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Trigeminal nerve, neuroanatomy of pain

Trigeminal nerve, neuroanatomy of pain. Dr. Károly Altdorfer. Trigeminal nerve. GSS: Skin of face , mucosa of nasal cavity + oral cavity , dura , teeth , s alivary glands ( only sensory !) SVM (BM): 1. Branchial arch ( mandibular arch ): Muscles of mastication ,

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Trigeminal nerve, neuroanatomy of pain

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  1. Trigeminal nerve, neuroanatomy of pain Dr. Károly Altdorfer

  2. Trigeminalnerve GSS: Skin of face, mucosa of nasalcavity + oralcavity, dura, teeth, salivaryglands (onlysensory!) SVM (BM): 1. Branchialarch(mandibulararch): Muscles of mastication, Tensortympani, tensorvelipalatini; Mylohyoid Digastric, ant. belly

  3. Nuclei (3 sensory, 1 motor)

  4. Nuclei: Motor nucleus (BM)

  5. Nuclei: Mesencephalic nucl.: proprioceptive (jaw reflex of masticatory muscles!) – pseudounipolar neurons! Main sensory (principal / pontine): epicritic Spinal: prothopathic

  6. CNS (brainstem) PNS Motor nucleus: Sensory nucleus:

  7. Pons – rostral part

  8. Brain exit Dural exit

  9. Skull exit V/1: Orbit V/2: Pterygopalatine fossa V/3: Infratemporal fossa

  10. Ophtalmic n. (V/1)

  11. Ophtalmic n. (V/1) GSS branchessupply: 1. forehead, dorsum of nose, 2. eye(cornea!), 3. nasalcavity(ant-sup. part - embryology!), 4. frontal, sphenoid, ethmoidsinuses, 5.tentoriumcerebelli, duramater anteriorly, 6. lacrimalgland(onlysensory!), 7. lacrimalsac, caruncule

  12. Common tendinous ring or Anulus tendineus communis (Zinn)

  13. r. tentorii (!) Frontal n. - supraorbital - supratrochlear Lacrimal n. (+ parasymp. guestfibresfrom pterygopalatineggl.) Nasociliary n. - ant. ethmoidal (ant. meningeal, ant. nasal, ext. nasal) - post. ethmoidal - infratrochlear - longciliary( bypassingciliaryggl.) Ophtalmic n. (V/1)

  14. Maxillary n. (V/2)

  15. Maxillary n. (V/2) GSS branchessupply: 1. theupperteeth & gums 2. palatinemucosa, 3. mucosa of nasalcavity (post-inf. – embryology!), maxillary sinus, 4. dura 5. skin:

  16. Maxillary n. (V/2) r. meningeus(medius) Zygomatic n. Infraorbital n. Pterygopalatinenerves

  17. N. maxillaris (V/2) r. meningeus (medius) Zygomatic n. - communicating branch with lacrimal n.* - zygomatico-facial - zygomatico-temporal („Y”-shape) * Guest fibres join them from CN VII. (parasymp.)

  18. N. maxillaris (V/2) r. meningeus (medius) Zygomatic n. - communicating branch with lacrimal n.* - zygomatico-facial - zygomatico-temporal („Y”-shape) Infraorbital n. - rr. alveolares supp. (post., med., ant.) - inf. palpebral - nasal (ext., int.) - sup. labial (pes anserinus minor) * Guest fibres join them from CN VII. (parasymp.)

  19. r. meningeus (medius) Zygomatic n. - communicating branch with lacrimal n.* - zygomatico-facial - zygomatico-temporal („Y”-shape) Infraorbital n. - rr. alveolares supp. (post., med., ant.) - inf. palpebral - nasal (ext., int.) - sup. labial (pes anserinus minor) Pterygopalatine nerves - orbital - rr. nasales postt. supp.(med., lat.)* - rr. nasales postt. inff.* - nasopalatine n. (Scarpa)* - greater palatine n.* - lesser palatine nerves* - r. pharyngeus * Guest fibres join them from CN VII. (parasymp. and taste fibres to palatine nerves) Maxillary n. (V/2)

  20. Mandibular n. (V/3)

  21. Mandibular n. (V/3): GSS and BM ramusmeningeus Motor group(BM): masseteric deeptemporal lat. pterygoid med. pterygoid n. totensortympani n. totensorvelipalatini buccal n. (GSS!)

  22. Mandibular n (V/3): GSS and BM Posterior, sensorygroup: Auriculotemporal n. rr. auricularesanteriores rr. meatusacusticiexterni rr. membranaetympani rr. parotidei(parasymp. guestfibresjointhem!) rr. articulares (TM) spf. temp. branches Lingual n. nn. linguales rr. sublinguales rr. ganglionares(guestfibresforthesubmand. ggl.!) rr. isthmifaucium Inf. alveolar n. mylohyoid(BM!) rr. dentales, gingivales mental Parasympathetic guest fibres join the branches of V. nerve

  23. Trigeminal neuralgy – trigger points

  24. The neuroanatomy of pain

  25. Tegmentum Pain, temperature Crude touch

  26. Radiations of the thalamus

  27. Trigeminal lemniscus

  28. Pain is a symptom! • Several causes: • trauma, • ischemia, • Smooth muscle contraction (ureteric or gall stone) - Algopyrin, No-Spa • Discs, teeth, trigeminal neuralgy, phantom pain, visceral etc. • Psychological origin? Depression. Psycho-neuro-immunology. • Brain? • Dissimulation (children!)

  29. Syringomyelia C, Th segments of spinal cord – cavity, connected to the central canal: destroys the tracts in anterior white commissure: upper limb pain and temperature fibres -- Mucius Scaevola).

  30. Pain causes numerous reactions • Nociceptive reflex • Brain „knows” also: conscious reception (somatotopy & bad feeling) • Autonomic reactions (sweating, pupil dilation, tachycardia -hypothalamus, RF, endokrine organs)

  31. How to influence pain transmission

  32. Pain: gate control mechanism(Melzack & Wall)

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