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Head & Neck Nerves
Cranial Nerves
| Question | Answer |
|---|---|
| what are the two divisions of the nervous system | central and peripheral |
| the CNS consists of | the brain and spinal cord |
| the PNS consists of | all nervous tissue outside of organs |
| what is a ganglion | an accumulation of nerve cell bodies |
| afferent nerve | sensory nerves that carry information away from the periphery of the body to the brain and spinal cord. |
| efferent nerve | Motor nerves carries information away from the brain or spinal cord to the periphery of the body. |
| the efferent division of the PNS is further divided into | somatic nervous system and autonomic nervous system |
| somatic nervous system | cranial and spinal nerve fibers that connect the CNS to the skin and skeletal muscles, voluntary movement. |
| autonomic nervous system | Nerve fibers that connect visceral organs (heart, stomach, glands) to the CNS function automatic, without conscious effort from the individual, or involuntary. |
| two divisions of the ANS | sympathetic and parasympathetic |
| sympathetic division | -fight or flight -increase in pupil size, increase heart rate, shutdown of salivary gland secretion, release of epi |
| parasympathetic division | -rest and digest -decrease pupil size, stimulation of salivary gland, stimulation of digestive and immune system |
| what ganglion travels with the cranial nerves | parasympathetic ganglion |
| first important ganglion in CN VII | pterygopalatine -> lacrimal |
| second important ganglion in CN VII | submandibular -> submand and subling glands |
| important ganglion in CN IX | otic -> parotid |
| important ganglion in CN V | trigeminal (semilunar, gasserian) |
| CN I name and afferent/efferent | olfactory, afferent |
| CN I function | transmits smell |
| CN I location | enters through the cribriform plate of the ethmoid bone |
| CN II name and afferent/efferent | optic, afferent |
| CN II function | transmits sight from the retina to the brain |
| CN II location | enters through the optic canal located in the sphenoid bone |
| CN III name and afferent/efferent | oculomotor, efferent |
| CN III function | moves the eyeball |
| CN III location | exits through the superior orbital fissure of the sphenoid bone on its way to the orbit |
| CN IV name and afferent/efferent | trochlear, efferent |
| CN IV function | moves the superior oblique muscle of the eye |
| CN IV location | exits through the superior orbital fissure of the sphenoid bone on its way to the orbit |
| CN V name and afferent/efferent | trigeminal, both afferent and efferent |
| what is the largest cranial nerve | trigeminal nerve (CN V) |
| what is the most significant cranial nerve to the dental profession | trigeminal nerve (CN V) |
| three divisions of the trigeminal nerve | ophthalmic V1, maxillary V2, mandibular V3 |
| afferent function of the trigeminal nerve | sensation of pain, temperature, touch, and pressure from the skin and mucous membrane of the head, teeth, oral cavity, and tongue |
| efferent function of the trigeminal nerve | muscles of mastication |
| ophthalmic division V1 | -afferent -provides sensation to the eyes, skin of the forehead, eyelids, and nose (nothing in oral cavity) |
| maxillary division V2 | -afferent -provides sensation to the cheek, lower eyelid, nose, upper lip, all max teeth |
| mandibular division V3 | -afferent and efferent -afferent: provides sensation of pain, temp, touch, pressure to lower face and jaw, all mand teeth -efferent: muscles of mastication |
| where does the ophthalmic division enter | superior orbital fissure |
| where does the maxillary division enter | foramen rotundum |
| where does the mandibular division enter | foramen ovale |
| other names for trigeminal ganglion | semilunar or gasserian ganglion |
| location of trigeminal ganglion | anterior surface of the petrous portion of the temporal bone |
| CN VI name and afferent/efferent | abducens, efferent |
| CN VI function | moves the lateral rectus muscle of the eye |
| CN VI location | exits through the superior orbital fissure on its way to the orbit |
| CN VII name and afferent/efferent | facial nerve, both afferent and efferent |
| CN VII motor/efferent functions | muscles of facial expression, lacrimal glands, submandibular and sublingual glands |
| FPL | facial nerve> pterygopalatine ganglion> lacrimal glands |
| Chorda tympani | branch of the facial nerve |
| FACTSss | facial nerve> chorda tympani> submandibular ganglion> submandibular and sublingual salivary glands |
| CN VII sensory function | feeling to the tiny patch of skin behind the ear, taste to the anterior two thirds of the tongue (chorda tympani) |
| CN VII leaves the cranial cavity through | internal acoustic meatus which leads to the facial canal in the temporal bone |
| CN VII exits the skull through | styloidmastoid foramen of the temporal bone |
| CN VII is important to dental professionals because it passes through | the parotid salivary gland |
| What disorder does CN VII effect | Bells Palsy |
| CN VIII name and afferent/efferent | acoustic/vestibulocochlear, afferent |
| CN VIII function | receptors in the inner ear (in temporal bone) for equilibrium and hearing |
| CN VIII exits the cranial cavity through the | internal acoustic meatus |
| CN IX name and afferent/efferent | glossopharyngeal, afferent and efferent |
| CN IX afferent function | taste and general sensory fibers-pain, pressure, temperature-to the posterior 1/3 of the tongue, pharyngeal mucosa and tonsils, afferent branch of the gag reflex and swallowing |
| CN IX efferent function | stylopharyngeal muscle (pull pharynx up and opens it)- pharynx muscle |
| CN IX innervates | parotid gland, tongue, pharynx |
| CN IC exits cranial cavity through the | jugular foramen |
| Glossopharyngeal nerves one job | tell otic ganglion to tell parotid gland to secrete |
| CN X name and afferent/efferent | vagus, both afferent and efferent |
| What nerve affects more areas of the body than any other cranial nerve | vagus nerve |
| CN X motor/efferent function | muscles of the pharynx and larynx, most of the muscles of the soft palate, and smooth muscle of the body, cardiac muscle, and many of the glands |
| CN X afferent/sensory function | taste sensation from epiglottis |
| CN X exits the cranial cavity through | jugular foramen |
| CN XI name and afferent/efferent | spinal accessory nerves |
| CN XI has two parts | cranial and spinal |
| CN XI cranial part function | motor to muscle of the larynx, most of the soft palate muscles and pharynx muscles (swallowing) |
| CN XI spinal part function | motor to sternocleidomastoid and trapezius muscle in the neck |
| CN XI exits the cranial cavity through the | jugular foramen |
| What nerves make up the pharyngeal plexus | CN IX, X, XI |
| CN XII name and afferent/efferent | hypoglossal, efferent |
| CN XII efferent function | innervates intrinsic and extrinsic muscles of the tongue, hypoglossus, styloglossus, geioglossus |
| CN XII exits the cranial cavity through the | hypoglossal canal |
| Three divisions/branches of V1 of the trigemnal | -nasociliary nerve -supraorbital and supratrochlear -lacrimal nerve |
| Pathway of V1 | trigeminal ganglion> travels anteriorly to cavernous sinus, enters superior orbital fissure then divides into 3 branches |
| Four branches of V2 | -pterygopalatine -posterior superior alveolar -zygomatic -infraorbital |
| Pathway of V2 | foramen rotundum> pterygopalatine fossa> infraorbital canal as the infraorbital nerves exits the canal |
| PSA stands for | posterior superior alveolar nerve (branch of the V2) |
| zygomatic nerve of V2 | -branches into zygomaticofacial and zygomaticotemporal -innervates bone and skin of upper cheek, part of temporal bone, and part of the orbit |
| PSA innervation | -sensory to the maxillary molars except the MB root of max 1st molar, adjacent buccal gingiva, periodontium, PDL, and max sinus. -sensation: pain, temperature, touch, pressure. |
| PSA location | branches off maxillary nerve in the pterygopalatine fossa, passes through the pterygomaxillary fissure and lies on posterior surface of the maxilla |
| One branch of PSA | buccal gingiva and adjacent buccal mucosa of the three max molars |
| Two other branches of PSA | enter the small foramina in the maxilla and go through small canals in the lateral walls of maxillary sinus toward the molars |
| Pterygopalatine truck (V2) | connects maxillary nerve to pterygopalatine ganglion- sensory fibers from nasal and palatal mucosa |
| Pterygopalatine (V2) five sensory branches from Pterygopalatine ganglion | -pharyngeal -greater palatine -lesser palatine -nasopalatine -posterior superior lateral nasal branches |
| Greater palatine nerve of V2 | -goes through the greater palatine foramen -extends forward to the alveolar process of the maxilla -supplies sensation to mucosa of the hard palate and lingual gingiva of maxillary posterior teeth |
| Lesser palatine nerve of V2 | -goes through the lesser palatine foramen -supplies sensation to the soft palate and palatine tonsil |
| Nasopalatine nerve of V2 | -goes from pterygopalatine ganglion through sphenopalatine foramen to the roof of nasal cavity -turns and passes through the incisive canal to supply hard palate directly behind the maxillary incisor teeth -enters through incisive foramen |
| Nasopalatine nerve of V2 innervates | anterior palatal mucosa, nasal septum, palatal gingiva of maxillary anterior |
| Infraorbital nerve of V2 | -continuation of maxillary nerve- enters the orbit through the inferior orbital fissure -exits onto the face through infraorbital foramen -innervates: skin of lower eyelid, side of nose, and upper lip -terminal branch |
| Middle Superior Alveolar Nerve (MSA) of V2 | -sometimes not present -branches off infraorbital nerve within the infraorbital canal -premolars and MB root of max 1st molar -pulp, PDL, and alveolar process -buccal gingiva -part of maxillary sinus |
| What is the largest branch of the trigeminal nerve | mandibular division (V3) |
| V3 of the trigeminal nerve | -both sensory and motor -motor part of V3 does not go through the Trigeminal Ganglion |
| Two branches of V3 | -anterior branch (sensory and motor) -posterior branch (sensory) |
| V3 pathway | V3 exits the skull through the foramen ovale, travels downward enters the infratemporal fossa and divides into anterior and posterior branch |
| V3 smaller branches before it divides into anterior and posterior branches | -meningeal branches -medial pterygoid nerve |
| Meningeal branches of V3 | sensory/afferent to the meninges (protective membrane around the brain and spinal cord) |
| Medial pterygoid nerve of V3 | motor/efferent to the medial pterygoid (elevates the mandible), tensor veli palatini (tenses soft palate, opens auditory tube during swallowing), and tensor tympani (middle ear) muscles |
| Anterior Branch of the Mandible Division V3 MUSCULAR BRANCH- MOTOR | -anterior deep temporal- motor to temporalis -posterior deep temporal- motor to temporalis -masserteric- motor to masseter -lateral pterygoid- motor to the lateral pterygoid muscle |
| Anterior Branch of the Mandible Division V3 BUCCAL BRANCH- SENSORY | BUCCAL NERVE- Sensory to the buccal gingiva in the mandible premolar and molar area and the buccal mucosa up to the mental foramen -lowest of its branches -penetrates buccinator muscle "long buccal" |
| Posterior Branch of the Mandible Division V3 has 3 branches | -auriculotemporal nerve -lingual nerve -inferior alveolar nerve |
| Auriculotemporal nerve of posterior V3 | -sensory nerve passed through the parotid gland to skin in front of the ear. -branches to the TMJ -innverates: TMJ, outer ear, part of the skin of the scalp and cheek, parotid gland |
| Lingual nerve of posterior V3 | -sensory to anterior 2/3 of the tongue, lingual gingiva of the mandibular teeth, and the floor of the mouth -location: deep to the lateral pterygoid, then passes between the medial pterygoid and the mandible before entering the tongue |
| Inferior Alveolar Nerve (IA) of posterior of V3 | -enters the mandibular canal at the mandibular foramen -gives off branches to mandibular molars and premolars while in the mandibular canal. -before the nerve enters the canal, gives off a small motor branch of the mylohyoid nerve |
| IA incisive nerve | -continuation of the IA which supplies the canines and incisors. (part that stays in the canal) -innervates: pulp, PDL, and alveolar bone of the mandibular anteriors |
| IA mental nerve | -continuation of the inferior alveolar which comes out of the mental foramen (located between the first and second premolars) -innervates: lower lip and facial gingival and facial mucosa adjacent to the incisors, canines and premolars |
| Five branches of the VII | -temporal/frontal -zygomatic -buccal -mandibular -cervical |
| Nerve lesions of the head and neck | facial paralysis- loss of muscular action of the muscles of facial expression (VII) can be unilateral or bilateral and affects speech, chewing, and eye closure |
| Causes of facial paralysis | -stroke -damage directly to VII (branches lie superficially therefore easily injured) -injury/tumor/surgery- in the parotid gland region -transient- improper inferior alveolar block |
| Bells Palsy | -unilateral facial paralysis -no known cause -loss of excitability of VII -abrupt onset -all or some of VII can be affected -possibly inflamed -may be chronic -no specific treatment- anti-inflammatory injection/physical therapy |
| Trigeminal Neuralgia (tic douloureux) | -afferent nerves of V- Usually V2 or V3 -cause- possible pressure on the sensory root of the trigeminal ganglion by blood vessels -excruciating short-term pain on touch, talking, chewing -trigger zones very -treatment: neurectomy |
| INFILTRATION | -SUPERPERIOSTEAL, PLEXUS, OR FIELD BLOCK -target is the nerve endings in the region of a particular teeth (infiltration) and the nerve to the tooth itself (field block) -anesthetic is deposited on the periosteum and diffuses to the nerve fibers |
| Where is infiltration used | maxilla and mand anteriors |
| Field block | -further back on the nerve branch -used to anesthetize the nerve of a teeth but a greater area than the infiltration |
| Nerve block | -even further up in the nerve block -bigger branch to the nerve -dropping anesthetic up here will anesthetize a larger area |
| Most common block injections | -mandibular nerve block/inferior alveolar block (IA) -mental nerve block (ME) -posterior Superior Alveolar nerve block (PSA) -infraorbital nerve block |
| Mandibular nerve block/inferior alveolar block (IA) | all mandibular teeth on one side |
| Mental nerve block (ME) | mandibular incisors, canine, and premolar teeth on one side |
| Posterior Superior Alveolar nerve block (PSA) | maxillary 3rd, 2nd and DB and palatal roots of the 1st molar |
| Infraorbital nerve block | anterior and middle superior alveolar nerves for the maxillary incisors, canines, premolars, and MB root of the maxillary 1st molar |
| PSA supplies | 2nd and 3rd maxillary molars and the distobuccal and palatal roots of the 1st maxillary molars |
| MSA supplies | maxillary premolars and the MB root of the maxillary 1st molar, facial gingiva, PDL, alveolar bone |
| ASA supplies | maxillary centrals, laterals, and canines and their facial gingiva, PDL, and alveolar bone |
| Nasopalatine Block | -anesthetizes gingiva on the lingual of the maxillary incisors, canine to canine -penetrate tissue lateral to the incisive papilla -solution goes into the incisive canal at the incisive foramen -blocks the nasopalatine nerve |
| Greater palatine Block | -anesthetizes soft tissue of posterior two- thirds of the hard palate up to the canine -penetrate near the greater palatine foramen near the second molar apex |
| Inferior Alveolar block/Mandibular block | -anesthetizes all lower teeth on one side (lingual periodontium and facial periodontium of mandibular anteriors and premolars) -block the nerve BEFORE it enters the mandibular canal at the mandibular foramen -V3 mandibular branch of trigeminal nerve |
| Bony Landmarks for Inferior Alveolar Injection Site | -coronoid notch -coronoid process -lingula (bone sticks out over mandibular foramen) |
| Mental Nerve Block | -anesthetizes premolars, incisors and facial gingiva, chin and the lip -inject near mental foramen, which is located between the premolars’ apices. -lip will be numb or tingling |
| Buccal Block (Long Buccal) | -buccal nerve part of V3 located at the anterior border of mandibular ramus -anesthetizes the soft tissue on the buccal aspect of the mandibular molar teeth and mucous membrane of the cheek |
Created by:
kaelynatkinson
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