Lecture 5 (The maxillary nerve and pterygopalatine ganglion)
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The maxillary nerve originates as the second branch of the trigeminal ganglion. It is a pure sensory nerve that passes through the foramen rotundum into the pterygopalatine fossa, where it suspends the pterygopalatine ganglion. It then enters the inferior orbital fissure and exits the face through the infraorbital foramen. The maxillary nerve gives off several branches that innervate the skin and mucosa of the face, orbit, and palate. The pterygopalatine ganglion receives fibers from the maxillary nerve, facial nerve, and sympathetic plexus. Its branches innervate nasal and palatal structures.
Lecture 5 (The maxillary nerve and pterygopalatine ganglion)
- 1. Maxillary Nerve By Dr: Joseph Amin M.D of anatomy & embryology Faculty of medicine-Zagazig university Jaaziz@zu.edu.eg joseph.Aziz@su.ed.eg
- 2. Maxillary Nerve ❑ Origin: The second branch of the trigeminal ganglion; it is pure sensory nerve. ❑ Course & Relation: - It passes forward in the lateral wall of cavernous sinus. - It enters foramen rotundum to reach the pterygopalatine fossa where it suspends the pterygopalatine (sphenopalatine) ganglion. - It then enters the inferior orbital fissure to and runs on the floor of the orbit as the infraorbital nerve first, in the infraorbital groove then in the infraorbital canal. - Finally it exits from infra-orbital foramen on the face. Foramen rotundum Infraorbital N. Inf. Orbital fissure G
- 4. ❑ Branches: MGZPI Meningeal branch: It arises from the maxillary nerve in the middle cranial fossa Ganglionic branch: suspends pterygopalatine (sphenopalatine) ganglion. Zygomatic nerve: it pierces the zygomatic bone and divides into zygomatico-temporal & zygomatico-facial nerves Posterior superior alveolar nerve: it pierces the posterior wall of maxilla and descends in the posterior wall of maxillary sinus supplying its mucous membrane. It innervates the roots of molar teeth except for the mesiobuccal root of the 1st (28%) Infraorbital nerve: It gives the middle and anterior posterior superior alveolar nerves. On the face it gives palpebral, nasal & labial branches - Middle superior alveolar it descends in the lateral wall of the maxillary sinus supplying its mucous membrane. It innervates premolars + mesiobuccal root of the 1st molar). It is frequently absent - Anterior superior alveolar nerve, it descends in the anterior wall of maxillary sinus supplying its mucous membrane. It innervates canine and incisors
- 6. Z.T Z.F Z M Cavernous sinus P M A I.O p n L 2nd branch of Trigeminal ganglion Course: -It finally exits from infraorbital foramen to end on the face - It enters the inferior orbital fissure, runs on the floor of the orbit in infraorbital groove, then the infraorbital canal as infraorbital nerve - It enters foramen rotundum to reach pterygopalatine fossa where it suspends pterygopalatine ganglion. - It passes forward inside the lateral wall of cavernous sinus Maxillary Nerve M: meningeal br. Z: Zygomatic br. G: Ganglionic Zygomaticofacial Zygomaticotemporal P: Posterior superior alveolar M: Middle superior alveolar A: Anterior superior alveolar I.O: infraorbital palpebral nasal labial Branches: - It appears in the infra temporal fossa G Origin:
- 7. Pterygopalatine (Sphenopalatine ) ganglion: It is the largest of the 4 peripheral parasympathetic ganglion . Pterygopalatine fossa hanging from maxillary nerve❑Site: ❑ Roots: - Sympathetic: from plexus around ICA → deep petrosal nerve - General sensory: from the maxillary nerve - Parasympathetic : from superior salivary nucleus → facial nerve → geater superficial petrosal (GSP) nerve. - Taste: from solitary nucleus → facial nerve → (GSP) nerve N.B: the GSP & deep petrosal form “ The Nerve of Pterygoid canal” which passes in the pterygoid canal to reach pterygoplalatine fossa to join the sphenopalatine ganglion (nerve fibers entering the ganglion)
- 8. ❑ Branches: 1- Orbital Pass through SOF. They are sensory to the periosteum of the orbit 2- Nasal branches (sensory + postganglionic) 5-7 branches pass through sphenopalatine foramen. They are divided into - lateral branches to the lateral wall & medial branches to the nasal septum N.B. The largest of septal branches is called “nasopalatine nerve” it passes through the incisive canal to reach the hard palate. It supplies palatine gingiva of the incisors. 3- Greater & lesser palatine nerves (sensory+ taste + postganglionic) Lesser palatine N. passes through the lesser palatine foramen, runs backward to supply the mucosa of soft palate Greater palatine N. passes through the greater palatine canal to reach the hard palate and runs forward supplying the mucosa of hard palate and adjacent gingiva till incisor teeth 4- Pharyngeal branch (sensory) Passes through palatinovaginal canal to reach the nasopharynx 5- Postganglionic parasympathetic to the lacrimal gland.
- 9. Applied anatomy: Maxillary nerve block
- 10. Submandibular ganglion Site: Roots: (nerve fibers entering the ganglion) Branches: above submandibular gland in the submandibular region, hanging of the lingual nerve - General sensory from the lingual nerve - Parasympathetic from superior salivary nucleus…> facial nerve …> chorda tympani - Sympathetic from plexus around facial, lingual arteries Postganglionic parasympathetic to submandibular and sublingual salivary glands