The organs of the oral cavity receive innervation from motor, sensory, and autonomic (sympathetic and parasympathetic) nerves. To the sensory nerves innervating the skin of the face, soft fabrics and organs of the oral cavity, jaw, include the trigeminal, glossopharyngeal, vagus nerves and branches coming from cervical plexus(greater auricular and lesser occipital nerves). In the facial area, along the branches of the trigeminal nerve, there are five autonomic nerve nodes: 1) ciliary (gangl. ciliare), 2) pterygopalatine (gangl. pterigopalatinum), 3) auricular (gangl. oticum), 4) submandibular (gangl. submandibulare), 5) sublingual (gangl. sublinguale). The ciliary ganglion is connected to the first branch of the trigeminal nerve, the pterygopalatine ganglion to the second, the auricular, submandibular and hypoglossal nerve ny nodes. Sympathetic nerves to the tissues and organs of the face come from the superior cervical sympathetic ganglion.

Trigeminal nerve(n. trigeminus) mixed. It contains motor, sensory and parasympathetic nerve fibers. The organs of the oral cavity receive sensory innervation mainly from the trigeminal nerve (Fig. 5.5). Three large branches depart from the trigeminal ganglion:

1) optic nerve, 2) maxillary nerve and 3) mandibular nerve.

Ocular nerve in (n. ophthalmicus) sensitive, does not participate in the innervation of the jaws and tissues of the oral cavity.

(n. maxillaris) sensitive, leaves the cranial cavity through round hole(foramen rotundum) into the pterygopalatine fossa (fossa pterigopalatina), where it gives off a number of branches (Fig. 5.6).

The infraorbital nerve (n. infraorbitalis) is a continuation of the maxillary nerve and gets its name after the departure from the last zygomatic and pterygopalatine nerves. From the pterygopalatine fossa through the inferior orbital fissure it enters the orbit, where it lies in the infraorbital groove (sulcus infraorbitalis) and through the infraorbital foramen (foramen infraorbitalis) it leaves the orbit, dividing into terminal branches. The superior labial branches form the "minor" crow's foot"(pes anserinus minor), innervate the areas of the skin and mucous membrane of the upper lip, lower lip, infraorbital region, wing of the nose and the skin of the nasal septum.

In the pterygopalatine fossa, the posterior superior alveolar branches (rami alveolares superiores posteriores) depart from the infraorbital nerve in an amount of 4 to 8. A minority of them are not included in the thickness bone tissue and spreads down the outer surface of the tubercle of the upper jaw towards the alveolar process. They end in the periosteum of the upper jaw, adjacent to the alveolar process, the mucous membrane of the cheek and gums on the vestibular side at the level of the large and small molars. Most of the posterior superior alveolar branches penetrate through the foramina alveolaria posteriores onto the outer surface of the upper jaw and enter its bone canaliculi. These nerves innervate the tubercle of the maxilla, the mucous membrane of the maxillary sinus, the upper molars, the mucous membrane and periosteum of the alveolar process within these teeth. The posterior superior alveolar branches take part in the formation of the posterior section of the superior dental plexus.

In the posterior part of the infraorbital groove, the middle superior alveolar branch (ramus alveolaris superior medius) departs from the infraorbital nerve. The middle superior alveolar branch is formed at the posterior edge or in the region of the posterior third of the infraorbital canal. Before entering the anterior wall of the maxilla, this nerve often divides into two more branches. The middle superior alveolar branch runs through the anterior wall of the maxilla and branches in the alveolar process. This branch takes part in the formation of the middle section of the upper dental plexus, has anastomoses with the anterior and posterior upper alveolar branches, innervates the upper small molars, the mucous membrane of the alveolar process and the gums on the vestibular side in the area of ​​these teeth. The middle superior alveolar ramus is sometimes absent, so the premolars may receive sensory nerve fibers from the superior posterior alveolar nerves.

In the anterior section of the infraorbital canal, the anterior superior alveolar branches (rami alveolares superiores anteriores), 1-3 in total, depart from the infraorbital nerve. These branches may, however, arise from the infraorbital nerve along the entire length of the infraorbital canal or groove, at the level of the infraorbital foramen. The anterior alveolar nerves can exit in the same canal (infraorbital) with the infraorbital nerve or be located in a separate bone canal. Passing through the thickness of the anterior wall of the upper jaw, medial to the middle superior alveolar branch, the anterior superior alveolar branches take part in the formation of the anterior section of the superior dental plexus. They innervate the incisors and canines, the mucous membrane and periosteum of the alveolar process and the mucous membrane of the gums on the vestibular side in the area of ​​these teeth. The nasal branch departs from the anterior superior alveolar branches to the mucous membrane of the anterior floor of the nose, which anasgomosizes with the nasopalatine nerve.

The posterior, middle and anterior superior alveolar branches, passing through the thickness of the walls of the upper jaw, anastomose with each other, form the superior dental plexus (plexus dentalis superior), which anastomoses with the same plexus of the other side. The plexus is located in the thickness of the alveolar process of the upper jaw along its entire length above the apices of the roots of the teeth, as well as in the upper parts of it in close proximity to the mucous membrane of the maxillary sinus.

A number of branches arise from the superior dental plexus:

• dental branches (rami dentales) to the dental pulp;
• periodontal and gingival branches (rami periodontales et rami gingivales), innervating the periodontium of teeth and gum tissue;
• interalveolar branches to the interalveolar septa, from where branches extend to the periodontium of the teeth and the periosteum of the jaw;
• to the mucous membrane and bone walls maxillary sinus.

Branches from the posterior section of the dental plexus branch in the area of ​​large molars, from the middle section - in the area of ​​small molars, from the anterior - in the area of ​​incisors and canines.

From the infraorbital nerve at the exit from the infraorbital foramen depart:

• the lower branches of the eyelids (rami palpebrales inferiores), which innervate the skin of the lower eyelid;
• external nasal branches (rami nasales externi), innervating the skin of the wing of the nose;
• internal nasal branches (rami nasales interni), innervating the mucous membrane of the nasal vestibule;
• superior labial branches (rami labiales superiores), innervating the skin and mucous membrane of the upper lip to the corner of the mouth.

The last 4 groups of branches have connections with the branches of the facial nerve.

In the pterygopalatine fossa, the zygomatic nerve (n. zygomaticus) departs from the maxillary nerve, which penetrates the orbit through the inferior orbital fissure and is divided into two branches - the zygomaticofacial (ramus zygomaticofacial) and the zygomaticotemporal (ramus zygomaticotemporal). These branches enter the thickness of the zygomatic bone through the zygomaticoorbital foramen, and then leave it through the corresponding openings of the same name, branching in the skin of the zygomatic region, the upper part of the cheek and the outer corner of the eye, the anterior part of the temporal and posterior part of the frontal regions. The zygomatic nerve has connections with the facial and lacrimal nerves.

In the pterygopalatine fossa, the pterygopalatine nerves (nn. pterigopalatini) depart from the lower surface of the maxillary nerve. They go to the pterygopalatine ganglion, giving sensory fibers to the nerves starting from it. A significant part of the fibers passes along the outer surface of the unit without interruption in it. The pterygopalatine ganglion (gangl. pterigo-palatinum) is a formation of the autonomic nervous system (Fig. 5.7). It receives parasympathetic fibers from the ganglion geniculi of the facial nerve in the form of the large stony nerve (n. petrosus major), sympathetic fibers from the sympathetic plexus of the internal carotid artery in the form of the deep petrosal nerve (n. petrosus profundus). Passing along the pterygoid canal, the large and deep petrosal nerves unite and form the nerve of the pterygoid canal. Branches depart from the node, including secretory (parasympathetic and sympathetic) and sensory fibers: orbital (rami orbitales), posterior superior and inferior nasal branches (rami nasales posteriores superiores, rami nasales posteriores inferiores), palatine nerves (nn. palatini). The orbital branches branch in the mucous membrane of the posterior cells of the ethmoidal labyrinth and the sphenoid sinus.

The posterior superior nasal branches (rami nasales posteriores superiores) enter the nasal cavity from the pterygopalatine fossa through the foramen sphenopalatinum and are divided into 2 groups: lateral and medial. The lateral branches (rami laterales) branch in the mucous membrane of the posterior sections of the superior and middle nasal concha and nasal passages, the posterior cells of the ethmoid sinus, the upper surface of the choanae and the pharyngeal opening of the auditory tube. The medial branches (rami mediales) branch in the mucous membrane of the upper part of the nasal septum. The largest of them - the nasopalatine nerve (p. nasopalatine) - runs between the periosteum and the mucous membrane of the nasal septum down and forward to the incisive canal, where it anastomoses with the nerve of the same name on the other side and through the incisive opening enters the hard palate (Fig. 5.8). Passing along the incisive canal, sometimes before entering it, the nerve gives a series of anastomoses to the anterior section of the upper dental plexus. The nasopalatine nerve innervates a triangular section of the mucous membrane of the hard palate in its anterior section between the canines.

The lower posterior lateral nasal branches (rami nasales posteriores inferiores laterales) enter the canalis palatinus major and exit through small openings. They penetrate the nasal cavity, innervating the mucous membranes of the inferior turbinate, lower and middle nasal passages and the maxillary sinus.

The palatine nerves (nn. palatini) go from the pterygopalatine ganglion through the canalis palatinus major and form 3 groups of nerves.

The greater palatine nerve (n. palatinus major) is the largest branch, enters the hard palate through the foramen palatinus major, where it innervates the posterior and middle sections of the mucous membrane of the hard palate (up to the canine), minor salivary glands, the mucous membrane of the gums on the palatine side, partially mucous membrane of the soft palate.

The lesser palatine nerves (nn. palatini minores) exit through the lesser palatine foramina. They branch in the mucous membrane of the soft palate and palatine tonsil. They innervate the muscle that lifts the soft palate (m. levator veli palatini). Motor fibers go from the facialis point through the petrosus major point.

(n. mandibularis) mixed (Fig. 5.9). Contains sensory and motor fibers. It exits the cranial cavity through the foramen ovale and divides into a number of branches in the infratemporal fossa. Some of the latter are associated with nodes of the autonomic nervous system: with the internal pterygoid and auriculotemporal nerves - the ear node (gangl. oticum), with the lingual nerve - the submandibular node (gangl. submandibulare). The sublingual ganglion (gangl. sublinguale) is connected to the hypoglossal nerve (n. sublingualis), a branch of the lingual nerve. From these nodes postganglionic parasympathetic secretory fibers go to the salivary glands and gustatory fibers to the taste buds of the tongue. Sensory branches make up most of the mandibular nerve. Motor fibers from the third branch of the trigeminal nerve go to the muscles that lift the mandible (muscles of mastication).

The chewing nerve (n. massetericus) is predominantly motor. Often it has a common origin with other nerves of the masticatory muscles. Having separated from the main trunk, the masticatory nerve runs outward under the superior head of the lateral pterygoid muscle, then along its outer surface. Through the notch of the lower jaw it enters the masticatory muscle, heading towards its anterior corner. Branches extend from the main trunk to muscle bundles. Before entering the muscle, the masseteric nerve gives off a thin sensory branch to the temporomandibular joint.

The anterior deep temporal nerve (n. temporalis profundus anterior), separated along with the buccal nerve, passes outward over the upper edge of the lateral pterygoid muscle. Having gone around the infratemporal crest, it lies on the outer surface of the scales of the temporal bone. Branches in the anterior section of the temporal muscle, entering it from inner surface.

The middle deep temporal nerve (n. temporalis profundus medius) is unstable. Separating posteriorly from the anterior deep temporal nerve, it passes under the crista infratemporalis to the inner surface of the temporal muscle and branches in its middle section.

The posterior deep temporal nerve (n. temporalis profundus posterior) begins posterior to the middle or anterior deep temporal nerve. Rounding the infratemporal crest, it penetrates under the lateral pterygoid muscle onto the inner surface of the posterior section of the temporal muscle, innervating it.

All deep temporal nerves separate (depart) from the outer surface of the mandibular nerve.

The lateral pterygoid nerve (n. pterigoideus lateralis) usually arises along the same trunk as the buccal nerve. Sometimes it begins independently from the outer surface of the mandibular nerve and enters the lateral pterygoid muscle from above and from its inner surface.

The medial pterygoid nerve (n. pterygoidues medians) is predominantly motor. It starts from the inner surface of the mandibular nerve, goes forward and down to the inner surface of the medial pterygoid muscle, which it enters near its upper edge. The nerve of the tensor velum palatini muscle and the nerve of the tensor tympani muscle arise from the medial pterygoid nerve.

The mylohyoid nerve (n. mylochyoideus) departs from the inferior alveolar nerve before the latter enters the foramen mandibulare, goes to the mylohyoid and digastric muscles (to the anterior abdomen).

The following sensory nerves arise from the mandibular nerve.

1. The buccal nerve (n. buccalis) is directed downward, forward and outward. Separating below the foramen ovale from the main trunk, it passes between the two heads of the lateral pterygoid muscle to the inner surface of the temporal muscle. Then, passing at the anterior edge of the coronoid process, at the level of its base it spreads along the outer surface of the buccal muscle to the corner of the mouth. It branches in the skin and mucous membrane of the cheek, in the skin of the corner of the mouth. Gives branches to the area of ​​the mucous membrane of the gums of the lower jaw (between the second small and second large molars). Has anastomoses with the facial nerve and ear ganglion. It should be remembered that there are two types of branching of the buccal nerve - scattered and main. In the first type, its innervation zone extends from the wing of the nose to the middle of the lower lip, i.e. The buccal nerve is distributed in the zone of innervation of the mental and infraorbital nerves. This nerve does not always innervate the mucous membrane of the alveolar process on the vestibular side. The buccal nerve is not located together with the lingual and lower alveolar nerves in the region of the mandibular ridge (torus mandibularis), but passes anterior to the temporal muscle in the tissue of the buccal region at a distance of 22 mm from the lingual and 27 mm from the lower alveolar nerves. This may explain the inconsistent switching off of the buccal nerve during torusal anesthesia, when the optimal amount of anesthetic (2-3 ml) is administered (P.M. Egorov).

2. The auriculotemporal nerve (n. auriculotemporalis) contains sensory and parasympathetic fibers. Separating under the foramen ovale, it runs backward along the inner surface of the lateral pterygoid muscle, then goes outward, bending around the neck of the condylar process of the mandible from behind. After this, it goes upward, penetrating through the parotid salivary gland, approaches the skin of the temporal region, branching into terminal branches.

3. The lingual nerve (n. lingualis) begins near the foramen ovale at the same level as the inferior alveolar nerve and is located between the pterygoid muscles in front of it. At the upper edge of the medial pterygoid muscle, the tympanic chord (chorda tympani) joins the lingual nerve, which contains secretory fibers going to the sublingual and submandibular nodes, and taste fibers going to the papillae of the tongue. Next, the lingual nerve is located between the inner surface of the branch of the lower jaw and the internal pterygoid muscle. In front of the anterior edge of this muscle, the lingual nerve runs above the submandibular salivary gland along the outer surface of the hyoglossus muscle, bends around the outside and below the excretory duct of the submandibular salivary gland and is woven into lateral surface language. In the mouth, the lingual nerve gives off a number of branches (branches of the isthmus of the pharynx, hypoglossal nerve, lingual branches) innervating the mucous membranes of the pharynx, sublingual region, mucous membrane of the gums of the lower jaw on the lingual side, the anterior two-thirds of the tongue, sublingual salivary gland, and papillae of the tongue.

4. Lower alveolar nerve (n. alveolaris inferior) mixed. This is the largest branch of the mandibular nerve. Its trunk lies on the inner surface of the external pterygoid muscle behind and lateral to the lingual nerve. Passes in the interpterygoid tissue space formed by the lateral pterygoid muscle on the outside and the medial pterygoid muscle, i.e. in the pterygomaxillary cellular space. Through the opening of the lower jaw (foramen mandibulae) it enters the canal of the lower jaw (canalis mandibulae). In it, the inferior alveolar nerve gives off branches, which, anastomosing among themselves, form the inferior dental plexus (plexus dentalis inferior). The lower dental and gingival branches extend from it to the teeth, the mucous membrane of the alveolar part and the gums of the lower jaw on the vestibular side. Sometimes the lower dental and gingival branches arise directly from this nerve. At the level of small molars, a large branch departs from the lower alveolar nerve - the mental nerve (n. mentalis), which exits through the mental foramen and innervates the skin and mucous membrane of the lower lip, the skin of the chin. The section of the inferior alveolar nerve, located in the thickness of the bone in the area of ​​the canine and incisors, after the departure of the mental nerve, is called the incisive branch of the inferior alveolar nerve (ramus incisivus nervi alveolaris inferioris). Innervates the canine and incisors, the mucous membrane of the alveolar part and the gums on the vestibular side in the area of ​​these teeth. Anastomoses with the branch of the same name on the opposite side in the midline area. From the lower alveolar nerve, before it enters the canal of the lower jaw, a motor branch departs - the mylohyoid nerve (n. mylochyoideus).

Maxillary nerve, n. maxillaris (see Fig. , , , , , , ), sensitive. After leaving the trigeminal ganglion and passing the cavernous sinus, the nerve leaves the cranial cavity through the foramen rotundum and enters the pterygopalatine fossa, where it divides into main branches.

Even before leaving the skull, the nerve gives off (middle) meningeal branch, r. meningeus (medius), which branches in the dura mater of the brain along with the middle meningeal artery (see Fig.,).

In the pterygopalatine fossa the following branches arise from the maxillary nerve.

1. Infraorbital nerve, n. infraorbitalis(see Fig., ), is the most powerful of all branches of the maxillary nerve, which is, as it were, its direct continuation. From the pterygopalatine fossa, the nerve enters the orbital cavity through the inferior orbital fissure, runs in the infraorbital groove and, having passed the infraorbital canal, exits through the infraorbital foramen onto the anterior surface of the face in the area of ​​the canine fossa and is divided into branches:

1) lower branches of the eyelids, rr. palpebrales inferiores, innervate the skin of the lower eyelid and the area of ​​the corner of the eye;

2) external and internal nasal branches, rr. nasales externi et interni, numerous, innervate the skin of the lateral wall of the nose along its entire length, starting from internal corner eyes, to the circumference of the opening of the nostril;

3) superior labial branches, rr. labiales superiores, are directed to the skin and mucous membrane of the upper lip, gums and wings of the nose;

4) superior alveolar nerves, nn. alveolares superiores, along the way from the infraorbital nerve they give branches to the teeth of the upper jaw:

• posterior superior alveolar branches, rr. aheolares superiores posteriores(see Fig.,), begin with 2-3 branches from the trunk of the infraorbital nerve even before it enters the lower orbital fissure, go to the tubercle of the upper jaw and, having entered the openings of the same name, pass through canals located in the thickness of the bone to the roots of the three large molars of the upper jaw;
• middle superior alveolar branch, r. alveolaris superior medius, is a fairly powerful trunk. It arises from the infraorbital nerve in the infraorbital groove. Heading down and forward, the nerve branches in the thickness of the outer wall of the maxillary sinus, anastomoses with the upper posterior and anterior alveolar nerves and approaches the small molars of the upper jaw;
• anterior superior alveolar branches, rr. aheolares superiores anteriores(see fig.), the most powerful. They arise in 1–3 branches from the infraorbital nerve almost before its exit through the infraorbital foramen. These branches pass through the anterior alveolar canals in the thickness of the anterior wall of the maxillary sinus and, heading slightly forward and downward, branch into several dental branches and the nasal branch. The first approach the incisors and canines of the upper jaw, and the second takes part in the innervation of the anterior section of the mucous membrane of the bottom of the nasal cavity.

The superior alveolar nerves connect with each other in the canaliculi of the alveolar process of the upper jaw and form superior dental plexus, plexus dentalis superior. The branches of this plexus are called the upper dental and upper gingival branches, rr. dentales et gingivales superiores, are directed to the teeth and corresponding areas of the gums of the upper jaw.

2. Nodal branches, rr. ganglionares, are represented by 2–3 short thin nerves that approach pterygopalatine ganglion(see fig.).

Some of the fibers of these nerves enter the node; others connect with branches extending from the pterygopalatine ganglion.

Branches of the pterygopalatine ganglion:

1) orbital branches, rr. orbitales;

2) medial and lateral superior posterior nasal branches, rr. nasales posteriores superiores mediales et laterales;

3) pharyngeal branch, r. pharyngeus;

4) greater palatine nerve, n. palatinus major;

5) lesser palatine nerves, nn. palatini minores(for a description of these nerves, see “Autonomic (autonomic) nervous system”).

3. Zygomatic nerve, n. zygomaticus, departs from the maxillary nerve in the region of the pterygopalatine fossa and, together with the infraorbital nerve, enters the orbit through the inferior orbital fissure, located on its outer wall. Along its course, the zygomatic nerve has a connecting branch with the lacrimal nerve (from the optic nerve), consisting of fibers extending from the pterygopalatine ganglion.

Subsequently, the zygomatic nerve enters the zygomatic orbital foramen and divides into two branches inside the zygomatic bone:

1) zygomaticofacial branch, r. zygomaticofacialis, emerges from the hole of the same name, ending in the skin of the cheek and lateral corner of the eye;

2) zygomaticotemporal branch, r. zygomaticotemporalis, also emerges from the opening of the same name and branches in the skin of the temple and lateral part of the forehead.

Both nerves are widely connected to the facial nerve by their terminal branches.

This nerve exits from the cranial cavity through the foramen rotunda into the pterygopalatine fossa, where it gives off:

· infraorbital nerve

zygomatic nerve

The infraorbital nerve exits through the inferior orbital fissure into the orbital cavity and from there through the infraorbital canal to the anterior surface of the upper jaw. In the infraorbital canal it innervates the teeth and gums of the upper jaw. On the face, it innervates the skin of the lower eyelid, nose and upper lip. The zygomatic nerve enters the orbit, innervates the lacrimal gland, then goes into the zygomatic orbital foramen of the zygomatic bone and divides into 2 branches: one enters the temporal fossa, where it innervates the skin of the temporal region and the lateral corner of the eye. The second branch enters the anterior surface of the zygomatic bone and innervates the skin of the zygomatic and buccal areas.

Mandibular nerve.

This nerve exits the cranial cavity through the foramen ovale into the infratemporal fossa. It innervates all the masticatory muscles, the tensor tympani muscle, the mylohyoid muscle, and the anterior belly of the digastric muscle.

The sensory fibers of this nerve form branches:

1. meningeal branch (returns to the cranial cavity through the foramen spinosum and innervates the dura mater)

2. buccal nerve (innervates the skin and mucous membrane of the cheeks)

3. auricular-temporal nerve (skin of the auricle, external auditory canal, eardrum, skin of the temporal region)

4. lingual nerve ( general sensitivity mucous membrane of the anterior two-thirds of the tongue and oral mucosa)

5. inferior alveolar nerve (the largest nerve of these branches; enters the mandibular canal, innervates the teeth and gums of the lower jaw, then exits through the mental foramen and innervates the skin of the chin and lower lip)

Abducens nerve.

This nerve is a motor nerve, formed by the axons of the neurons of the nucleus located in the tegmentum of the bridge. The nerve passes into the orbit through the superior orbital fissure and innervates the lateral rectus muscle of the eyeball.

Facial nerve.

It is mixed in function and includes: the facial and intermediate nerves. Its cores are located in the bridge. Both nerves exit the brain cavity side by side, enter the internal auditory canal, and merge into the facial nerve. In the facial canal, the pyramids of the temporal bone extend from the nerve:

1. greater petrosal nerve (carries fibers to the pterygopalatine ganglion, innervates the lacrimal gland, glands of the mucous membrane of the oral cavity, nose and pharynx)

2. chorda tympani (passes through the tympanic cavity and merges with the lingual nerve)

3. stapedius nerve (innervates the stapedius muscle of the tympanic cavity)

Having given off its branches in the facial canal, the facial nerve leaves it through the stylomastoid foramen. Next, it innervates the posterior belly of the supracranial muscle, the posterior auricularis, the posterior belly of the 2nd abdominal muscle and the stylohyoid muscle. The nerve then enters the parotid gland and splits into a fan-shaped form, forming a large crow's foot - the parotid plexus. It consists of motor fibers and innervates everything facial muscles and partly the neck muscles. Facial nerve paralysis - Bel's palsy (infection, hypothermia).