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Introduction :

  • The maxillary nerve is one of the branches of the trigeminal nerve, otherwise known as the fifth cranial nerve (CN V).
  • Supplies sensory innervation to certain parts of the face, the mucosa of the nose, together with the teeth, this nerve allows you to feel that annoying fly landing underneath your eye or that annoying pain caused by your dentist.
  • The trigeminal nerve (cranial nerve V) is a mixed nerve, meaning that it is made of both afferent and efferent neuronal fibers.
  • Efferent fibers are actually descending motor fibers that innervate all of the four masticatory muscles.
  • And also innervate the muscles related to them, such as the anterior belly of the digastric muscle, mylohyoid muscle, tensor veli palatini muscle and also the tensor tympani muscle.
  • Afferent fibers are part of the general somatic afferent system.
  • They provide sensory innervation to the skin of the face and the frontal part of the scalp.
  • They also provide sensory innervation to mucosa of the nasal and the oral cavity, frontal two-thirds of the tongue.
  • And part of the ear and external acoustic meatus, part of the tympanic membrane also receive the sensory innervation.
  • Finally, the Conjuctiva and Duramater also receive the sensory innervation from the maxillary nerve. 
 

Maxillary nerve

Origin :

    • This nerve arises from the trigeminal ganglion.

Type :

    • Sensory type of nerve.

Course of the Nerve :

    • Trigeminal nerve – Cavernous sinus – Foramen rotundum – Pterygopalatine fossa – Infratemporal fossa – Inferior orbital fissure – Infraorbital nerve – Respective anatomical structures

Branches :

    • Meningeal, zygomatic, zygomaticofacial, zygomaticotemporal, infraorbital, anterior, middle, and posterior superior alveolar nerves, nasopalatine, greater palatine, lesser palatine nerves.

Innervation of Maxillary nerve :

    • Dura mater of the middle cranial fossa; mucosa of the nasopharynx, palate, nasal cavity, nasopharynx; teeth and also upper jaw; skin over the side of the nose, lower eyelid and cheek

    • And it also innervates the upper lip.

Anatomy :

    • The maxillary nerve is exclusively sensory, although its branches receive certain autonomous fibers that reach the maxillary nerve through the pterygopalatine ganglion.

    • This nerve carries sensory fibers from:
        • The dura mater of the middle cranial fossa.

        • The mucosa of the nasopharynx, the palate, the nasal cavity and maxillary sinus.

        • The teeth and the upper jaw.

        • The skin that covers the side of the nose, the lower eyelid, the cheek and the upper lip.

Courses and relation :

    • Firstly, The maxillary nerve arises from the anterior edge of the trigeminal ganglion.

    • Secondly, it courses forward through the lateral dural wall of the cavernous sinus, inferiorly and also laterally to the ophthalmic nerve.

    • The nerve leaves the middle cranial fossa after it passes through the foramen rotundum and also enters the upper part of the pterygopalatine fossa.

    • In this fossa, the nerve extends the most of its branches.

    • The fibers of the maxillary nerve leave the fossa by coursing forward through the pterygomaxillary fissure and also then enter the infratemporal fossa.

    • In the infratemporal fossa, the nerve is located adjacent to the maxillary tuberosity.

    • From that position, the nerve turns medially and enters the orbit through the inferior orbital fissure, where it is recognized by the name infraorbital nerve.

    • This nerve represents the terminal branch of the maxillary nerve.

Branches :

Branches of maxillary nerve

    • Its branches may be divided into four groups, depending upon where they branch off: in the cranium, in the pterygopalatine fossa, in the infraorbital canal, or on the face.

In the cranial cavity :

    • It gives meningeal branch which innervates duramater of the middle cranial fossa.

In the pterygopalatine fossa :

    • It gives : 2-3 ganglionic branches to pterygopalatine ganglion (sensory fibers pass through the branches of pterygopalatine ganglion to nasal cavity, palate, nasopharynx and orbit.

    • Posterior superior alveolar nerves which supply upper molar teeth and maxillary sinus.

    • Zygomatic nerve that divides into zygomaticotemporal, zygomaticofacial nerve, supply skin over the temporal region and also over the zygomatic bone.

    • Zygomaticotemporal branch carries postganglionic parasympathetic fibers (secretomotor fibers) from pterygopalatine ganglion to the lacrimal branch of ophthalmic nerve which supplies lacrimal gland.

Infraorbital nerve :

    • Infraorbital nerve is the continuation of maxillary nerve.

    • The infraorbital nerve gives following branches:
        • In the infra orbital canal:
            • Middle superior alveolar nerve- Innervates upper premolar teeth, gums and maxillary sinus.

            • Anterior superior alveolar nerve- Innervates upper canine and incisors, gums and maxillary sinus.

        • On the face:
            • Palpebral branch to lower eyelid.

            • Nasal branch to ala of nose.

            • Labial branch of upper lip.

Clinical aspects :

    • Trigeminal neuralgia:

        • . The condition causes sudden, intense facial pain on one side of your face.

        • The pain can feel like an electrical shock.

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