PARESE OF TRIGEMINAL NERVE

Oleh : Muh. Irfan Rasul

Pembimbing : Dr. Drg. Nuskah Sudjana, Sp.BM
Introduction
The biggest and complex nerve in cranial nerves
Opthalmicus, maxilary, and mandibulary branch
Mixed nerve : Large sensory part (portio major) &
much smaller motor part (portio minor)



SENSORIS

- NERVUS OPHTALMICUS
- NERVUS MAXILLARIS
- NERVUS MANDIBULARIS
MOTORIS

- NERVUS MANDIBULARIS
Anatomy (sensory)
Ophtalmikus
Forehead &
scalp
Eye (conj &
cornea)
Nose (tip)
Meninges
frontal sinus
Mucosa nasal

Maxillaris
Upper jaw and
teeth
Upper lip
cheek
Palatum
Maxillary,
ethmoid &
sphenoid sinus
Part meninges
Mandibularis
Lower jaw
Lower teeth
tongue
Part of MAE
Meninges
Cheek mucosa
Anatomy (motoric)
Masseter
temporalis
Median pterygoid
Lateral pterygoid
Muscle of
mastication
Tensor velli palatini
Mylohyoid
Anterior belly of digastric
Tensor tympani
Others
Ophtalmic division
Maxillary division
Mandibular division
Nucleus of Trigeminal Nerve
1. Motoric nuclei :
Medial pons
2. Mecencephalicus
nuclei : lateral pons
3. Sensory nuclei :
dorsolateral pontine
tegmentum
4. Spine nuclei : medulla
spinailis, lower pons
Sensory portion
Sensory root enters the pons course
dorsomedially & terminate within brainstem:
Nucleus of spinal tract of Vth N (Pain & temp)
Main sensory nucleus (Tactile & proprioceptive
sensation)
Mesencephalic nucleus ( propriceptive )
Motor Portion
Motor nucleus midpontine level
medial to main sensory nucleus of V th nerve , near
the floor of fourth ventricle.
Motor root : exits from motor nucleus , passes thr
substance of pons and emerges from anterolateral
aspect of pons anterior and medial to the large
sensory root.


Parese nerve trigeminal
Parese nerve trigeminal is a collective term for a
range nervous disorder that result in weakness or
immobility of nerves region.
MANDIBULAR NERVE (MOTORIC FUNCTION)
Lesions affecting preganglionic trigeminal
nerve roots
Tumour ( meningioma, schwannoma,
metastasis, nasopharyngeal ca )
Infection ( granulomatous, infectious ,
carcinomatous meningitis )
Trauma
Aneurysm

Nuclear lesions
Motor , sensory nuclei primary/met .
Tumours , AV malformations,
demyelinating, Infarction, that affect pons,
medulla and upper cervical cord.
Motor nucleus lesions of dorsal midpons
paresis, atrophy, fasiculations of muscles of
mastication
Supranuclear lesions
Lesions affecting corticobular pathway -
Contralateral trigeminal motor paresis
(deviation of jaw away from the lesion)
UMN lesions ( pseudobulbar palsy )
trigeminal motor paresis , exaggerated jaw
jerk.Mastication markedly impaired.
Clinical symptom

Trigeminal motor weakness
Deviation of jaw towards the weak side on opening
Unable to move the jaw contralaterally.
Flaccidity of floor of mouth : mylohyoid, digastric
paralysis
Difficulty in hearing high notes : paralysis of tensor
tymapani

Clinical examination
motor functions
Weakness of muscles of
mastication with inability
to close the mouth

Bulk & power of
masseters & pterygoids
palpating as pt clinches
the jaw

Ask pt to protrude &
retract the jaw


Support Examinaton
Neuroimaging (CT-Scan & MRI)
Elektrophysiology (elektroencephalografi)
Fluid and tissue analysis
Evaluation cerebrospinal fluid


Treatment
Management of parese trigeminal nerve
depend on caused or underline disease.
Sullivan, at all: medication with corticosteroid
Surgery treatment is the last choice after
conservative treatment has done