Maxillary Nerve

Origin, Courses & Branches

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What is Trigeminal Ganglion?

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

i) Ophthalamic Division.

ii) Maxillary Division.

iii) Mandible division.

Trigeminal Ganglion has a sensory root going to CNS connects with three nuclei; mesencephalic nucleus, central pontine nucleus, and spinal nucleus of the trigeminal system. It has also a motor root connected with the 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 areas like nose and palate come to the central pontine nucleus. Pain and temperature fibers from the trigeminal sensory system are connected to the spinal nucleus of the trigeminal system.


 Origin of Maxillary Nerve & its Course

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

The maxillary nerve passes anteriorly through the pterygopalatine fossa having very strong communication/branches going to the pterygopalatine ganglion. Then it moves to the inferior orbital fissure and enters into the floor of the orbit, at this point, we can say that the maxillary nerve continues as the infraorbital nerve. This nerve initially passes through an infraorbital groove then moves forward through the infraorbital canal, leaving this canal through the infraorbital 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 the cavernous sinus.

  • Foramen Rotundum.

  1. Pterygopalatine fossa.

  2. Inferior orbital fissure.

  3. Infraorbital groove.

  • Infraorbital canal.

  • 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 the Pterygopalatine fossa. Maxillary nerve gives sensory input to Pterygopalatine ganglion through these branches.

3- Zygomatic Nerve:

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

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

  2. ii) Zygomatic temporal.

iii) Communicating branch to the lacrimal nerve: responsible for secretomotor supply to the 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 the mucosa of the maxillary sinus.

5. Infra Orbital Nerve:

Actually, this is the continuation of the maxillary branch which gives further branches.

6. Middle Superior Alveolar Nerve:

This nerve is also given within the infraorbital groove. It comes down and moves laterally on the inner aspect of the lateral wall of the maxilla, supplying the mucosa of the maxillary sinus and upper premolar teeth.

7. Anterior Superior Alveolar Nerve:

It arises within the infraorbital canal. It also moves downward supplying the mucosa of maxillary sinus and canine and incisor teeth.

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 the eye.

9. Nasal Branches:

these branches supply the lateral part of the nose.

10. Superior Labial Branches

These branches supply the upper lip.


Direct branches of Maxillary Nerve

  1. Meningeal Branch (Dural Branch):

  2. Ganglionic Branches

  • Zygomatic Nerve

  1. Posterior Superior Alveolar Nerve:

  2. Infra Orbital Nerve


Branches of Infraorbital Nerve

  1. Middle superior alveolar nerve

  2. Anterior superior alveolar nerve

  • Inferior palpebral branches
  1. Nasal branches

  2. Superior labial branches


Indirect branches of the maxillary nerve

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


The input of Pterygopalatine ganglion

Pterygopalatine ganglion has the following fibers that enter to pterygopalatine ganglion.

  1. Sensory fibers from the maxillary nerve.

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

  • Sympathetic fiber from the deep petrosal nerve.


Branches of Pterygopalatine ganglion

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

i) Orbital Branches:

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

ii) Nasal Branches:

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

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

  2. 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 the incisive canal, and eventually supplies the anterior-most part of the palate and gums. This branch is called the nasopalatine branch.

iii) 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 the palate. It supplies hard palate fibers of touch, pain, and temperature coming from the 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.

iv) Lesser Palatine Branch:

This nerve along the greater palatine nerve also descends through the 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 the soft palate and tonsils area.

v) Nasopharyngeal Branch:

This nerve arising from the pterygopalatine ganglion passes through the palatovaginal canal and eventually supplies to the nasopharynx and Eustachian tube.

All these branches of pterygopalatine ganglion have maxillary nerve fibers (for touch, pain, and temperature) giving sensation to the 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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