Anatomy of the lower jaw, blood supply and innervation. Branches of the trigeminal nerve: ophthalmic and maxillary nerves Anatomical structure of the tooth

The maxillary nerve exits the cranial cavity through a round foramen ( f. rotundum) into the pterygopalatine fossa ( fossa pterygopalatina) where it gives off a number of branches:

1 - pes anserinus minor; 2-rr. labiales superiores; 3-rr. nasales externi; 4 - rr. palpebrales inferiores: 5 - for. infraorbitals; 6-n. infraorbitalis iv. 7-n. zygomaticofacialis: 8 - for zygomaticofaciale; 9-n. zygomaticotemporal; 10 - for. zygomaticotemporale; 11 - for zygomaticoorbital; 12 - n. lacrimalis; 13-r. communicans cum n. lacrimalis; 14 - fissura orbitalis inferior; 15 - n. zygomaticus; 16 - nn. pterygopalatine 17 - for. rotundum; 18-r. meningeus medius; 19 - gangl. pterygopalatinum; 20 - nn. palatini; 21-nn. nasales posteriores; 22-rr. orbitales; 23-rr. alveolares superiores posteriores; 24-rr. alveolares superior medius et anteriores; 25-pl. dentalis superior; 26-rr. den tales superiores.

Methods of anesthesia in the upper jaw:

• Blockade of the superior posterior alveolar nerve - tuberal anesthesia;
• Bocade of the infraorbital, superior anterior alveolar and superior middle alveolar nerves - infraorbital (infraorbital) anesthesia:
• intraoral method;
• Extraoral method.
• Blockade of the greater palatine nerve - palatal anesthesia;
• Nasopalatine nerve block - incisive anesthesia:
• intraoral method;
• Extraoral method.

Tuberal anesthesia:

The patient's mouth is half open, the cheek is taken away with a mirror. The needle is placed at 45° to the crest of the alveolar process. The injection of the needle is carried out at the level of the second molar, retreating from the transitional fold 5 mm down (in the absence of lateral teeth, the injection is performed behind the zygomatic-alveolar crest) - (Fig. 1). The needle is advanced upwards, posteriorly and medially to a depth of 2.5 cm without losing contact with the bone. At the reached point, an anesthetic is injected, thereby turning off the upper posterior alveolar branches.

Trigeminal nerve, n. trigeminus. The trigeminal nerve is a sensitive nerve for teeth, jaws, perimaxillary soft tissues, eye sockets and their contents, as well as other organs of the face (Fig. 27). Only the glossopharyngeal nerve, n. glossopharyngeus, vagus nerve, n. vagus, hypoglossal nerve, n. hypoglossus, and some branches of the cervical plexus take an insignificant part in the conduction pain sensitivity from the oral cavity, pharynx and partially - the skin of the face (Fig. 28).

This nerve emerges from the brain and appears as two roots at the base of the skull on the side of the pons, closer to the cerebellar peduncles. Smaller, anterior, weaker root (portio minor) - motor; larger, posterior, strong spine (portio major) -

sensitive. The last root (portio major) forms in the notch of the pyramid impressio trigemini of the temporal bone a semilunar vein (Gasserian node), called ganglion semilunare, s. gasseri, from the anterior edge of which three branches of the trigeminal nerve depart: ophthalmic, 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 node, joins the mandibular nerve and makes it a mixed (sensory and motor) nerve.

From the beginning of each of the three branches goes ramus meningeus to the dura mater.

The orbital nerve supplies sensory fibers, in addition to the hard shell of the brain, to all the organs of the orbit, the anterior part of the upper section and the lateral parts of the nose, the frontal sinus and partially other additional nasal cavities, the upper eyelid, the skin of the forehead and spinal cord.

ki of the nose, as well as the walls of the orbit, in particular the orbital wall of the upper jaw; the maxillary 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 come out of the cranium and near it enters the soy

dynamism with a node, into which other cranial nerves and sympathetic fibers also enter, in particular the ophthalmic nerve - with the ciliary node, ganglion ciliare, the maxillary nerve - with the main palatine node, ganglion sphehopalatinum, and the mandibular nerve - with the ear node, ganglion oticum.

ophthalmic nerve. The first branch of the trigeminal nerve. The ophthalmic nerve (see Fig. 27) (Fig. 29 and 30) departs from the Gasser node, passes along with the oculomotor nerve, n. oculomotorius, and trochlear nerve, n. trochlearis, in the thickness of the outer wall of the cavernous sinus, sinus cavernosus, and together with them and with the abducens nerve penetrates through the superior orbital fissure, fissura

orbifalis ffuperior, into the cavity of the orbit. Even before entering the orbit, often within the superior orbital fissure, the ophthalmic nerve divides on their 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 in the orbit most medially and supplies the nerve with its branches eyeball(partially), eyelids, lacrimal sac, posterior sieve mucosa

cells, the sphenoid sinus, the mucous membrane of the anterior and lateral sections of the nose, as well as partly the cartilage of the nose and the skin of the back and tip of the nose. Its branches are: 1) a long root, radix longa, - to the ciliary node, from which short ciliary nerves go to the eyeball, pp. ciliares breves;

2) long ciliary nerves, nn. ciliares longi, from the medial side optic nerve, n. opticus, - to the eyeball; 3) posterior ethmoidal nerve, p. ethmoidalis posterior, - through the posterior ethmoid opening to the mucous membrane of the posterior ethmoid cells, cellulae ethmoidales posteriores; 4) the anterior ethmoidal nerve, n. ethmoidalis anterior, - through the anterior ethmoid opening, foramen ethmoidale anterius, passes into the cranial cavity and through the cribriform plate, lamina cnbrosa - into the nasal cavity, to its mucous membrane; 5) terminal nasal branch exits

outward under the skin of the wing and the tip of the nose called n. nasalis externus; 6) lower trochlear nerve, n, infratrochlearis, goes under m. obliqus superior.

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 is the supraorbital nerve, n. supraorbitalis, - goes through the supraorbital notch, incisura supraorbitalis, - to the forehead and branches here in the skin; 2) the frontal branch, gamus frontalis, supplies the skin of the forehead medially to the previous nerve;

3) supratrochlear nerve, n. supratroch-learis, at the inner corner of the eye, emerges from under the roof of the orbit, supplies the skin with nerves upper eyelid, the root of the nose and the neighboring part of the forehead.

The lacrimal nerve runs laterally, supplying the lacrimal gland and partly the upper eyelid (its lateral part).

eyelash, or ciliary, the node (see Fig. 29 and 30) is located in the posterior third of the orbit laterally from the optic nerve and is peripheral nerve ganglion, whose cells 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.

4-6 nerve trunks depart from the ciliary node towards the eyeball - short ciliary nerves that divide on their way and enter the eyeball in the amount of 20 and contain motor, sensory and sympathetic fibers for the nerve supply to all tissues of the eyeball . Sympathetic fibers from the plexus of the internal carotid artery join the ciliary nerve trunks on their way to the eyeball, 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 - 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 a round hole and enters the pterygopalatine fossa, fossa pterygo-palatina, where it gives off the zygomatic nerve from its upper edge,

n. zygomaticus, and a little further anteriorly from its lower edge - the main palatine nerves, pp. sphenopalatini. Then it enters the infraorbital fissure, fissura orbitalis inferior, and goes under the name of the infraorbital nerve, n. infraorbitalis, in 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 splits like a fan into many terminal branches (see Fig. 29). Branches intersect with them facial nerve, n. facialis, which is why a complex plexus is formed - a small crow's foot, pes an-serinus minor.

zygomatic nerve, starting in the pterygopalatine fossa, it goes along with the infraorbital nerve through the infraorbital fissure into the cavity of the orbit and is divided there into two branches - zygomatic-facial, n. zygomaticofacialis, and zygomatic-temporal, n. zygomaticotemporalis;

both branches enter the zygomatic bone through the zygomatic-orbital foramen

stie, foramen zygomaticoorbitale. Then the zygomatic-facial nerve appears through the opening of the same name on the outer surface of the zygomatic bone (Fig. 32), and the zygomatic-temporal nerve (also through the opening of the same name) exits into temporal fossa and penetrates the temporal fascia, appearing slightly above the edge of the zygomatic arch. Both nerves branch out in the skin of their respective areas. The zygomatic-temporal nerve branches in the skin of the middle part of the temple, and the zygomatic-facial nerve branches in the skin of the cheek and the outer corner of the eye (see Fig. 32).

The main palatine nerves (see Fig. 27), usually 2-3, partly enter the main palatine ganglion sphenopalatinum ganglion, partly bypassing it, directly into its branches.

Basic palatine node(see Fig. 27, Fig. 33 and 34) is the so-called sympathetic, that is, in connection with the sympathetic nervous system, a node located in the pterygopalatine fossa slightly below the maxillary nerve. \

The nerve pathways leading to the node are its roots. These include the palatine nerves already familiar to us and, in addition, the nerve of the pterygoid canal-n._vid)