05. The Trigeminal System
Somatic Sensation of the Face and Head
David A. Morton, Ph.D.
Thursday February 7th, 2013
Objectives:
1.Outline the two pathways for facial sensation from the head.
2.Contrast facial sensation from the head and somatic sensation from the body. In whatways are they similar? Different? Try drawing this on the Haines atlas diagram at theend of the lecture.
3.Diagram the corneal reflex: the afferent and efferent limbs as well as nuclei involved inthe brainstem.
4.If a person does not blink, how would you determine if the problem were in the sensory(afferent) limb, motor (efferent) limb, or brainstem interconnections for the cornealreflex?
5.Explain how a single, small medullary vascular lesion could abolish pain and temperaturefrom the face on the right side and pain and temperature from the body on the left side.What vessel is most likely occluded?
Peripheral Receptors and Sensation
•Structures served by trigeminal system
CN V-1
CN V-2
CN V-3
?
Great auricular nerve (C2-C3)
How many neurons in sensorypathway?
DCML/ALS
1.Peripheral ganglion (DRG)
2.Spinal cord, medulla
3.VPL nucleus of the thalamus
Trigeminal system
1.Peripheral ganglion (Trig. gang.)
2.2 nuclei in brainstem (pons, medulla, sp cord)
3.VPM nucleus of the thalamus
II. Primary Sensory Neurons:Trigeminal ganglion
CN V-1
CN V-2
CN V-3
Trigeminalganglion
Primary Sensory Neurons:Trigeminal ganglion
CN V-1
CN V-2
CN V-3
Primary sensoryneuron
Second-Order Trigeminal Neurons
Originate in two brain stem nuclei:
• Principal (chief) trigeminal nucleus
• Spinal (descending) trigeminal nucleus
Young, Young and Tolbert, 2008 Fig 11-10
Second-Order Trigeminal Neurons
A. Principal (chief) trigeminal nucleus
• Mediates fine touch, joint position,vibration.
• Located in pons lateral to motornucleus of CN V.
This would be equivalent to what nucleusof the brainstem? _____________
Young, Young and Tolbert, 2008 Fig 11-10
Second-Order Trigeminal Neurons
B. Spinal (descending) trigeminal nucleus
• Mediates pain and temperature.
• Spinal (descending) trigeminal tract
• Descends caudally as far as C2-C3and is continuous with dorsal horn.
This would be equivalent to what regionin the spinal cord? _____________
Young, Young and Tolbert, 2008 Fig 11-10
Second-Order Trigeminal Neurons
Young, Young and Tolbert, 2008 Fig 11-10
C. Ascending Trigeminal Pathways
• Axons of second-order neurons formthe trigeminothalamic pathway to theVPM nucleus of the thalamus.
a.Axons from neurons in the chief sensorynucleus carry sensations such as: _____
b.Axons from neurons in the spinaltrigeminal nucleus carry sensations suchas: ____
Secondary sensoryneuron
Secondary sensoryneuron
Second-Order Trigeminal Neurons
Young, Young and Tolbert, 2008 Fig 11-10
Secondary sensoryneuron
Secondary sensoryneuron
Project from VPM in the thalamus to the Postcentral gyrus (primary sensory cortex)
• Axons course through the internal capsule
Third-Order Trigeminal Neurons
Pons
ALS
Med lem
Chief trig nucleus
Medulla oblongata (rostral)
ALS
Med lem
Spinal trigeminal
tract & spinal trig nucleus
The right side of the pons is lesioned. What sensory loss would you expect?
L
The right side of the pons is lesioned. What sensory loss would you expect?
Below the lesion:
• Loss of facial sensation on right
• Loss of pain and temp from left side
• Loss of proprioception/vibration from left side
Self-assessment: When you think you have mastered the pathways, select 2colors in both a dark and light shade. Use the dark color for the body and thelighter color for the face pathways.
e.g.Light blue-Trigeminothalamic (ventral)
Dark blue – ALS
Pink – trigeminothalamic (dorsal) from chief
Red – DCML