Trigeminal nerve, n. trigeminus. The sensitive nerve for the teeth, jaws, perimaxillary soft tissues, eye sockets and their contents, as well as other organs of the face is the trigeminal nerve (Fig. 27). Only the glossopharyngeal nerve, n. glossopharyngeus, vagus nerve, n. vagus, hypoglossal nerve, n. hypoglossus, and some branches of the cervical plexus take a minor part in transmitting pain sensitivity from the oral cavity, pharynx and partly the skin of the face (Fig. 28 ).
This nerve leaves the brain and appears in two roots at the base of the skull from the side of the pons, closer to the cerebellar peduncles. The smaller, anterior, weaker root (portio minor) is motor; larger, posterior, strong root (portio major) - Sensitive. The last root (portio major) forms in the notch of the pyramid impressio trigemini of the temporal bone a semilunar node (Gasserian node), called ganglion semilunare, s. gasseri, from the anterior edge of which three branches of the trigeminal nerve extend: orbital, maxillary and mandibular - n. ophthalmicus, n. maxillaris et n. mandibularis. The anterior trunk (portio minor), which is not involved in the formation of the gasser ganglion, joins the mandibular nerve and makes it a mixed (sensory and motor) nerve.
Rice. 27. Nerve supply of jaws and teeth; branches of the maxillary and mandibular nerves:
1- semilunar node (Gasserov); 2- maxillary nerve; 3 - orbital nerve; 4 - infraorbital nerve; 5 - posterior superior alveolar nerves; 6 - anterior superior alveolar nerves; 7 - middle superior nerve; 8 - upper dental plexus; 9 - mental nerve; 10-11 - lower dental plexus; 12 - inferior ophthalmic nerve; 13 - palatine nerve; 14 - basal palatal node; 15 - lingual nerve; 16 - inferior ophthalmic nerve.
From the beginning of each of the three branches the ramus meningeus goes to the dura mater. shell.
The orbital nerve supplies sensory fibers, in addition to the dura mater of the brain, to all organs of the orbit, the anterior part of the upper part and lateral parts of the nose, the frontal sinus and partly other additional nasal cavities, the upper eyelid, the skin of the forehead and dorsum of the nose, and also the walls of the orbit, in particular the orbital wall of the upper jaw; The vesicular nerve innervates the upper jaw and the soft parts covering it, as well as the lower eyelid and wings of the nose; The mandibular nerve supplies the lower jaw with its covering soft tissues. Each of these nerves leaves the cranium and, near it, enters into connection with a node into which other cranial nerves and sympathetic fibers enter, in particular the orbital nerve - with the ciliary ganglion, ganglion ciliare, the maxillary nerve - with the sphenopalatine ganglion , ganglion sphenopalatinum, and the mandibular nerve - with the ear node, ganglion oticum.
Rice. 28. Distribution of the trigeminal nerve, as well as adjacent cranial nerves, partially involved in the nerve supply of the face (semi-schematically, according to Corning):
1 - vagus nerve; 2 - glossopharyngeal nerve; 3 -internal carotid artery; 4 - drum string; 5 - genu of the facial nerve; 6 - semilunar node; 7 - trochlear nerve, 8 ~ Oculomotor nerve; 9 - optic nerve; 10 - ciliary node; 11- lacrimal nerve; 12 13 - small superficial petrosal nerve; 14 - supraorbital nerve; 15 - Supraorbital nerve; 16 - Lacrimal gland; 17 - short ciliary nerves; 18 - Branch of the III Nerve to the inferior oblique muscle; 19 - infraorbital nerve; 20 - basal palatal node; 21 - buccal nerve; 22 - lingual nerve: 23 - mental nerve; 24 - inferior alveolar nerve; 25 - parotid plexus of the facial nerve; 26 - cervical nerves II and III; 27 - sublingual
Orbital nerve. First branch of the trigeminal nerve. The orbital nerve (see Fig. 27) (Fig. 29 and 30) arises from the Gasserian ganglion and passes along with the oculomotor nerve, n. oculomotorius. and the trochlear nerve, p. trochlearis, in the thickness of the outer wall of the cavernous sinus, sinus cavernosus, and together with them and with the abducens nerve, it penetrates through the superior orbital fissure, fissura orbitalis superior, into the orbital cavity. More. before entering the orbit, often within the upper orbital fissure, the orbital nerve is divided into its three large terminal branches: the nasociliary nerve, n. nasociliaris, the frontal nerve, n. frontalis, and the lacrimal nerve, n. lacrimalis (see Fig. 29 and 30)
The nasociliary nerve is located most medially in the orbit and with its branches supplies the eyeball (partially), eyelids, lacrimal sac, mucous membrane of the posterior sieves -
Rice. 29. Scheme of the branching of the ophthalmic nerve (shaded) and the formation of the ciliary ganglion (black); superior branch of the oculomotor nerve
Removed, according to Corning: 1 - semilunar (Gasserian) node; 2 - oculomotor nerve; 3 - long root (sensing) of the ciliary ganglion; 4 - short root (motor) of the ciliary ganglion; 5 - nasociliary nerve; 6 - frontal nerve; 7 - supraorbital nerve; 8 ~ Lacrimal gland; 9 - external nasal nerve; 10 - inferior oblique muscle; 11 - short ciliary nerves; 12 - Inferior branch of the oculomotor nerve; 13 - ciliary node; 14 - lacrimal nerve.
Common cells, sphenoid sinus, mucous membrane of the anterior and lateral parts of the nose, as well as partially the cartilage of the nose and the skin of the dorsum and tip of the nose. Its branches are: 1) a long root, radix longa, - to the ciliary ganglion, from which short ciliary nerves, nn, go to the eyeball. ciliares breves; 2) long ciliary nerves, nn. ciliares longi, on the medial side of the optic nerve, n. opticus, - to eyeball; 3) posterior ethmoidal nerve, n. ethmoidalis posterior, - through the posterior ethmoidal opening to the mucous membrane of the posterior ethmoidal cells, cellulae ethmoidales posteriores; 4) the anterior ethmoidal nerve, n. ethmoidalis anterior, - through the anterior ethmoidal opening, foramen ethmoidale anterius, passes into the cranial cavity and through the cribriform plate, lamina cribrosa - into the nasal cavity, to its mucous membrane; 5) the terminal nasal branch goes out under the skin of the wing and tip of the nose called n. nasalis externus; 6) inferior trochlear nerve, n, infratrochlearis, goes under m. obliqus superior.
Rice. 30. Diagram of the branches of the ophthalmic nerve:
1 - gasser knot; 2 - mandibular nerve: 3 - maxillary nerve; 4 and 8 - frontal nerve; 5 - lacrimal nerve; 6 - ciliary node; 7 - short ciliary branches (from the ciliary node to the eyeball); 8 - frontal nerve; 9 - anastomosis between the lacrimal nerve and the zygomatic (branch of the maxillary nerve); 10 - supraorbital nerve; 11 - nasociliary nerve; 12 - oculomotor nerve.
The frontal nerve, the thickest, runs in the middle of the orbit below its upper wall and is divided into three branches: 1) the strongest of them - the supraorbital nerve, p. supraorbital - goes through the supraorbital notch, incisura supraorbitalis, - to the forehead and branches here in the skin; 2) the frontal branch, ramus frontalis, supplies the skin of the forehead medial to the previous nerve; 3) the supratrochlear nerve, n. supratrochlearis, at the inner corner of the eye it comes out from under the roof of the orbit, supplies the skin with nerves upper eyelid, the root of the nose and the adjacent part of the forehead.
The lacrimal nerve runs laterally, supplying the lacrimal gland and partly the upper eyelid (its lateral part).
The ciliary, or ciliary, node (see Fig. 29 and 30) is located in the posterior third of the orbit lateral to the optic nerve and is a peripheral nerve ganglion, the cells of which are associated with sensory, motor and sympathetic fibers. It receives three roots: one sensory from the nasociliary nerve - radix longa, one motor from the oculomotor nerve - radix brevis, one sympathetic (middle root) - from the plexus of the internal carotid artery, plexus caroticus internus, - radix sympatica.
From the ciliary ganglion, 4-6 nerve trunks extend towards the eyeball - short ciliary nerves, which on their way divide and enter the eyeball in the amount of 20 and contain motor, sensory and sympathetic fibers for the nerve supply of all tissues of the eyeball . On their way to the eyeball, the ciliary nerve trunks are also joined by sympathetic fibers from the plexus of the internal carotid artery, bypassing the sympathetic ganglion. These short and long ciliary nerves supply all tissues of the eyeball.
Maxillary nerve. The second branch of the trigeminal nerve is the maxillary nerve (see Fig. 27) (Fig. 31) Innervates the gums, teeth, upper jaw, skin of the nose (wings), lower eyelid, upper lip, partially cheek, nasal cavity, sphenoid and maxillary sinuses. This nerve leaves the cranial cavity through the foramen rotundum and enters the pterygopalatine fossa, fossa pterygo-palatina, where it gives off the zygomatic nerve from its upper edge,
Rice. 31. Diagram of the branches of the maxillary nerve:
1 - Vidian nerve; 2, 3 and 4- palatine nerves; 5, 6 AND 8 - upper dental nerves; 7 - dental plexus of nerves; 9 - branches of the infraorbital nerve (as it exits the infraorbital foramen; the so-called pes anserine); 10 - infraorbital nerve; 11 - zygomatic nerve; 12 - anastomosis between the zygomatic nerve and the lacrimal nerve (a branch of the orbital nerve); 13 - lacrimal nerve; 14 - frontal nerve; 15 - nasociliary nerve; 16 - basal palatal node; 17 - orbital nerve.
P. zyggmaticus, and a little further anteriorly from its lower edge - the basal palatine nerves) nn. sphenopalatine Then it enters the lower orbital fissure, fissura orbitalis inferior, and goes under the name of the infraorbital nerve; n: infraorbitalis, b The infraorbital groove and through the infraorbital canal, canalis infraorbitalis, and the infraorbital foramen, foramen infraorbitale, it appears on the face, in the depths of the canine fossa, fossa canina, where it fans out into many terminal branches (see Fig. 29). The branches of the facial nerve, p. facialis, intersect with them, resulting in the formation of a complex plexus - the lesser crow's foot, pes an-serinus minor.
The zygomatic nerve, starting in the pterygopalatine fossa, is directed together with the infraorbital nerve through the lower orbital fissure into the orbital cavity and is divided there into two branches - the zygomatico-facial, n. zygomaticofacial, and the zygomatic-temporal, n. zygomaticotemporalis; both branches enter the zygomatic bone through the zygomaticoorbital foramen
Rice. 32. Branch exit points
Trigeminal nerve: 1 - supraorbital nerve; 2 - zygomaticofacial nerve; 3 - infraorbital nerve; 4 - mental nerve. 
Stie, foramen zygomaticoorbitale. Then the zygomaticofacial nerve appears through the foramen of the same name on outer surface zygomatic bone (Fig. 32), and the zygomaticotemporal nerve (also through the opening of the same name) enters the temporal fossa and penetrates the temporal fascia, appearing slightly above the edge of the zygomatic arch. Both nerves branch in the skin of their respective areas. The zygomaticotemporal nerve branches in the skin of the middle temple, and the zygomaticofacial nerve branches in the skin of the cheek and outer corner of the eye (see Fig. 32).
The sphenopalatine nerves (see Fig. 27), usually 2-3, partly enter the sphenopalatine ganglion sphenopalatinum, partly bypassing it, directly into its branches.
The sphenopalatine node (see Fig. 27, Fig. 33 and 34) is a so-called sympathetic, i.e., in connection with the sympathetic nervous system, node located in the pterygopalatine fossa slightly below the maxillary nerve.
The nerve pathways leading to the node are its roots. These include the already familiar sphenopalatine nerves and, in addition, the nerve of the pterygoid canal - n. vidianus, seu n. sa-nalis pterygoideus, which is formed from the connection of the superior major petrosal nerve, n. petrosus superficialis major, with the deep petrosal nerve , n. petrosus profundus. The superior greater petrosal nerve comes from the facial nerve, from its knee ganglion, ganglion geniculi, and the deep petrosal nerve comes from the sympathetic plexus, entwining the internal carotid artery, near the base of the skull. Thus, the roots of the sphenopalatine ganglion consist of trigeminal (sensory), facial (sensory, secretory and motor) fibers and, finally, sympathetic, n. sympathicus.
The nerves leaving the ganglion are branches of the sphenopalatine ganglion. In addition to the orbital ones, the following branches are distinguished:
A) the upper posterior nasal branches, rami nasales superiores posteriores, going to the upper and middle concha (lateral branches, rami laterales) and to the nasal septum, rami mediales. The largest branch of the latter runs along the nasal septum obliquely downward and forward to the incisive opening, foramen incisivum, called the nasopalatine nerve, p. nasopalatinus (Fig. 35), and ends in the mucous membrane of the anterior part of the palate;
B) the lower posterior nasal branches, rami nasales inferiores posteriores, go to the mucous membrane of the inferior concha;
B) HeHDieTíefebL^nn. palatini (see Fig. 27), pass through the pterygonaval canal, canalis pterygopalatinus, into the palatine canals, canales palatini, and from here through the large palatine openings, foramina palatina majora, into the oral cavity. Among the palatine nerves, three branches are distinguished: 1) the anterior palatine nerve, p. paiatinus anterior, going to the mucous membrane of the hard and soft palate through the large palatine foramen, foramen palatinum majus, to the palatine side of the gums; 2) the middle palatine nerve, n. paiatinus medius, emerging through one of the small palatine foramina, foramina palatina minora, and spreading, in addition to the mucous membrane of the soft palate, also in the area of the tonsils, and 3) the posterior palatine nerve, n. paiatinus posterior, also exiting through the lesser palatine foramen and supplying motor fibers from the facial nerve, n. petrosus superficialis major, to all palatine muscles, with the exception of m. tensor veli palatini. The sensory fibers of the posterior palatine nerve extend into the soft palate.
Rice. 33. Basic palatal node [according to Sicher]:
1 - main palatal node; 2
- palatine nerves; 3
- posterior superior nasal nerves (lateral); 4
- posterior inferior nasal nerves; 5 - posterior palatine nerve; 6
- anterior palatine nerve.
Infraorbital nerve (see Fig. 27). This nerve is the main sensory nerve for the maxilla and its teeth. Its main branches are as follows:
A) posterior superior alveolar nerves, nn. alveolares superiores posteriores. They branch immediately before the entry of the nerve trunk into the orbit, run along the infratemporal surface, facies infratemporalis, down, forward and outward and enter the posterior superior alveolar foramina, foramina alveolada supe -
Fig. 34. Diagram of the branches of the main palatal node:
1 - maxillary nerve; 2 - branches of the node to the maxillary nerve; 3 AND 9 - Vidian nerve; 4 - Deep petrosal nerve; 5 - sympathetic plexus of the carotid artery; 6 - The geniculate ganglion of the facial nerve; 7 - facial nerve; 8 - greater superficial petrosal nerve; 10 - Substantial palatal node.
Riora posteriora, located on the tubercle of the upper jaw, tuber maxillae;
B) middle superior alveolar nerves, nn. alveolares superioresmedii, branch in the posterior part of the infraorbital canal, canalis infraorbitalis, and go down into the body of the jaw - to the dental plexus, plexus dentalis;
B) anterior superior alveolar nerves, nn. alveolares superiores anteriores, also leave the trunk in the infraorbital canal, but closer to the infraorbital foramen and go through the alveolar canals, canales alveolares, down into the bone tissue. The superior alveolar nerves (posterior, middle and anterior) are in close connection with each other: through their branches they form the superior dental plexus, plexus dentalis superior, from which the superior dental nerves, nn. dentales superiores, to the apical openings of the teeth, foramina apicalia, upper gingival nerves, nn. gingivales superiores, to the gums and other nerves to the bone and mucous membrane membrane of the maxillary sinus.
When leaving the infraorbital foramen, the infraorbital nerve splits into its terminal branches: rami palpebrales inferiores - for the lower eyelid and the lower third of the lacrimal sac, rami nasales - for the skin of the wing of the nose and rarai labiales superiores - for the skin and mucous membrane upper lip and gums.
Mandibular nerve. The third branch of the trigeminal nerve, the mandibular nerve (see Fig. 27) (Fig. 36), contains, as we have already said, in addition to the sensory fibers emerging from the semilunar ganglion, also motor ones from the portio minor. The mandibular nerve supplies sensory fibers to the lower teeth
Rice. 35. Nasopalatine nerve, n.
The nasopalatine nerve passes through the incisive canal and branches in the mucous membrane of the palate.
and gums, lower jaw, lower lip, partially cheek, mucous membrane of the floor of the mouth, two anterior parts of the tongue, chin, temple, partially the auricle and the wall of the external auditory canal, as well as the parotid and submandibular salivary glands.
When exiting through the foramen ovale, for. ovale, from the cranium this nerve is divided into two parts: a smaller, anterior, almost exclusively motor, and a larger, posterior, almost exclusively sensitive. The motor part goes mainly to the masticatory muscles and breaks up according to the muscles into the following nerves: masticatory nerve, n. massetericus, deep temporal nerves, n. temporales profundi, external pterygoid nerve, n. pterygoideus externus, internal pterygoid nerve, n. pterygoideus internus, muscle nerve that stretches the soft palate, n. tensoris veli palatini, muscle nerve that stretches eardrum, n. tensoris" tympani, buccal nerve, n. buccinatorius.
The buccal nerve arises from the mandibular nerve along with the motor branches of the temporalis muscle in the same trunk. It then runs anterior and often laterally to the external pterygoid muscle (sometimes it perforates this muscle or even runs along its outer side). Further, this nerve reaches the inner surface of the tendon of the temporal muscle at the point of attachment to the coronoid process, processus coronoideus. The anterior edge of the coronoid process intersects with the buccal nerve at the height of the chewing surface of the upper molars with the mouth open.
It should be noted that the buccal nerve is the only sensory branch in the anterior motor part of the mandibular nerve. It passes with its terminal branches through the buccal muscle, giving sensory fibers to the skin and mucous membrane the shell of the cheek and, what is especially important for us, to the outer part of the gums (to the area from the middle of the second premolar to the middle of the second molar). Anastomoses with the rami buccales of the facial nerve. 
The posterior (sensitive) part of the mandibular nerve has a connection with the auricular ganglion and the facial nerve and gives off, in addition to a number of motor branches, the following sensory branches: the auriculotemporal nerve, P. Auriculotemporalis, begins at the oval opening with two roots, which, covering the middle artery of the brain the shells are reconnected into one trunk; the latter, rounding the back of the neck of the articular process of the lower jaw, rises in the thickness of the parotid salivary gland immediately anterior to the external cartilage ear canal, gives branches to the last one, to the capsule mandibular joint, to the skin of the anterior part of the auricle Fig. 3b Diagram of the Branches of the Mandibular Nerve:
JUICY Area. HE SENDS - Temporoauricular nerve; 2 - facial nerve; 3 - drum string; 4 - inferior alveolar nerve; 5-lingual nerve; 6-superior - jaw nerve; 7th orbital nerve.
Ear salivary gland.
Inferior alveolar (inferior alveolar) nerve, Alveolaris inferior (see Fig. 27).
The inferior alveolar nerve, like the lingual nerve, n. lingualis, is a large terminal branch of the mandibular nerve. First, it goes along with the lingual nerve down between the external and internal pterygoid muscles, then enters the mandibular foramen, foramen mandibulare. Before entering this opening, it gives the last motor fibers from the portio minor - the mylohyoid nerve (nerve of the diaphragm of the mouth) - to the mylohyoid muscle. Thus, the mylohyoid nerve is a mixed nerve (sensory and motor). This nerve, starting, as indicated, from the mandibular nerve before its entrance into the mandibular foramen, lies in the mylohyoid groove, goes further along the lower surface of the mylohyoid muscle, gives off its branches to it in the same way as the anterior belly of the digastric muscle bottom
Jaws; in addition, the nerve sends sensory branches to the skin of the chin and to the lower jaw.
In the mandibular canal, the inferior alveolar nerve gives off the lower dental nerves, forming the lower dental plexus, plexus dentalis inferior, and sending branches to each apical foramen, to the root membrane and alveolus, and also gingival branches, rami gingivales, to the gums. Through the mental foramen, foramen mentale, a large part of the inferior alveolar nerve, called the mental nerve, n. mentalis, branches off, which is divided into mental branches, rami mentales, going to the skin of the chin, lower labial branches, rami labiales inferiores, going to the skin and mucous membrane of the lower lip , and alveolar branches, rami alveolares, - to the outer gum. The smaller part of the inferior alveolar nerve goes to the lower jaw further forward called incisive nerve, n. incisi-VUS, Innervates the lower canines, incisors and partially premolars and forms anastomoses with the res-VR„IDS„ev37kanashlN°iI BGDan^Gpol^ D°?"M Nerve opposite -
The second nerve enters under the mucous membrane of the floor of the mouth. It passes over the submandibular salivary gland, gianduia submaxillaris, and the mylohyoid muscle and splits into the following branches: submandibular branches, rami submaxillares, - for the submandibular salivary gland, gl. . submaxillaris, sublingual branches, rami sublinguales, - for the sublingual salivary gland, gl. sublingualis, alveolar branches, rami alveolares, - for the gums, mucous membrane and periosteum of the lower jaw on the lingual side and, finally, lingual branches, rami linguales, - for the anterior two-thirds of the tongue. The mandibular nerve has the following sympathetic nodes.
The ear node, ganglion oticum (Arnoldi) (Fig. 37), receives branches:
A) from the mandibular nerve - 2-3 branches, b) from the sympathetic plexus around the middle artery of the dura mater, c) from tympanic nerve, branches of the glossopharyngeal nerve, in the form of the superficial small petrosal or Jacobson's nerve - n. petrosus superficialis minor.
This node gives off the following branches: a) branches to the muscles: tensor tympanic membrane, stretching the soft palate and to the internal pterygoid, b) branch to the spinous nerve, c) to the auriculotemporal and d) to the chorda tympani (Fig. 38) .
The submandibular ganglion, ganglion submaxillare, lies at the posterior edge of the mylohyoid muscle above the posterior end of the submandibular gland, below the lingual nerve. The node has a spindle-shaped shape and also receives three roots: a) sensory - from the lingual nerve, b) motor, or rather secretory, or parasympathetic - from the tympanic chord, which is part of the lingual nerve, c) sympathetic - from the sympathetic plexus around the external maxillary artery.
The node gives branches to the submandibular gland and its duct.
The skin of the face is innervated by everyone. three branches of the trigeminal nerve (see Fig. 32) (Fig. 39) (see diagram on page 122).
Facial nerve, n. facialis. The facial nerve, the seventh pair, is a motor nerve of the face that innervates the facial muscles of facial expression, the muscles of the cranial cap, the stapes muscle, the subcutaneous muscle of the neck, the posterior belly of the digastric muscle and the stylohyoid muscle.
In addition to motor fibers, it carries taste fibers for the tongue and secretory fibers for the salivary glands of the floor of the mouth, as well as sensory fibers for the facial muscles of facial expression.
The facial nerve (Fig. 40 and 41) enters the pyramid of the temporal bone through interior the auditory canal, porus et meatus acusticus internus, and, having made a complex path in the canal for the facial nerve, canalis facialis, leaves the temporal bone through the stylomastoid foramen, for. stylomastoideum, goes below the external auditory canal and laterally from the posterior belly of the digastric muscle, external carotid artery, posterior facial vein forward to the parotid gland, which is perforated.
In the skull, the nerve gives off the following branches:
A) to auditory nerve, b) superficial major petrosal nerve, n. petrosus superficialis major, to the sphenopalatine node, c) to the ear node, d) chorda tympani, chorda tympani, to the lingual nerve, e) to the vagus nerve and f) branch for the stapes muscle .
Upon exiting the skull, the nerve gives:
1) posterior auricular nerve, n. auricularis posterior, for the occipital muscle and muscles that change the position of the auricle; 2) branch for the posterior belly of the digastric muscle, g. digastricu^
Which, like the previous one, departs immediately near the exit of the nerve from the skull, slightly below the first, and branches into: a) the stylohyoid branch, ramus stylohyoideus, for the stylohyoid muscle and b) a branch into the glossopharyngeal nerve, ramus anastomoticus cum n. glossopharyngeo.
In the depths parotid gland The facial nerve is divided into two branches - the upper, thicker, temporofacial, temporofacial, and the lower, smaller, cervicofacial, cervicofacial.
Rice. 39. Distribution of innervation of the trigeminal nerve (diagram):
1 - area of distribution of the ophthalmic nerve; 2 - area of distribution of the maxillary nerve; 3 - area of distribution of the mandibular Nerve., 
Rice. 38. Diagram of the roots and branches of the ear ganglion:
1 - small superficial petrosal nerve; 2 - branches of the node to the temporoauricular nerve; 3 - Drum string; 4 - lingual nerve; 5 - branch of the node to the drum string; 6 - ear node; 7 - sphenopalatine nerves; 8 - nerve of the Vidian canal, or Vidian nerve (this is the name of two nerves - the large superficial petrosal nerve and the deep petrosal nerve - both together); 9 - greater superficial petrosal nerve.
The upper one goes up and forward, the lower one goes down, to the angle of the lower jaw, and both of them give rise to a number of radially diverging branches connected by anastomoses, collectively called the large crow's foot, pes anserinus major, and serving to supply the nerves to the facial muscles.
All branches are divided into three groups: 1) the upper one, composed of the temporal and zygomatic branches, rami temporales et zygomatici, for the muscles of the external ear, forehead, orbicularis orbital muscle and zygomatic; 2) middle, buccal, giving rami buccales, branches for the buccal muscle, muscles of the nose, upper lip, orbicularis oris muscle and triangular and quadratic muscles of the lower lip and 3) lower group - ramus marginalis mandibulae, composed of the marginal branch of the lower jaw, running along the lower edge of the lower jaw and innervating the quadratus muscle of the lower lip and mental.
In the neck, the facial nerve gives off a cervical branch, ramus colli, which runs down and forward to supply the subcutaneous muscle of the neck (see Fig. 41).
Rice. 41. Topography of the face area from the side and the branching of the facial nerve (according to Corning):
Rice. 40. Branching of the facial nerve:
1 - zygomaticotemporal branches; 2 - superior, or temporofacial branch; 3 - trunk of the facial nerve; 4 - Lower branch; 5 - marginal branch of the lower jaw; b - superior subcutaneous cervical branch; 7 - molar branches.
1 - great auricular nerve; 2 - lower branches of the facial nerve; 3 - masseter; 4 - Parotid gland; 5 - duct of the parotid gland; 6 Transverse artery of the face; 7 - superficial temporal artery and vein; 8 - auriculotemporal nerve; 9 - superior branches of the facial nerve; 10 - Parotid branch of the superficial temporal artery; // - frontal branches of the superficial temporal artery; 12 - supraorbital nerve; 13 - Angular artery; 14 - anterior facial vein; 15 - middle branches of the facial nerve; 16 - external maxillary artery; 17 - middle branches of the facial nerve; 18 - external maxillary artery; 19 - Marginal branch of the facial nerve; 20 - Middle cutaneous cervical nerve.
The facial nerve anastomoses with the following adjacent sensory nerves: auriculotemporal, zygomatic-facial branch of the zygomatic nerve, buccal, infraorbital, lingual, chin, auditory, parasitic, vagus (Fig. 42).
As a result of these connections, the nerve receives sensory fibers with which it supplies the facial muscles.
Very important anastomoses are the chorda tympani and the superficial greater petrosal nerve, which branch from the facial nerve before its exit from the stylomastoid foramen.
Rice. 42. Diagram of the branches of the facial nerve:
1 and 3 - facial nerve. 2 - intermediate nerve; 4 - a bundle of branches of the facial nerve on the face (the so-called greater crow's foot, or parotid plexus); 5 - lingual nerve (branch of the mandibular nerve); 6 - drum string; 7 - internal carotid artery and the sympathetic plexus on it; 8 - basal palatal node; 9 - deep petrosal nerve; 10 - greater superficial petrosal nerve; 11th geniculate ganglion of the facial nerve.
The tympanic chord, starting from the facial nerve shortly before it exits the stylomastoid process, runs at an acute angle in the opposite direction and enters the tympanic chord through a special canaliculus in the bone. cavity. Here, in a fold of the mucous membrane, it lies between the two auditory ossicles (the malleus and the incus), then leaves the tympanic cavity through the petrotympanic fissure, fissura petrotympanica, goes in an arc down and forward on the medial side from the middle meningeal artery and the inferior alveolar nerve and under the acute The angle joins the lingual nerve. The chorda tympani contains secretory fibers for the submandibular and sublingual salivary glands and taste fibers for the fungiform papillae of the tongue.
The superficial greater petrosal nerve arises in the mass of the pyramid of the temporal bone, passes through the opening of the facial canal, hiatus canalis facialis, into the cranial cavity, enters the pterygoid canal, canalis pterygoideus, and through it penetrates the pterygopalatine fossa and flows into the sphenopalatine node.
The anatomical structure of human jaws explains the peculiarities of their functioning. To understand the principles of the structure of the maxillofacial region, you should pay attention not only to those fibers that are responsible for transmitting impulses, but also to the blood supply. Innervation of the maxillofacial region – important process, and it’s worth talking about it in detail.
The human facial skeleton includes two jaws - lower and upper. A number of functions depend on their formation - breathing, swallowing, chewing food. Thanks to the jaws, a person’s profile is formed, they determine his attractiveness and aesthetics, and are required for the formation of cavities where the sensory organs are located.
The trigeminal nerve and its branches innervate the maxillofacial region - it is located in the cranial cavity. The mandibular nerve (it gives rise to the nerves of the lower jaw), the maxillary nerve and the orbital nerve depart from it. The facial nerve is responsible for transmitting impulses to the facial muscles. If one of its branches is damaged, it will result in distorted expression or permanent paralysis of the patient's face.
The maxillary nerve is one of the branches of the trigeminal nerve. There is a circular opening in the skull through which the maxillary nerve exits the cranial cavity. Branches arise from the maxillary nerve. If we consider the approximate diagram of their placement, it looks like this in the order of movement of the maxillary nerve:
Sensory and motor fibers make up the trunk of the mandibular nerve. This nerve of the lower jaw is characterized by branching into the anterior and posterior lobes at the exit from the cranial cavity. The structure of the branches is not the same - in the first case, most of them are fibers of the sensory type, and in the second - motor fibers. This category of fibers is the basis of the mylohyoid nerve. Its main branches:
The ophthalmic nerve is the 3rd branch of the trigeminal nerve. Innervation of the teeth or jaw is not one of its functions. As the name suggests, it refers to the transmission of impulses to the organs of vision and nearby tissues. It is examined when a patient develops a malignant neoplasm or neuralgia.
The hypoglossal nerve has a motor nucleus, its function is to innervate the muscles of the tongue. The branch consists of 10 - 15 fibers, each of them goes to a separate muscle. The nerve takes part in the implementation of the processes of chewing food, swallowing, licking, sucking - it is one of the parts of the corresponding reflex arc.
When mentioning pathologies of the trigeminal nerve, the first thing that comes to mind is neuralgia or neuritis. However, other lesions may also occur.
Both itself and one/several of its branches can be damaged. For example, sometimes only the maxillary nerve is affected. Pathological processes completely or partially disrupt the innervation of the maxillofacial area. The main operational problems include:
A common pathology affecting the trigeminal nerve is neuralgia. Neuritis, tooth extraction, surgery when treating teeth or sinuses, massive facial trauma - these causes provoke damage to the maxillary nerve and one (sometimes several) of its branches. The main symptom of the disease is severe acute pain syndrome, therefore, in the complex of therapy, an important place is given to its relief.
| Treatment of neuralgia | ||
| Conservative | Physiotherapeutic | Surgical |
| Painkillers (Novocaine) – for prolonged and intense pain syndrome | Massage (used with caution only as prescribed by a doctor after a comprehensive examination) | Vascular decompression (pathological impulses are eliminated by installing a special protector) |
| Antidepressants (Ampitriline) | Pulse currents (impact is carried out pointwise, on areas of the patient’s face) | Pain fibers are destroyed using an inflated balloon (balloon microcompression) |
| Complex therapy (Pantogam, Baclofen) | Ionic galvanization | Rhizotomy (represents the destruction of pain fibers with an electrode or glycerin) |
| Anticonvulsants (Finlepsin, Difenin) | Laser or acupuncture | Branch blockade (novocaine, 80% ethyl alcohol) |
| Anticonvulsants, analgesics (Carbamazepine) - a group of drugs that form the basis of the treatment of neuralgia | Electrophoresis | |
| Ultrasound therapy | ||
The largest vessel responsible for the blood supply to the area under consideration is the maxillary artery. The function of blood supply to the lower jaw (in particular, its chin region) is performed by branches of the lingual artery. The branches and body of this part of the skull are supplied with blood through a complex of vessels and their processes. This feature of the blood supply is important to take into account when carrying out surgical operations. This is also true for tooth extraction.
The blood supply to the lower row of teeth is carried out by branches of the inferior alveolar artery. The blood supply to the teeth of the upper row and the alveolar process is carried out by the branches of the maxillary artery. The maxillofacial region is characterized by good lymphatic drainage due to the developed lymphatic network.
It should be taken into account that not a single complex preventive measures does not provide an absolute guarantee that the person performing them will never encounter pathologies of the nerves of the maxillofacial area.
Frequently asked questions
First of all, one that does not injure the gums during use. At the same time, the quality of hygiene oral cavity depends more on whether your teeth are brushed correctly than on the shape or type of toothbrush. As for electric brushes, for uninformed people they are a more preferable option; although you can clean your teeth efficiently with a simple (manual) brush. In addition, a toothbrush alone is often not enough - floss (special dental floss) must be used to clean between the teeth.
Mouthwashes are additional hygiene products that effectively cleanse the entire oral cavity of harmful bacteria. All these products can be divided into two large groups - therapeutic and preventive and hygienic.
The latter include mouthwashes that eliminate unpleasant odors and promote fresh breath.
As for therapeutic and prophylactic ones, these include rinses that have anti-plaque/anti-inflammatory/anti-carious effects and help reduce the sensitivity of hard dental tissues. This is achieved due to the presence of various biologically active components in the composition. Therefore, the mouthwash must be selected individually for each individual, as well as toothpaste. And since the product is not washed off with water, it only consolidates the effect of the active ingredients of the paste.
This type of cleaning is completely safe for dental tissues and causes less trauma. soft fabrics oral cavity. The fact is that in dental clinics a special level of ultrasonic vibrations is selected, which affects the density of the stone, disrupts its structure and separates it from the enamel. In addition, in places where tissues are treated with an ultrasonic scaler (this is the name of the device for cleaning teeth), a special cavitation effect occurs (after all, oxygen molecules are released from water droplets, which enter the treatment area and cool the tip of the instrument). The cell membranes of pathogenic microorganisms are ruptured by these molecules, causing the microbes to die.
It turns out that ultrasonic cleaning has a comprehensive effect (provided that really high-quality equipment is used) both on the stone and on the microflora as a whole, cleansing it. Oh mechanical cleaning you can't say that. Moreover, ultrasonic cleaning more pleasant for the patient and takes less time.
According to dentists, dental treatment should be carried out regardless of your situation. Moreover, a pregnant woman is recommended to visit the dentist every one to two months, because, as you know, when carrying a baby, the teeth are significantly weakened, suffer from a deficiency of phosphorus and calcium, and therefore the risk of developing caries or even tooth loss increases significantly. To treat pregnant women, it is necessary to use harmless anesthetics. The most appropriate course of treatment should be selected exclusively by a qualified dentist, who will also prescribe the required medications that strengthen tooth enamel.
It is quite difficult to treat wisdom teeth due to their anatomical structure. However, qualified specialists successfully treat them. Wisdom teeth prosthetics are recommended when one (or several) adjacent teeth are missing or need to be removed (if you also remove a wisdom tooth, there will simply be nothing to chew). In addition, removal of a wisdom tooth is undesirable if it is located in the correct place in the jaw, has its own antagonist tooth and takes part in the chewing process. You should also take into account the fact that poor quality treatment can lead to the most serious complications.
Here, of course, a lot depends on a person’s taste. So, there are absolutely invisible systems attached to the inside of the teeth (known as lingual), and there are also transparent ones. But the most popular are still metal bracket systems with colored metal/elastic ligatures. It's really fashionable!
To begin with, it is simply unattractive. If this is not enough for you, we present the following argument - tartar and plaque on the teeth often provoke bad breath. Is this not enough for you? In this case, we move on: if tartar “grows”, this will inevitably lead to irritation and inflammation of the gums, that is, it will create favorable conditions for periodontitis (a disease in which periodontal pockets form, pus constantly flows out of them, and the teeth themselves become mobile ). And this is a direct path to loss healthy teeth. Moreover, the number of harmful bacteria increases, which causes increased dental caries.
The service life of a well-established implant will be tens of years. According to statistics, at least 90 percent of implants function perfectly 10 years after installation, while the service life is on average 40 years. Typically, this period will depend both on the design of the product and on how carefully the patient cares for it. That is why it is imperative to use an irrigator during cleaning. In addition, it is necessary to visit the dentist at least once a year. All these measures will significantly reduce the risk of implant loss.
Removal of a dental cyst can be done therapeutically or surgically. In the second case, we are talking about tooth extraction with further cleaning of the gums. In addition, there are modern methods that allow you to save the tooth. This is, first of all, cystectomy - a rather complex operation that involves removing the cyst and the affected root tip. Another method is hemisection, in which the root and a fragment of the tooth above it are removed, after which it (the part) is restored with a crown.
As for therapeutic treatment, then it consists in cleaning out the cyst by root canal. This is also a difficult option, especially not always effective. Which method should you choose? This will be decided by the doctor together with the patient.
In the first case, professional systems based on carbamide peroxide or hydrogen peroxide are used to change the color of teeth. Obviously, it is better to give preference to professional whitening.
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(p. mandibularis) - the third branch of the trigeminal nerve, is a mixed nerve and is formed by sensory nerve fibers coming from the trigeminal ganglion and motor fibers of the motor root (Fig. 1, 2). The thickness of the nerve trunk ranges from 3.5 to 7.5 mm, and the length of the extracranial part of the trunk is 0.5-2.0 cm. The nerve consists of 30-80 bundles of fibers, including from 50,000 to 120,000 myelinated nerve fibers.
Rice. 1. Mandibular nerve, left view. (Mandibular ramus removed):
1 - auriculotemporal nerve; 2 — middle meningeal artery; 3 - superficial temporal artery; 4 - facial nerve; 5 - maxillary artery; 6—inferior alveolar nerve; 7 - mylohyoid nerve; 8—submandibular node; 9— internal carotid artery; 10—mental nerve; 11 - medial pterygoid muscle; 12—lingual nerve; 13— drum string; 14 - buccal nerve; 15 - nerve to the lateral pterygoid muscle; 16 - pterygopalatine node; 17 - infraorbital nerve; 18 - maxillary nerve; 19 - zygomaticofacial nerve; 20—nerve to the medial pterygoid muscle; 21 - mandibular nerve; 22 - chewing nerve; 23 - deep temporal nerves; 24 - zygomaticotemporal nerve
Rice. 2. Mandibular nerve, view from the medial side:
1—motor root; 2—sensitive root; 3—greater petrosal nerve; 4— lesser petrosal nerve; 5—nerve to the tensor tympani muscle; 6, 12— drum string; 7—auriculotemporal nerve; 8—inferior alveolar nerve; 9— mylohyoid nerve; 10—lingual nerve; 11 - medial pterygoid nerve; 13 - ear node; 14 - nerve to the muscle that strains the velum palatine; 15 - mandibular nerve; 16 - maxillary nerve; 17 - optic nerve; 18 - trigeminal node
The mandibular nerve provides sensory innervation to the dura mater of the brain, skin of the lower lip, chin, lower part of the cheek, anterior part of the auricle and external auditory canal, part of the surface of the eardrum, mucous membrane of the cheek, floor of the mouth and anterior two-thirds of the tongue, teeth of the lower jaw , as well as motor innervation of all masticatory muscles, the mylohyoid muscle, the anterior belly of the digastric muscle and the muscles that strain the tympanic membrane and the velum palatine.
From the cranial cavity, the mandibular nerve exits through the foramen ovale and enters the infratemporal fossa, where it divides near the exit site into a number of branches. Branching of the mandibular nerve is possible either in a scattered type (more often with dolichocephaly) - the nerve breaks up into many branches (8-11), or in trunk type(more often with brachycephaly) with branching into a small number of trunks (4-5), each of which is common to several nerves.
Three nodes of the autonomic nervous system are associated with the branches of the mandibular nerve: auricular (ganglion oticum); submandibular(ganglion submandibulare); sublingual (ganglion sublinguale). From the nodes postganglionic parasympathetic secretory fibers go to the salivary glands.
The mandibular nerve gives off a number of branches.
1. Meningeal branch(r. meningeus) passes through the foramen spinosum along with the middle meningeal artery into the cranial cavity, where it branches in the dura mater.
2. Masseteric nerve(n. massetericus), predominantly motor, often (especially in the main form of branching of the mandibular nerve) has a common origin with other nerves of the masticatory muscles. It passes outward over the upper edge of the lateral pterygoid muscle, then through the notch of the mandible and is embedded in the masseter muscle. Before entering the muscle, it sends a thin branch to the temporomandibular joint, providing its sensitive innervation.
3. Deep temporal nerves(pp. temporales profundi), motor, pass along the outer base of the skull outward, bend around the infratemporal crest and enter the temporal muscle from its inner surface in the anterior ( n. temporalis profundus anterior) and rear ( n. temporalis profundus posterior) departments.
4. Lateral pterygoid nerve(n. pterygoideus lateralis), motor, usually departs through a common trunk with the buccal nerve, approaches the muscle of the same name, in which it branches.
5. Medial pterygoid nerve(n. pterygoideus medialis), mainly motor. It passes through the ear ganglion or is adjacent to its surface and follows forward and down to the inner surface of the muscle of the same name, into which it penetrates near its upper edge. In addition, near the ear ganglion it gives off the nerve to the muscle, straining the velum palatine (p. musculi tensoris veli palatine), muscle nerve, tensor tympani (p. musculi tensoris tympani), and a connecting branch to the node.
6. The buccal nerve (p. buccalis), sensitive, penetrates between the two heads of the lateral pterygoid muscle and runs along the inner surface of the temporal muscle, spreading further along with the buccal vessels along the outer surface of the buccal muscle to the corner of the mouth. On its way, it gives off thin branches that pierce the buccal muscle and innervate the mucous membrane of the cheek (to the gum of the 2nd premolar and 1st molar) and branches to the skin of the cheek and corner of the mouth. Forms a connecting branch with the branch of the facial nerve and with the ear ganglion.
7. Auriculotemporal nerve(n. auriculotemporalis), sensitive, starts from the posterior surface of the mandibular nerve with two roots covering the middle meningeal artery, which then connect into a common trunk. Receives from the ear ganglion a connecting branch containing parasympathetic fibers. Near the neck of the articular process of the lower jaw, the auriculotemporal nerve goes upward and through the parotid salivary gland enters the temporal region, where it branches into terminal branches - superficial temporal (rr. temporales superficiales). Along its path, the auriculotemporal nerve gives off the following branches:
1) articular (rr. articulares), to the temporomandibular joint;
2) parotid (rr. parotidei), to the parotid salivary gland. These branches contain, in addition to sensory ones, parasympathetic secretory fibers from the ear ganglion;
3) nerve of the external auditory canal(n. meatus acustuci externi), to the skin of the external auditory canal and the eardrum;
4) anterior auricular nerves(pp. auriculares anteriores), to the skin of the anterior part of the auricle and the middle part of the temporal region.
8. Lingual nerve (n. lingualis), sensitive. It originates from the mandibular nerve near the foramen ovale and is located between the pterygoid muscles anterior to the inferior alveolar nerve. At the upper edge of the medial pterygoid muscle or slightly lower, it joins the nerve drum string(chorda tympani), which is a continuation of the intermediate nerve. As part of the chorda tympani, the lingual nerve includes secretory fibers that go to the submandibular and sublingual nerve ganglia, and taste fibers to the papillae of the tongue. Next, the lingual nerve passes between the inner surface of the lower jaw and the medial pterygoid muscle, above the submandibular salivary gland along the outer surface of the hyoglossus muscle to the lateral surface of the tongue. Between the hypoglossal and genioglossus muscles, the nerve splits into terminal lingual branches (rr. linguales).
Along the course of the nerve, connecting branches with the hypoglossal nerve and the chorda tympani are formed. In the oral cavity, the lingual nerve gives off the following branches:
1) branches to the isthmus of the pharynx(rr. isthmi faucium), innervating the mucous membrane of the pharynx and posterior floor of the oral cavity;
2) hypoglossal nerve(p. sublingualis) departs from the lingual nerve at the posterior edge of the hypoglossal ganglion in the form of a thin connecting branch and spreads forward along the lateral surface of the sublingual salivary gland. Innervates the mucous membrane of the floor of the mouth, gums and sublingual salivary gland;
3) lingual branches (rr. linguales) pass along with the deep arteries and veins of the tongue through the muscles of the tongue forward and end in the mucous membrane of the apex of the tongue and its body to the border line. As part of the lingual branches, taste fibers pass to the papillae of the tongue, passing from the chorda tympani.
9. Inferior alveolar nerve(p. alveolaris inferior), mixed. This is the largest branch of the mandibular nerve. Its trunk lies between the pterygoid muscles behind and lateral to the lingual nerve, between the mandible and the sphenomandibular ligament. The nerve enters, together with the vessels of the same name, into the mandibular canal, where it gives off multiple branches that anastomose with each other and form inferior dental plexus(plexus dentalis inferior)(in 15% of cases), or directly the lower dental and gingival branches. It leaves the canal through the mental foramen, dividing before exiting onto the mental nerve and incisive branch. Gives the following branches:
1) mylohyoid nerve(p. mylohyoides) arises near the entrance of the inferior alveolar nerve into the mandibular foramen, is located in the groove of the same name in the branch of the mandible and goes to the mylohyoid muscle and the anterior belly of the digastric muscle;
2) lower dental and gingival branches(rr. dentales et gingivales inferiors) originate from the inferior alveolar nerve in the mandibular canal; innervate the gums, alveoli of the alveolar part of the jaw and teeth (premolars and molars);
3) mental nerve(p. mentalis) is a continuation of the trunk of the inferior alveolar nerve as it exits through the mental foramen from the canal of the mandible; here the nerve is divided fan-shaped into 4-8 branches, among which there are mental (rr. mentales), to the skin of the chin and lower labials (rr. labials inferiors), to the skin and mucous membrane of the lower lip.
Ear node (ganglion oticum) - a rounded flattened body with a diameter of 3-5 mm; located under the foramen ovale on the posteromedial surface of the mandibular nerve (Fig. 3, 4). The lesser petrosal nerve (from the glossopharyngeal) approaches it, bringing preganglionic parasympathetic fibers. A number of connecting branches extend from the node:
1) to the auriculotemporal nerve, which receives postganglionic parasympathetic secretory fibers, which then go as part of the parotid branches to the parotid salivary gland;
2) to the buccal nerve, through which postganglionic parasympathetic secretory fibers reach the small salivary glands of the oral cavity;
3) to the drum string;
4) to the pterygopalatine and trigeminal nodes.
Rice. 3. Autonomic nodes of the head, view from the medial side:
1 - nerve of the pterygoid canal; 2 - maxillary nerve; 3 - optic nerve; 4 - ciliary node; 5 - pterygopalatine node; 6 - greater and lesser palatine nerves; 7 - submandibular node; 8 - facial artery and nerve plexus; 9 - cervical region sympathetic trunk; 10, 18 - internal carotid artery and nerve plexus; 11—superior cervical ganglion of the sympathetic trunk; 12 - internal carotid nerve; 13 - drum string; 14 - auriculotemporal nerve; 15 - lesser petrosal nerve; 16 - ear node; 17 - mandibular nerve; 19 - sensitive root of the trigeminal nerve; 20 - motor root of the trigeminal nerve; 21 - trigeminal node; 22 - greater petrosal nerve; 23 - deep petrosal nerve
Rice. 4. Ear node of an adult (preparations by A.G. Tsybulkin):
a — macromicroscopic specimen, stained with Schiff’s reagent, UV. x12: 1 - mandibular nerve in the foramen ovale (medial surface); 2— ear node; 3 - sensitive root of the ear node; 4 - connecting branches to the buccal nerve; 5 - additional ear nodes; 6 - connecting branches to the auriculotemporal nerve; 7 - middle meningeal artery; 8 - lesser petrosal nerve;
b — histotopogram, hematoxylin-eosin staining, UV. x10x7
(ganglion submandibulare) (size 3.0-3.5 mm) is located under the trunk of the lingual nerve and is associated with it nodal branches (rr. ganglionares)(Fig. 5, 6). Along these branches the preganglionic parasympathetic fibers of the chorda tympani go to the node and end there. The branches extending from the node innervate the submandibular and sublingual salivary glands.
Rice. 5. Submandibular ganglion, lateral view. (Most of the lower jaw has been removed):
1 - mandibular nerve; 2 - deep temporal nerves; 3 - buccal nerve; 4 _ lingual nerve; 5 - submandibular node; 6 - submandibular salivary gland; 7 - mylohyoid nerve; 8 - inferior alveolar nerve; 9 - drum string; 10 - auriculotemporal nerve
Rice. 6. Submandibular node (preparation by A.G. Tsybulkin):
1 - lingual nerve; 2 - nodal branches; 3 - submandibular node; 4 - glandular branches; 5 - submandibular salivary gland; 6 - branch of the submandibular node to the sublingual gland; 7 - submandibular duct
Sometimes (up to 30% of cases) there is a separate sublingual node(ganglion sublingualis).
Human anatomy S.S. Mikhailov, A.V. Chukbar, A.G. Tsybulkin
Blood supply to teeth occurs mainly due to a. maxillaris. The superior alveolar arteries, aa, depart from it. alveolares superiores, and inferior alveolar artery, a. alveolaris inferior. On the upper jaw, the molars receive blood from the posterior superior alveolar artery, and the anterior ones - from the anterior superior alveolar arteries, extending from one of the terminal branches of a. maxillaris - infraorbital artery, a. infraorbitalis, which runs in the canal of the same name.
A. alveolaris inferior, passing in the mandibular canal, gives branches to the teeth of the lower jaw.
From the alveolar arteries go away ah. dentales, penetrating into the pulp through the apical foramina.
Venous drainage from teeth occurs along the veins accompanying the arteries into the pterygoid plexus, plexus pterygoideus. The veins of the teeth of the upper jaw are also connected to the ophthalmic veins and, through them, to the venous sinuses of the skull. Through the facial and mandibular veins, blood from the teeth enters the jugular vein system.
Lymphatic drainage from teeth carried out to the submandibular and mental lymph nodes. From here the lymph flow goes to the superficial and deep cervical nodes.
The upper teeth are innervated from n. maxillaris, 11th branch of the trigeminal nerve, which gives rise to the superior alveolar nerves accompanying the arteries of the same name. The posterior superior anterior, middle and posterior alveolar nerves, interconnected by arcades, form the superior dental plexus, plexus dentalis superior. This plexus may be partially located directly under the mucous membrane of the maxillary sinus.
The lower teeth innervate III branch of the trigeminal nerve, n. mandibularis. The n departs from it. alveolaris inferior, which, passing in the mandibular canal, usually branches into stems that form the lower dental plexus, plexus dentalis inferior. From the latter, through the apical opening of the root, the dental branches (rami dentales) enter the pulp.
Autonomic innervation of teeth carried out from the head part of the sympathetic and parasympathetic nervous system.
Lower jaw: development, ossification nuclei, structure. Age and individual characteristics of the lower jaw. Locations of typical fractures. Buttresses. Topography of the mandibular canal. The relationship between the roots of the teeth and the canal of the lower jaw. Conduction anesthesia
Lower jaw, mandibula, is a movable bone of the skull. It has a horseshoe shape, determined both by its function (the most important part of the masticatory apparatus) and by its development from the first gill (mandibular) arch, the shape of which it retains to a certain extent. In many mammals, including lower primates, the lower jaw is a paired bone. In accordance with this, in humans it is formed from two primordia, which, gradually growing, merge in the 2nd year after birth into an unpaired bone, maintaining, however, along the midline a trace of fusion of both halves ( symphysis mentalis). According to the structure of the masticatory apparatus from the passive part, i.e., the teeth that perform the chewing function, and the active part, i.e., the muscles, the lower jaw is divided into a horizontal part, or body, corpus mandibulae, which carries teeth, and a vertical part in the form of two branches, rami mandibulae, which serve to form the temporomandibular joint and attach the masticatory muscles. Both of these parts - horizontal and vertical - converge at an angle, angulus mandibulae, to which the masticatory muscle is attached on the outer surface, causing the appearance of the same name tuberosities, tuberositas masseterica. On the inner surface of the corner there is pterygoid tuberosity, tuberositas pterygoidea, attachment point another masticatory muscle, m. pterygoideus medialis. Therefore, the activity of the masticatory apparatus affects the size of this angle. In newborns it is close to 150°, in adults it decreases to 130-110°, and in old age, with the loss of teeth and weakening of the act of chewing, it increases again. Also, when comparing monkeys with various species of hominids, according to the weakening of the chewing function, a gradual increase in the angulus mandibulae is observed from 90° in apes to 95° in Heidelberg man, 100° in Neanderthal man and 130° in modern man (Fig. 33)
The structure and relief of the body of the lower jaw are determined by the presence of teeth and its participation in the formation of the mouth.
So, upper part body, pars alveolaris, bears teeth, as a result of which its edge, arcus alveolaris, are dental alveoli, With septa, septa interalveolaria, corresponding to external alveolar eminences, juga alveolaria. The rounded lower edge of the body is massive, forms the base bodies of the lower jaw, basis mandibulae. In old age, when teeth fall out, pars alveolaris atrophies and the whole body becomes thin and low. Along the midline of the body, the crest of the symphysis passes into the mental eminence triangular, protuberantia mentalis, the presence of which characterizes modern man. Of all mammals, the chin is expressed only in humans, and even then modern ones. In apes, Pithecanthropus and Heidelberg man, there is no chin protrusion and the jaw in this place has an edge that curves back. In Neanderthals, the mental protuberance is also absent, but the corresponding edge of the lower jaw looks like right angle. Only modern man shows a real chin. On the sides of this elevation there are noticeable mental tubercles, tubercula mentalia, one on each side. On the lateral surface of the body, at the level of the space between the 1st and 2nd small molars, there is mental foramen, foramen mentale, representing the output canal of the lower jaw, canalis mandibulae, serving for the passage of nerves and blood vessels. Stretches back and upward from the tuberculum mentale area oblique line, linea obliqua. Two mental muscles protrude on the inner surface of the symphysis awns, spinae mentales, - places of tendon attachment mm. genioglossi. In anthropomorphic monkeys, this muscle is attached not by a tendon, but by a fleshy part, as a result of which a fossa is formed instead of a spine. In the series of fossil jaws there are all transitional forms - from the pit characteristic of monkeys, caused by fleshy attachment m. genioglossus and combined with the absence of a chin, until the development of a spine caused by the tendon attachment of the genioglossus muscle and combined with a protruding chin. Thus, changing the method of attachment of m. genioglossus from fleshy to tendon resulted in the formation spina mentalis and accordingly the chin. Considering that the tendinous method of attachment of the tongue muscles contributed to the development of articulate speech, the transformation of the bone relief of the lower jaw in the chin area should also be associated with speech and is a purely human characteristic. On either side of spina mentalis, closer to the lower edge of the jaw, attachment points are visible digastric muscle, fossae digastricae. Further posteriorly goes back and upward towards the branch mylohyoid line, - the place of attachment of the muscle of the same name.
Branch of the jaw, ramus mandibulae, extends upward on each side from the posterior part of the body of the lower jaw. It is noticeable on the inner surface opening of the lower jaw, foramen mandibulae, leading to the above mentioned canalis mandibulae. The inner edge of the hole protrudes in the form lingula of the lower jaw, lingula mandibulae, where lig is attached. sphenomandibulare; The lingula is more developed in humans than in monkeys. Posterior to the lingula begins and goes down and forward mylohyoid groove, sulcus mylohyoideus(trace of nerve and blood vessels). At the top, the branch of the lower jaw ends in two processes: the anterior one, coronoid, processus coronoideus(formed under the influence of the strong temporal muscle), and the posterior condylar, processus condylaris, participates in the articulation of the lower jaw with the temporal bone. A notch is formed between both processes incisura mandibulae. Towards the coronoid process it rises on the inner surface of the branch from the surface of the alveoli of the last large molars buccal crest, crista buccinatoria.
Condylar process has a head caput mandibulae, And neck, collum mandibulae; located in front of the neck fossa, fovea pterygoidea(place of attachment of m. pterygoideus lateralis).
To summarize the description of the lower jaw, it should be noted that its shape and structure characterize modern humans. Along with this, a person began to develop articulate speech, associated with the strengthened and delicate work of the tongue muscles attached to the lower jaw. Therefore, the mental region of the lower jaw, associated with these muscles, functioned intensively and resisted the action of regression factors, and mental spines and a protrusion appeared on it. The formation of the latter was also facilitated by the expansion jaw arch, associated with an increase in the transverse dimensions of the skull under the influence of a growing brain. Thus, the shape and structure of the human lower jaw were influenced by the development of labor, articulate speech and the brain that characterize a person.
FRACTURES OF THE LOWER JAW. Typical locations of fractures are in the area of the canine, incisors, angle of the lower jaw, and articular process.
Clinic for mandibular fractures. Sharp pain when chewing, talking; restriction of movements of the lower jaw, pathological mobility of fragments and their displacement, malocclusion; changes in sensitivity in the area of innervation of the mental nerve, swelling of soft tissues. Individual symptoms depend on the nature and location of the fractures and the action of the masticatory muscles.
Skull buttresses
In some places the skull has thickenings called buttresses. Thanks to them, the strength of those shocks and mechanical shocks that the skull experiences when walking, running, jumping, chewing movements, as well as when playing certain sports (boxing, football, etc.) becomes moderate. Buttresses are a kind of supporting places for the skull, between which its more subtle formations are located.
The mandibular buttress is a thickening in the area of the body of the lower jaw, which on one side rests on its dental sockets, and on the other, continues along this branch; bones to its neck and head. When chewing, pressure is transmitted from the lower jaw to the temporal bone through the head.
Mandibular canal - (inferior dental canal) - a bone canal passing on each side of the lower jaw. The inferior alveolar nerve passes through it and blood vessels; part of its border can be observed during dental x-rays;
