The Trigeminal Nerve
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Lingual Nerve Course and Its Communication with Hypoglossal
International Journal of Health and Clinical Research, 2021;4(5):117-122 e-ISSN: 2590-3241, p-ISSN: 2590-325X ____________________________________________________________________________________________________________________________________________ Original Research Article Lingual Nerve Course and Its Communication with Hypoglossal Nerve: Variations in Cadavers in Western India Javia Mayank Kumar1, Chhabra Prabhjot Kaur2*, Anand Mahindra Kumar3 1Associate Professor, Department of Anatomy, Banas Medical College & Research Institute, Palanpur, Gujarat,India 2Assistant Professor, Department of Anatomy,Jaipur National University Institute For Medical Sciences & Research Centre, Jaipur, Rajasthan,India 3Professor,Department of Anatomy, Banas Medical College & Research Institute, Palanpur,India Received: 22-12-2020 / Revised: 09-02-2021 / Accepted: 23-02-2021 Abstract Background:Locationand variations in branching pattern of lingual nerve makes it vulnerable to injury in various oral and dental surgical procedures. Awareness of variations in distribution pattern will reduce the chances of injury to lingual nerve and post-operative complications in excision of ranulas, extraction of third molar tooth, sub mental endotracheal intubationand during difficult suspension laryngoscopy. Present study was undertaken to describe the course, morphology and variationsof lingual nerve in infra-temporal and submandibular regions and to find out communication(s) if any with hypoglossal nerve.Methods: Head and neck dissection was performed in fifteen formalin -
Numb Tongue, Numb Lip, Numb Chin: What to Do When?
NUMB TONGUE, NUMB LIP, NUMB CHIN: WHAT TO DO WHEN? Ramzey Tursun, DDS, FACS Marshall Green, DDS Andre Ledoux, DMD Arshad Kaleem, DMD, MD Assistant Professor, Associate Fellowship Director of Oral, Head & Neck Oncologic and Microvascular Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, Division of Oral Maxillofacial Surgery, Leonard M. Miller School of Medicine, University of Miami INTRODUCTION MECHANISM OF NERVE Microneurosurgery of the trigeminal nerve INJURIES has been in the spotlight over the last few years. The introduction of cone-beam When attempting to classify the various scanning, three-dimensional imaging, mechanisms of nerve injury in the magnetic resonance neurography, maxillofacial region, it becomes clear that endoscopic-assisted surgery, and use of the overwhelming majority are iatrogenic allogenic nerve grafts have improved the in nature. The nerves that are most often techniques that can be used for affected in dento-alveolar procedures are assessment and treatment of patients with the branches of the mandibular division of nerve injuries. Injury to the terminal cranial nerve V, i.e., the trigeminal nerve. branches of the trigeminal nerve is a well- The lingual nerve and inferior alveolar known risk associated with a wide range of nerve are most often affected, and third dental and surgical procedures. These molar surgery is the most common cause 1 injuries often heal spontaneously without of injury. medical or surgical intervention. However, they sometimes can cause a variety of None of these nerves provide motor symptoms, including lost or altered innervation. However, damage to these sensation, pain, or a combination of these, nerves can cause a significant loss of and may have an impact on speech, sensation and/or taste in affected patients. -
Regional Anesthesia in Head and Neck Surgery
TITLE: Regional Anesthesia in Head and Neck Surger SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology DATE: May 24, 2006 RESIDENT PHYSICIAN: Jacques Peltier, MD FACULTY PHYSICIAN: Francis B. Quinn, MD SERIES EDITORS: Francis B. Quinn, Jr., MD and Matthew W. Ryan, MD "This material was prepared by resident physicians in partial fulfillment of educational requirements established for the Postgraduate Training Program of the UTMB Department of Otolaryngology/Head and Neck Surgery and was not intended for clinical use in its present form. It was prepared for the purpose of stimulating group discussion in a conference setting. No warranties, either express or implied, are made with respect to its accuracy, completeness, or timeliness. The material does not necessarily reflect the current or past opinions of members of the UTMB faculty and should not be used for purposes of diagnosis or treatment without consulting appropriate literature sources and informed professional opinion." Introduction Local anesthetic techniques were popularized early in the history of surgery with the advent of injectable nerve blocking agents. Until their discovery, patients were either held down or knocked unconscious to perform procedures. In the early days of general anesthesia, local anesthesia was preferred in all cases that it was applicable due to the significant risks associated with general anesthesia. Many procedures performed today under general anesthesia, such as tonsillectomy, rhinoplasty, and even bronchoscopy, were performed under local anesthesia to avoid the perils of general anesthetics. With the introduction of pulse oximetry, safer inhaled anesthetics, and combined intravenous and inhaled general anesthesia techniques, general anesthesia has become much safer, resulting in many surgeons being unfamiliar with regional nerve blocks to perform surgery. -
Endocrine Block اللهم ال سهل اال ما جعلته سهل و أنت جتعل احلزن اذا شئت سهل
OSPE ENDOCRINE BLOCK اللهم ﻻ سهل اﻻ ما جعلته سهل و أنت جتعل احلزن اذا شئت سهل Important Points 1. Don’t forget to mention right and left. 2. Read the questions carefully. 3. Make sure your write the FULL name of the structures with the correct spelling. Example: IVC ✕ Inferior Vena Cava ✓ Aorta ✕ Abdominal aorta ✓ 4. There is NO guarantee whether or not the exam will go out of this file. ممكن يأشرون على أجزاء مو معلمه فراح نحط بيانات إضافية حاولوا تمرون عليها كلها Good luck! Pituitary gland Identify: 1. Anterior and posterior clinoidal process of sella turcica. 2. Hypophyseal fossa (sella turcica) Theory • The pituitary gland is located in middle cranial fossa and protected in sella turcica (hypophyseal fossa) of body of sphenoid. Relations Of Pituitary Gland hypothalamus Identify: 1. Mamillary body (posteriorly) 2. Optic chiasma (anteriorly) 3. Sphenoidal air sinuses (inferior) 4. Body of sphenoid 5. Pituitary gland Theory • If pituitary gland became enlarged (e.g adenoma) it will cause pressure on optic chiasma and lead to bilateral temporal eye field blindness (bilateral hemianopia) Relations Of Pituitary Gland Important! Identify: 1. Pituitary gland. 2. Diaphragma sellae (superior) 3. Sphenoidal air sinuses (inferior) 4. Cavernous sinuses (lateral) 5. Abducent nerve 6. Oculomotor nerve 7. Trochlear nerve 8. Ophthalmic nerve 9. Trigeminal (Maxillary) nerve Structures of lateral wall 10. Internal carotid artery Note: Ophthalmic and maxillary are both branches of the trigeminal nerve Divisions of Pituitary Gland Identify: 1. Anterior lobe (Adenohypophysis) 2. Optic chiasma 3. Infundibulum 4. Posterior lobe (Neurohypophysis) Theory Anterior Lobe Posterior Lobe • Adenohypophysis • Neurohypophysis • Secretes hormones • Stores hormones • Vascular connection to • Neural connection to hypothalamus by hypothalamus by Subdivisions hypophyseal portal hypothalamo-hypophyseal system (from superior tract from supraoptic and hypophyseal artery) paraventricular nuclei. -
Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery
brain sciences Article Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery Grzegorz Wysiadecki 1,* , Maciej Radek 2 , R. Shane Tubbs 3,4,5,6,7 , Joe Iwanaga 3,5,8 , Jerzy Walocha 9 , Piotr Brzezi ´nski 10 and Michał Polguj 1 1 Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, ul. Zeligowskiego˙ 7/9, 90-752 Łód´z,Poland; [email protected] 2 Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, University Hospital WAM-CSW, 90-549 Łód´z,Poland; [email protected] 3 Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA; [email protected] (R.S.T.); [email protected] (J.I.) 4 Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA 70433, USA 5 Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA 6 Department of Anatomical Sciences, St. George’s University, Grenada FZ 818, West Indies 7 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA 8 Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan Citation: Wysiadecki, G.; Radek, M.; 9 Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland; Tubbs, R.S.; Iwanaga, J.; Walocha, J.; [email protected] Brzezi´nski,P.; Polguj, M. -
Anatomy of Maxillary and Mandibular Local Anesthesia
Anatomy of Mandibular and Maxillary Local Anesthesia Patricia L. Blanton, Ph.D., D.D.S. Professor Emeritus, Department of Anatomy, Baylor College of Dentistry – TAMUS and Private Practice in Periodontics Dallas, Texas Anatomy of Mandibular and Maxillary Local Anesthesia I. Introduction A. The anatomical basis of local anesthesia 1. Infiltration anesthesia 2. Block or trunk anesthesia II. Review of the Trigeminal Nerve (Cranial n. V) – the major sensory nerve of the head A. Ophthalmic Division 1. Course a. Superior orbital fissure – root of orbit – supraorbital foramen 2. Branches – sensory B. Maxillary Division 1. Course a. Foramen rotundum – pterygopalatine fossa – inferior orbital fissure – floor of orbit – infraorbital 2. Branches - sensory a. Zygomatic nerve b. Pterygopalatine nerves [nasal (nasopalatine), orbital, palatal (greater and lesser palatine), pharyngeal] c. Posterior superior alveolar nerves d. Infraorbital nerve (middle superior alveolar nerve, anterior superior nerve) C. Mandibular Division 1. Course a. Foramen ovale – infratemporal fossa – mandibular foramen, Canal -> mental foramen 2. Branches a. Sensory (1) Long buccal nerve (2) Lingual nerve (3) Inferior alveolar nerve -> mental nerve (4) Auriculotemporal nerve b. Motor (1) Pterygoid nerves (2) Temporal nerves (3) Masseteric nerves (4) Nerve to tensor tympani (5) Nerve to tensor veli palatine (6) Nerve to mylohyoid (7) Nerve to anterior belly of digastric c. Both motor and sensory (1) Mylohyoid nerve III. Usual Routes of innervation A. Maxilla 1. Teeth a. Molars – Posterior superior alveolar nerve b. Premolars – Middle superior alveolar nerve c. Incisors and cuspids – Anterior superior alveolar nerve 2. Gingiva a. Facial/buccal – Superior alveolar nerves b. Palatal – Anterior – Nasopalatine nerve; Posterior – Greater palatine nerves B. -
Risks and Complications of Orthodontic Miniscrews
SPECIAL ARTICLE Risks and complications of orthodontic miniscrews Neal D. Kravitza and Budi Kusnotob Chicago, Ill The risks associated with miniscrew placement should be clearly understood by both the clinician and the patient. Complications can arise during miniscrew placement and after orthodontic loading that affect stability and patient safety. A thorough understanding of proper placement technique, bone density and landscape, peri-implant soft- tissue, regional anatomic structures, and patient home care are imperative for optimal patient safety and miniscrew success. The purpose of this article was to review the potential risks and complications of orthodontic miniscrews in regard to insertion, orthodontic loading, peri-implant soft-tissue health, and removal. (Am J Orthod Dentofacial Orthop 2007;131:00) iniscrews have proven to be a useful addition safest site for miniscrew placement.7-11 In the maxil- to the orthodontist’s armamentarium for con- lary buccal region, the greatest amount of interradicu- trol of skeletal anchorage in less compliant or lar bone is between the second premolar and the first M 12-14 noncompliant patients, but the risks involved with mini- molar, 5 to 8 mm from the alveolar crest. In the screw placement must be clearly understood by both the mandibular buccal region, the greatest amount of inter- clinician and the patient.1-3 Complications can arise dur- radicular bone is either between the second premolar ing miniscrew placement and after orthodontic loading and the first molar, or between the first molar and the in regard to stability and patient safety. A thorough un- second molar, approximately 11 mm from the alveolar derstanding of proper placement technique, bone density crest.12-14 and landscape, peri-implant soft-tissue, regional anatomi- During interradicular placement in the posterior re- cal structures, and patient home care are imperative for gion, there is a tendency for the clinician to change the optimal patient safety and miniscrew success. -
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’. -
Innervation of the Temporomandibular Joint Can Be Discussed It Is Necessary First to Describe Its Embryology, Gfoss Anatomy and Microscopic Appe¿Ìrance
à8.ì 'R? INNERVATION OF THE TEMPOROMAI\DIBULAR J AN EXPERIMENTAL AMMAL MODEL USING AUSTRALIAN MERINO STIEEP ABDOLGHAFAR TAHMASEBI-SARVESTANI' B. Sc, M. Sc Thesis submitted for the degree of DOCTOR OF PHILOSOPHY In The Department of Anatomical Sciences The University of Adelaide (Faculty of Medicine)' Adelaide, South Australia, 5005 April, L997 tfüs tñesisis [elicatelø nl wtfe Aggñleñ ø¡tlour g4.arzi"e tfr.re e c friûfren Ía fiera ñ, fo zic ñ atú fi l-1 ACKNOWLEDGMENTS I am greatly indebted to my supervisors Dr. Ray Tedman and Professor Alastair Goss who first inrroduced me to this freld of study and providing me with the opportunity to carry out this work. I wish to thank them for their constant interest and guidance throughout the course of this study. I am also indebted to the scholarship committee of the Shiraz Medical Science University and Ministry of Health and Medical Education, Iran for gânting me a 4 year scholarship to study at the Universiry of Adelaide. I thank professor Goss and the Japanese Surgical Research team for their expertise in surgical animal models, and Professor July Polak and Dr Mika Hukkanen, Royal postgraduate Medical School London University for their expertise in immunohistochemistry and for providing some of the antisera used in the neuropeptide studies. I would also like to thank Professor Ian Gibbins, Department of Anatomy and Histology of the Flinders Medical Centre for, without the use of his laboratories, materials, and expertise, the double and triple labelling parts of the immunocytochemical work would not have occurred. I also orwe many thanks to Susan Matthew, a senior laboratory officer for her skilful technical assistance in double and triple immunocytochemistry. -
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. -
Cranial Neuralgias
CRANIAL NEURALGIAS Presented by: Neha Sharma M.D. Date: September 27th, 2019 TYPES OF NEURALGIAS ❖ TRIGEMINAL NEURALGIA ❖ GLOSSOPHARYNGEAL NEURALGIA ❖ NASOCILIARY NEURALGIA ❖ SUPERIOR LARYNGEAL NEURALGIA ❖ SUPRAORBITAL NEURALGIA ❖ OCCIPITAL NEURALGIA ❖ SPHENOPALATINE NEURALGIA ❖ GREAT AURICULAR NEURALGIA ❖ NERVUS INTERMEDIUS NEURALGIA ❖ TROCHLEAR NEURALGIA WHAT IS CRANIAL NEURALGIA? ❖ Paroxysmal pain of head, face and/or neck ❖ Unilateral sensory nerve distribution ❖ Pain is described as sharp, shooting, lancinating ❖ Primary or Secondary causes ❖ Multiple triggers TRIGEMINAL (CN V) NEURALGIA TRIGEMINAL NEURALGIA ❖ Also called Tic Douloureux ❖ Sudden, unilateral, electrical, shock-like, shooting, sharp pain. Presents affecting Cranial Nerve V; primarily V2 and V3 branches ❖ F>M; 3:1 TRIGEMINAL NEURALGIA ❖ Anatomy of Trigeminal Nerve ❖ Cranial Nerve V ❖ Three Branches: Ophthalmic, Maxillary and Mandibular ❖ Sensory supply to forehead/supraorbital, cheeks and jaw https://www.nf2is.org/cn5.php TRIGEMINAL NEURALGIA – TRIGGERS ❖ Mastication (73%) ❖ Eating (59%) ❖ Touch (69%) ❖ Talking (58%) ❖ Brushing Teeth (66%) ❖ Cold wind (50%) TYPES OF TRIGEMINAL NEURALGIA ❖ Primary/Classic/Idiopathic ❖ Vascular compression of the nerve – superior cerebellar artery ❖ Secondary/Symptomatic ❖ Caused by intracranial lesions ❖ Tumors, Strokes, Multiple Sclerosis (4%) ❖ Typical vs. Atypical ❖ Paroxysmal (79%) vs. Continuous (21%) IASP/IHS & CLASSIFICATIONS OF TRIGEMINAL NEURALGIA ❖ IASP – International Association ❖ Classifications for the Study of Pain ❖ I