Trigemino Trigeminal Nerve
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Transcript of Trigemino Trigeminal Nerve
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NERVIO TRIGÉMINO NERVIO TRIGÉMINO
Dr. Pedro Aravena TorresInstituto de Anatomía, Histología y Patología
Facultad de Medicina
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Estímulo receptor sensorial centro integrador
Respuesta efector
VIA SENSITIVA TRIGEMINALVIA MOTORA TRIGEMINAL
NERVIO NERVIO TRIGÉMINOTRIGÉMINO
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DermatomaDermatomass
V1 rama oftálmicaV2 rama maxilarV3 rama mandibular
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SENSITIVOS•Núcleo mesencefálico•Núcleo sensitivo principal•Núcleo espinalMOTORES•Núcleo motor
-Distribución de neuronas sensitivas
-Neuronas pseudounipolares
-Ramos ascendentes cortos y descendentes largos
Trigémino: origen Trigémino: origen realreal
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Nervio Nervio trigémino trigémino
origen real – aparente – vías origen real – aparente – vías sensitivassensitivas
Núcleo espinal: subnúcleo oralSubnúcleo interpolarSubnúcleo caudal
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Lámina I y II: zona parvocelular - tº y dolorLámina III y IV: zona magnocelular – tacto no discriminativo
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Núcleo MesencefálicoNúcleo Mesencefálico propiocepciónpropiocepciónPropiocepción completa de la cabeza proveniente de Propiocepción completa de la cabeza proveniente de fibras motoras (husos neuromusculares)fibras motoras (husos neuromusculares)
Núcleo sensitivo principalNúcleo sensitivo principal tacto fino, discriminativotacto fino, discriminativo(ramos ascendentes cortos) 2/3 puente(ramos ascendentes cortos) 2/3 puenteTacto y presión burda (epicrítico) , propiocepción conciente, vibración, sinestesiaTacto y presión burda (epicrítico) , propiocepción conciente, vibración, sinestesia
Núcleo espinalNúcleo espinal(ramos ascendentes largos)(ramos ascendentes largos)
Subnúcleo oralSubnúcleo oral tacto fino y discriminativotacto fino y discriminativoSubnúcleo interpolarSubnúcleo interpolar dolor y tºdolor y tºSubnúcleo caudalSubnúcleo caudal dolor y tºdolor y tº
1/3 puente – bulbo – c2 a c3 médula cervical1/3 puente – bulbo – c2 a c3 médula cervical
Tacto y presión burda (protopática, propiocepción conciente), Tacto y presión burda (protopática, propiocepción conciente), termoalgesiatermoalgesia (dolor y temperatura) y (dolor y temperatura) y
aferencia dolorsa pulpar aferencia dolorsa pulpar propiocepción conciente, vibración, sinestesia + propiocepción conciente, vibración, sinestesia + 50% aferencias pulpares.50% aferencias pulpares.
Fibras AFibras Aαα y Ay Aββ →→ sensibilidad protopáticasensibilidad protopáticaFibras AFibras Aδδ – fibras tipo C – fibras tipo C →→ sensibilidad termoalgesia, epicrítica sensibilidad termoalgesia, epicrítica
Aferencias núcleos sensitivos Aferencias núcleos sensitivos principalesprincipales
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1era neurona:1era neurona: pseudounipolarpseudounipolar2da neurona:2da neurona: Núcleo sensitivo principalNúcleo sensitivo principal
Núcleo espinalNúcleo espinal3era neurona:3era neurona: conexiones de núcleos conexiones de núcleos trigeminales:trigeminales:
Haz trigémino – talámica NVPM (lemnisco trigeminal)Haz trigémino – talámica NVPM (lemnisco trigeminal)
Haz trigémino – cerebelosaHaz trigémino – cerebelosaHaz trigémino – reticularesHaz trigémino – reticularessistema reticular periacueductalsistema reticular periacueductalnúcleo talámico anteriornúcleo talámico anteriorcorteza del cíngulo (sist. límbico)corteza del cíngulo (sist. límbico)trigémino – reflejatrigémino – refleja
90% contralateral – 10% ipsilateral90% contralateral – 10% ipsilateral
Vías sensitivasVías sensitivas
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PropiocepcióPropiocepciónn::
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Reflejo Reflejo maseterinomaseterino::
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TRIGÉMINO: origen aparenteTRIGÉMINO: origen aparente
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Tentorio cerebelarIncisura trigeminalSeno petroso superiorProlongación de la duramadre
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Arteria cerebelar anterior
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TRIGÉMINO: trayecto y TRIGÉMINO: trayecto y relacionesrelaciones
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Arteria cerebelar anterior
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V1: nervio Oftálmico
TrayectoRelaciones
RAMOS•Colateral meníngea•NASOCILIAR•FRONTAL•LAGRIMAL
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V1: nervio Oftálmico
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V1: nervio Oftálmico•NASOCILIAR - colaterales ramas ganglio ciliar (sensitivos) – nv. clilares cortos
nervios ciliares largos
nervio etmoidal posterior
- terminales etmoidal anterior (nasal interno y nasolobular)
infratroclear
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V1: nervio Oftálmico•NASOCILIAR
- terminales etmoidal anterior (nasal interno y nasolobular)
infratroclear
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V1: nervio Oftálmico
•FRONTAL -terminales: supraorbitario (lateral y medial) supratroclear
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V1: nervio Oftálmico•LAGRIMAL -Ramo lateral o lagrimal, comunicación
con el nervio orbitario del nv. maxilar
-Ramo medial o palpebral
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V2: nervio maxilar
TrayectoRelaciones
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RAMOS COLATERALES (6)•Nervio recurrente meníngeo (meníngeo medio)•Nervio orbitario o cigomático: ramos lagrimales
nervio cigomático facialnervio cigomático temporal
•com. ganglio pterigopalatino•nervio pterigopalatino (por agujero efenopalatino)
- nasopalatino
- nasal posterosuperiores, superiores y medios
-nervio palatino mayor -nervios palatinos menores
•nervio palatovaginal •Ramos alveolares posterosuperiores•Ramos alveolares superior medio•Ramos alveolares superior anterior
RAMOS TERMINALES•Nervio infraorbitario (penacho infraorbitario)
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V2: nervio maxilar•Nervio recurrente meníngeo (agujero oval o espinoso)
•Nervio orbitario o cigomático ramos lagrimales (ag. cigomaticoorbitario)
•nervio cigomático facial y nervio cigomático temporal
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V2: nervio maxilar•nervio pterigopalatino (por agujero esfenopalatino)
- nervio nasopalatino - nasal superiores - nervio palatino mayor - nervios palatinos accesorios
•nervio palatovaginal (techo de rinofaringe)
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•Ramos alveolares posterosuperiores
•Ramos alveolares superior medio
•Ramos alveolares superior anterior
RAMOS TERMINALES
•Nervio infrarbitario (palpebrales, labiales y nasales)
V2: nervio maxilar
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ganglio esfenopalatinoaferencias del nervio vidiano (nv. Canal pterigoideo) (unión de nervios petrosos-superficial VII par y profundo IX par,), llevan fibras parasimpáticas a la glándula lagrimal, glándulas salivales menores de paladar y labios, mucosa nasal y seno maxilar
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TrayectoRelacionesUbicación nervio motor, desdoblamiento de la duramadre, división de dos troncos terminalesAgujero oval.
V3: nervio mandibular
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COLATERALES
•Ramo lateral (3): nervio temporomaseterino
temporal profundo medio
nervio temporobucal
•Ramo medial (3): tronco común para pterigideo medial, tensor del velo del paladar y ttensor del tímpanotímpano
•Ramas posterior: nervio auriculotemporal
TERMINALES: nervio alveolar inferior
- Nervio milohioídeo
- Nervio mentoniano
nervio lingual
V3: nervio mandibular
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Nervio mandibularCae en espacio interpterigoideo, por lateral a fascia interpterigoidea y medial al pterigoideo lateral y fascia pterigotemporomandibular.
•Ramo lateral:Los tres ramos atraviesan el agujero crutafiticobuccinatorio de Hyrtl
-nervio temporobucal (temp prof ant. y bucal)
-temporal profundo medio
-nervio temporomaseterino (temp prof post y maseterino)
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Ramo lateral:-nervio temporobucal (temp prof ant. y bucal)
-temporal profundo medio-nervio temporomaseterino (temp prof post y maseterino)
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V3: nervio mandibular
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Ramo medial:
tronco común para pterigoideo medial,tensor del velo del paladar y tensor del tímpano
(se dirigen hacia inferior cruzando la fascia interpterigoidea)
Ramas posteriores: nervio auriculotemporal
(ojal arteria meningea media, atraviesa ojal retrocondileo
Ramos inferiores: Nervio alveolar inferior
- Nervio milohioídeo - Nervio mentoniano -Nervio lingual
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Ramo medial:
tronco común para pterigoideo medial,tensor del velo del paladar y tensor del tímpano
Ramas posteriores: nervio auriculotemporal(ojal arteria meningea media, atraviesa ojal retrocondileo, comunicación con ganglio ótico)
Ramos inferiores: Nervio alveolar inferior - Nervio milohioídeo- Nervio mentoniano-Nervio lingual
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nervio lingual - nervio lingual mixto ( + nv. Cuerdas del tímpano)
Inerva mucosa arco palatogloso y tonsilas
a gland. submandibular y sublingual
Inerva región anterior de lengua
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Técnicas anestésicas
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canal palatino anterior
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canal palatino mayor
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foramen mandibularforamen mandibular
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NERVIO TRIGÉMINO NERVIO TRIGÉMINO
Dr. Pedro Aravena TorresInstituto de Anatomía, Histología y Patología
Facultad de Medicina