What is the neuroanatomy of the trigeminal system relevant to facial pain and headache?

Updated: Jan 29, 2020
  • Author: Tejas Raval, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

The trigeminal nerve (cranial nerve V) and its constituent 3 major branches provide most somatosensory innervation to the head and face region. The trigeminal nerve originates in the lateral pons then divides into the following 3 divisions from the gasserian ganglion: the ophthalmic (V-1), the maxillary (V-2), and the mandibular (V-3) divisions.

The ophthalmic division (V-1) provides sensory innervation to most of the upper third of the head and face, including (but not limited to) the skin of the eyelids, eyebrow, forehead, and nose and part of the mucous membranes of the nasal cavity. [5] Ethmoidal branches supply the mucous membranes of the ethmoid sinuses. An intracranial branch called the tentorial nerve of Arnold supplies the tentorium, superior surface of the transverse and straight dural sinuses, and the inferior two thirds of the falx cerebri. [6]

The maxillary division (V-2) innervates several key areas in the midface region including the upper teeth, the floor and anterior region of the nasal cavity, and the skin of the lateral nose and malar region. The sphenopalatine branches innervate the lining of the maxillary sinuses, and the middle meningeal branch supplies portions of the floor of the middle fossa dura. [7]

The mandibular branch (V-3) supplies the teeth and gums of the mandible, the skin of the lower face, the temporomandibular joint (TMJ) and also the dura of the lateral portion of the middle fossa and most of the cranium. [7]

The trigeminal system is the main source for sensory innervation to the supratentorial dura, venous sinuses, and meningeal arteries. The 7th, 9th, and 10th cranial nerves also contain somatosensory pain fibers that synapse with trigeminal pain axons. [7]


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