Maxillary Nerve

 

Maxillary Nerve


Trigeminal Ganglion

It lies in the Petrous part of temporal bone in the middle cranial fossa. It has three divisons:

1. Ophthalamic division.

2. Maxillary division.

3. Mandible division.

Trigeminal Ganglion has a sensory root going to CNS connects with three nuclei; mesencephalic nucleus, central pontine nucleus and spinal nucleus of trigeminal system. It has also a motor root connected with motor nucleus and goes along the mandibular nerve.

Proprioception fibers coming from mastication muscles divert to the mesencephalic nucleus. Fine touch fibers coming from the face and mucosal area like nose and palate come to central pontine nucleus. Pain and temperature fibers from trigeminal sensory system are connected to spinal nucleus of trigeminal system.


Origin of Maxillary Nerve and its course

Maxillary nerve takes origin from trigeminal ganglion and it moves forward in the lateral wall of cavernous sinus. It transverses through cavernous sinus and leaves middle cranial fossa through foramen rotundum and enters to pterygopalatine fossa. Formen rotundum is a communication between middle cranial fossa and pterygopalatine fossa. Pterygopalatine fossa is a pyramidal bony space below the posterior end of orbit, behind the upper and posterior part of maxilla and anterior inferior to the middle cranial fossa.

The maxillary nerve passes anteriorly through pterygopalatine fossa having very strong communication/branches going to the pterygopalatine ganglion. Then it moves to the inferior orbital fissure and enters into floor of the orbit, at this point, we can say that maxillary nerve continues as infra orbital nerve. This nerve initially passes through infra orbital groove then moves forward through infra orbital canal, leaving this canal through infra orbital foramen and here it gives branches like palpebral branches, nasal branches and superior labial branches.


Important anatomical land marks of maxillary nerve.

1. Trigeminal ganglion.

2. Lateral wall of cavernous sinus.

3. Foramen rotundum.

4. Pterygopalatine fossa.

5. Inferior orbital fissure.

6. Infra orbital groove.

7. Infra orbital canal.

8. Infra orbital foramen.


Main Branches of Maxillary nerve

1- Meningeal branch (dural branch): Before maxillary nerve exits middle cranial fossa, it gives meningeal branch supplying to meninges

2- Ganglionic branches: It gives two ganglionic branches within Pterygopalatine fossa. Maxillary nerve gives sensory input to Pterygopalatine ganglion through these branches.

3- Zygomatic nerve: Main trunk of maxillary nerve gives this branch within the Pterygopalatine fossa. This branch moving upward enters in the orbit posteriorly through inferior orbital fissure. Zygomatic nerve gives further branches:

i)Zygomatic facial nerve: cutaneous supply (touch, temperature and pain) to the prominence of the cheek.

ii)Zygomatic temporal.

iii)Communicating branch to the lacrimal nerve: responsible for secretomotor supply to lacrimal gland

4. Posterior superior alveolar nerve: Maxillary nerve gives this branch within the Pterygopalatine fossa, this branch comes out through pterygomaxillary fissure. It moves lateral and downward supplying upper molar teeth. This nerve gives further branches for mucosa of maxillary sinus.

5. Infra orbital nerve: Actually this is the continuation of maxillary branch which give further branches.

6. Middle superior alveolar nerve: This nerve is also given within the infra orbital groove. It comes down and moves laterally on the inner aspect of lateral wall of maxilla, supplying the mucosa of maxillary sinus and upper premolar teeth.

7. Anterior superior alveolar nerve: It arises within the infra orbital canal. It also moves downward supplying the mucosa of maxillary sinus and canine and incisor teeth.

Note— Superior alveolar plexus: Posterior superior alveolar nerve, middle superior alveolar nerve and anterior superior alveolar nerve are interconnected making a network that is called superior alveolar plexus.

8. Inferior palpebral branches: these branches supply the inferior lid of eye.

9. Nasal branches: these branches supply the lateral part of the nose.

10. Superior labial branches: these branches supply upper lip.


Direct branches of maxillary nerve

1. Meningeal branch (dural branch):

2. Ganglionic branches

3. Zygomatic nerve

4. Posterior superior alveolar nerve:

5. Infra orbital nerve


Branches of Infraorbital nerve

1. Middle superior alveolar nerve

2. Anterior superior alveolar nerve

3. Inferior palpebral branches

4. Nasal branches

5. Superior labial branches


Indirect branches of maxillary nerve

These are the fibers of the maxillary nerve passing through Pterygopalatine ganglion and go along with each pterygopalatine ganglionic branch to their destinations.


Input of Pterygopalatine ganglion

Pterygopalatine ganglion has following fibers which enter to pterygopalatine ganglion.

1. Sensory fibers from maxillary nerve.

2. Parasympathetic (Secretomotor fibers) from greater petrosal nerve.

3. Sympathetic fiber from deep petrosal nerve.


Branches of Pterygopalatine ganglion

These branches are also called as indirect branches of maxillary nerve because they pass through the ganglion without relaying in the ganglion and reach to their final destination along with Pterygopalatine ganglionic branches.

1. Orbital branches: Orbital branches arise from the pterygopalatine ganglion, passing through inferior orbital fissure, go upward. These branches supply to orbital periosteum, sphenoid sinus mucosa and posterior ethmoidal sinus mucosa.

2. Nasal Branches: Nasal branches arising from the pterygopalatine ganglion move medially and pass through sphenopalatine foramen. These branches spread out and go to posterior and superior part of the nose, so these branches are also called posterior superior nasal branches, which further divide into:

a. Posterior superior lateral nasal branches: These branches go to the lateral wall with conchae and meatus.

b. Posterior superior medial nasal branches: These branches go to the nasal septum. One of these medial nasal branches goes down the septum anteriorly, passes through incisive canal and eventually supplies anterior most part of palate and gums. This branch is called nasopalatine branch.

3. Greater palatine branch: This nerve arises from the pterygopalatine ganglion, coming down through a greater palatine canal and exits from the greater foramen of the canal and moves anteriorly on a groove just inferior aspect of palate. It supplies hard palate fibers of touch, pain and temperature coming from maxillary nerve and it also supplies vasomotor fibers, sympathetic and secretomotor fibers for serous and mucosal glands in the palate.

All the branches like orbital branches, nasal branches and greater palatine nerve participate in the sneezing reflex

4. Lesser palatine branch: This nerve along greater palatine nerve also descends through same canal but exits from the lesser foramen of the canal and it moves posteriorly supplying soft palate and tonsils. This is the only branch which additionally has taste fibers supplying soft palate and tonsils area.

5. Nasopharyngeal branch: This nerve arising from the pterygopalatine ganglion passes through palatovaginal canal and eventually supplies to nasopharynx and eustachian tube.

All these branches of pterygopalatine ganglion have maxillary nerve fibers (for touch, pain and temperature) giving sensation to nose, hard palate, soft palate, tonsils and nasopharynx and all the mucosas of these areas; nasal mucosa, paranasal sinuses mucosa, soft palate mucosa, hard palate mucosa and nasopharyngeal mucosa. These areas are also“ innervated by sympathetic fibers and secretomotor parasympathetic fibers.


 

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