Q 1.11. Trigeminal Nerve: Anatomy, Physiology, and Pathology

  1. Anatomy of the Trigeminal Nerve:

    • The trigeminal nerve, also known as the fifth cranial nerve, is the largest of the cranial nerves.
    • It has both motor and sensory components.
    • Motor Supply: It innervates the muscles of mastication (chewing).
    • Sensory Transmission: It carries sensory information from the faceoral cavitynasal cavities, and most of the scalp.
    • The trigeminal nerve has three main sensory nuclei:
      • Principal Sensory Nucleus: Located within the lateral aspect of the pons.
      • Spinal Trigeminal Nucleus: Extends through the medulla and reaches the upper cervical cord.
      • Mesencephalic Nucleus: Extends from the upper pons to the midbrain.
    • The trigeminal nerve exits the pons as a large sensory root and a smaller motor root, traversing the pre-pontine cistern.
    • The point of transition from central to peripheral myelin, known as the root entry zone (REZ), is where the nerve is susceptible to compression by tortuous branches of posterior circulation vessels, a significant cause of trigeminal neuralgia.


2. The trigeminal nerve has three branches, each with its own role:

    • Ophthalmic division (CN V1): Carries sensations from the upper eyelids, forehead, and scalp up to the vertex of the head.
    • Maxillary division (CN V2): Covers the middle part of the face, including the cheeks, upper lip, and part of the nose.
    • Mandibular division (CN V3): Innervates the lower face, jaw, and anterior two-thirds of the tongue.


3. Sensory pathways:

  • Pathway to the Thalamus:

    • The trigeminal nerve fibers travel from the face to the trigeminal nuclei in the brainstem.
    • Next stop: the thalamus—our sensory relay station.


  • Thalamus: The Brain’s Switchboard

    • The thalamus receives sensory input from various pathways, including the trigeminal nerve.
    • It sorts, filters, and directs these signals to specific brain regions.


  • Gyrus Postcentralis (Somatosensory Cortex):

    • Our final destination! Located in the parietal lobe.
    • Here, the trigeminal sensations are decoded into touch, temperature, and pain perceptions.


4. Clinical Clues:

    • Trigeminal Neuralgia: When the trigeminal nerve throws a tantrum, it causes sudden, severe facial pain.
    • Corneal Reflex: The ophthalmic division ensures our eyes blink when touched.
    • Jaw Jerk Reflex: The mandibular division tests the reflex when tapping the jaw.


5. Trigeminal Neuralgia in details:

    • Trigeminal Neuralgia: Also called tic douloureux, it is characterized by severe, recurrent, stabbing pain along the trigeminal nerve distribution (usually the maxillary or mandibular divisions).
    • Etiology: Often due to vascular compression at the REZ.
    • MRI Imaging: MRI is the modality of choice for suspected trigeminal nerve pathology. It can reveal most lesions involving the nerve and nucleus.
    • Management: Surgical or medical interventions can improve or resolve symptoms.
    • Subdivisions of Pathology:
      • Nucleus: Involves the trigeminal nerve nuclei within the brainstem.
      • Pre-pontine Cistern: Pathology in the cisternal segment of the nerve.
      • Meckel’s Cave/Cavernous Sinus: Lesions affecting these regions.
      • Extracranial: Pathology beyond the skull base.

In summary, understanding the trigeminal nerve’s anatomy and its associated pathologies is crucial for medical students, especially when diagnosing and managing conditions like trigeminal neuralgia. MRI plays a pivotal role in visualizing these structures and guiding treatment decisions.







Verified by Dr. Petya Stefanova