nerve (V3) are literally upper eyelids, and lateral aspects "three twins" carrying information of the nose. about light touch, temperature, • The maxillary nerve (V2) pain, and proprioception from the enters the middle cranial fossa face and scalp to the brainstem. through foramen rotundum and may or may not pass through the • The three branches converge on cavernous sinus en route to the the trigeminal ganglion (also called trigeminal ganglion. Branches of the semilunar ganglion or the maxillary nerve convey sensory gasserian ganglion), which contains information from the lower eyelids, the cell bodies of incoming sensory zygomae, and upper lip. It is nerve fibers. The trigeminal formed by the union of the ganglion is analogous to the dorsal zygomatic nerve and infraorbital root ganglia of the spinal cord, nerve. which contain the cell bodies of • The mandibular nerve (V3) incoming sensory fibers from the enters the middle cranial fossa rest of the body. through foramen ovale, coursing • From the trigeminal ganglion, a directly into the trigeminal single large sensory root enters the ganglion. -
Atlas of the Facial Nerve and Related Structures
Rhoton Yoshioka Atlas of the Facial Nerve Unique Atlas Opens Window and Related Structures Into Facial Nerve Anatomy… Atlas of the Facial Nerve and Related Structures and Related Nerve Facial of the Atlas “His meticulous methods of anatomical dissection and microsurgical techniques helped transform the primitive specialty of neurosurgery into the magnificent surgical discipline that it is today.”— Nobutaka Yoshioka American Association of Neurological Surgeons. Albert L. Rhoton, Jr. Nobutaka Yoshioka, MD, PhD and Albert L. Rhoton, Jr., MD have created an anatomical atlas of astounding precision. An unparalleled teaching tool, this atlas opens a unique window into the anatomical intricacies of complex facial nerves and related structures. An internationally renowned author, educator, brain anatomist, and neurosurgeon, Dr. Rhoton is regarded by colleagues as one of the fathers of modern microscopic neurosurgery. Dr. Yoshioka, an esteemed craniofacial reconstructive surgeon in Japan, mastered this precise dissection technique while undertaking a fellowship at Dr. Rhoton’s microanatomy lab, writing in the preface that within such precision images lies potential for surgical innovation. Special Features • Exquisite color photographs, prepared from carefully dissected latex injected cadavers, reveal anatomy layer by layer with remarkable detail and clarity • An added highlight, 3-D versions of these extraordinary images, are available online in the Thieme MediaCenter • Major sections include intracranial region and skull, upper facial and midfacial region, and lower facial and posterolateral neck region Organized by region, each layered dissection elucidates specific nerves and structures with pinpoint accuracy, providing the clinician with in-depth anatomical insights. Precise clinical explanations accompany each photograph. In tandem, the images and text provide an excellent foundation for understanding the nerves and structures impacted by neurosurgical-related pathologies as well as other conditions and injuries. -
A Review of the Mandibular and Maxillary Nerve Supplies and Their Clinical Relevance
AOB-2674; No. of Pages 12 a r c h i v e s o f o r a l b i o l o g y x x x ( 2 0 1 1 ) x x x – x x x Available online at www.sciencedirect.com journal homepage: http://www.elsevier.com/locate/aob Review A review of the mandibular and maxillary nerve supplies and their clinical relevance L.F. Rodella *, B. Buffoli, M. Labanca, R. Rezzani Division of Human Anatomy, Department of Biomedical Sciences and Biotechnologies, University of Brescia, V.le Europa 11, 25123 Brescia, Italy a r t i c l e i n f o a b s t r a c t Article history: Mandibular and maxillary nerve supplies are described in most anatomy textbooks. Accepted 20 September 2011 Nevertheless, several anatomical variations can be found and some of them are clinically relevant. Keywords: Several studies have described the anatomical variations of the branching pattern of the trigeminal nerve in great detail. The aim of this review is to collect data from the literature Mandibular nerve and gives a detailed description of the innervation of the mandible and maxilla. Maxillary nerve We carried out a search of studies published in PubMed up to 2011, including clinical, Anatomical variations anatomical and radiological studies. This paper gives an overview of the main anatomical variations of the maxillary and mandibular nerve supplies, describing the anatomical variations that should be considered by the clinicians to understand pathological situations better and to avoid complications associated with anaesthesia and surgical procedures. # 2011 Elsevier Ltd. -
Clinical Anatomy of Greater Petrosal Nerve and Its Surgical Importance
[Downloaded free from http://www.indianjotol.org on Monday, August 18, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal ORIGINAL ARTICLE Clinical anatomy of greater petrosal nerve and its surgical importance Prashant E Natekar, Fatima M De Souza Department of Anatomy, Goa Medical College, Bambolim, Goa, India Background: Surgical approach towards greater petrosal nerve has to be done with caution as many surgeons ABSTRACT are unfamiliar with the anatomy of the facial nerve. The anatomical landmarks selected must be reliable and above all easy to identify for identification of the greater petrosal nerve so as to avoid injury to the structures in the middle cranial fossa. Observation and Results: The present study is carried out on 100 temporal bones by examining the following measurements of the right and the left sides a) length of the hiatus for grater petrosal superficial nerve b) distance from superior petrosal sinus c) distance from lateral margin of middle cranial fossa d) arcuate eminence and e) distance from exit to the foramen ovale. Conclusion: The anatomical landmarks selected must be reliable and above all easy to identify. Bony structures are more suitable than soft tissue or cartilaginous landmarks because of their rigid and reliable location. These anatomical landmarks will definitely help the surgeon while performing vidian nerve neurectomy and also the anatomical relationship of the facial nerve in temporal bone. The middle fossa approach involves a temporal craniotomy in cases of perineural spread of adenoid cystic carcinomas hence these anatomical landmarks will serve as useful guide for the surgeons and radiologists. -
05 Trigeminal System 2013.Pdf
Dental Neuroanatomy Thursday February 7th, 2013 David A. Morton, Ph.D. 5. THE TRIGEMINAL SYSTEM Somatic Sensation of the Face and Head Objectives 1. Outline the two pathways for facial sensation from the head. 2. Contrast facial sensation from the head and somatic sensation from the body. In what ways are they similar? Different? Try drawing this on the Haines atlas diagram at the end of the lecture. 3. Diagram the corneal reflex: the afferent and efferent limbs as well as nuclei involved in the brainstem. 4. If a person does not blink, how would you determine if the problem were in the sensory (afferent) limb, motor (efferent) limb, or brainstem interconnections for the corneal reflex? 5. Explain how a single, small medullary vascular lesion could abolish pain and temperature from the face on the right side and pain and temperature from the body on the left side. What vessel is most likely occluded? Introduction – The trigeminal system for the face and oral cavity is organized in a manner similar to the spinal cord. It has the equivalent of both the DCML pathway and the ALS pathway. The two trigeminal pathways will converge in the thalamus. The most confusing thing is that one of them descends before crossing and the other crosses immediately. Peripheral Receptors and Sensation Structures served by trigeminal system. 1. Cornea 2. Mucocutaneous tissues around mouth and nostrils. 3. Oral and nasal mucosae 4. Paranasal sinuses 5. Tongue (anterior two thirds) 6. Teeth and gums 7. Dura of anterior and middle cranial fossae 8. Skin of face to the vertex except angle of jaw 9. -
The Mandibular Nerve: the Anatomy of Nerve Injury and Entrapment
5 The Mandibular Nerve: The Anatomy of Nerve Injury and Entrapment M. Piagkou1, T. Demesticha2, G. Piagkos3, Chrysanthou Ioannis4, P. Skandalakis5 and E.O. Johnson6 1,3,4,5,6Department of Anatomy, 2Department of Anesthesiology, Metropolitan Hospital Medical School, University of Athens Greece 1. Introduction The trigeminal nerve (TN) is a mixed cranial nerve that consists primarily of sensory neurons. It exists the brain on the lateral surface of the pons, entering the trigeminal ganglion (TGG) after a few millimeters, followed by an extensive series of divisions. Of the three major branches that emerge from the TGG, the mandibular nerve (MN) comprises the 3rd and largest of the three divisions. The MN also has an additional motor component, which may run in a separate facial compartment. Thus, unlike the other two TN divisions, which convey afferent fibers, the MN also contains motor or efferent fibers to innervate the muscles that are attached to mandible (muscles of mastication, the mylohyoid, the anterior belly of the digastric muscle, the tensor veli palatini, and tensor tympani muscle). Most of these fibers travel directly to their target tissues. Sensory axons innervate skin on the lateral side of the head, tongue, and mucosal wall of the oral cavity. Some sensory axons enter the mandible to innervate the teeth and emerge from the mental foramen to innervate the skin of the lower jaw. An entrapment neuropathy is a nerve lesion caused by pressure or mechanical irritation from some anatomic structures next to the nerve. This occurs frequently where the nerve passes through a fibro-osseous canal, or because of impingement by an anatomic structure (bone, muscle or a fibrous band), or because of the combined influences on the nerve entrapment between soft and hard tissues. -
Maxillary Nerve Variations and Its Clinical Significance
Sai Pavithra .R et al /J. Pharm. Sci. & Res. Vol. 6(4), 2014, 203-205 Maxillary Nerve Variations and Its Clinical Significance Sai Pavithra .R,Thenmozhi M.S Department of Anatomy, Saveetha Dental College Tamil nadu. Abstract: The aim of this review is to collect data from the literature and gives a detailed description of the innervation of the maxilla. We carried out a search of studies published in PubMed up to 2011, including clinical and anatomical studies .several articles has has been published regarding the anatomical variations of the maxillary nerve supplies. The purpose of this paper is to demonstrate the variation in the paths and communications of the maxillary nerve which should be considered by the clinicians as nerve supply,assumed prime importance to oral surgeons to understand better and to avoid complications associated with anaesthesia and surgical procedures. Key words: maxillary nerve, clinical variations THE MAXILLARY NERVE: foramen is usually a single foramen but several studies 1. Anatomical variations of the maxillary nerve supply. have proven to have two or three foramen[2-8]. A low 2. Anatomical variations of the infraorbital nerve. percentage (4.7%) was observed during a study on 3. Anatomical variations of the superior alveolar nerve 1064 skulls, with a higher frequency on the left side, 4.Anatomical variations of the greaterpalatine nerve. both in male and in female skulls[9]. The distance from 5. Anatomical variations of the nasopalatine nerve. the infraorbital foramen to the inferior border of the [10-13] orbital rim is from 4.6 to 10.4 mm . AXILLARY NERVE: Since the infraorbital nerve block is often used to The maxillary nerve is a sensory nerve.