60

CASE 60

A 56-year-old woman presented to her physician with the chief complaint of excruciating facial pain that comes and goes. Triggered by eating, drinking, and face washing, the pain occurs on her nose, upper cheek, upper lip, and upper teeth. The patient has lost weight since her last visit 10 months ago and is dehydrated. The physical examination was unremarkable and a magnetic resonance imaging (MRI) study of the head revealed demyelination of a cranial nerve. Based on these findings, the patient was diagnosed with cranial nerve neuralgia and was initially treated with carbamazepine, an oral anticonvulsant. When the patient developed tolerance to this medication, microvascular decompression surgery was performed.

WHICH CRANIAL NERVE IS INVOLVED IN PRODUCING THE PATIENT’S SYMPTOMS?

The patient was diagnosed with neuralgia of the trigeminal nerve, which is also known as tic douloureux. The trigeminal nerve is composed of three divisions:

• Ophthalmic (V1)
• Maxillary (V2)
• Mandibular (V3)

The specific division producing the symptoms in this scenario is the maxillary nerve, which conveys general sensory fibers. Trigeminal neuralgia frequently involves the maxillary or mandibular divisions, or both, but rarely affects the ophthalmic nerve.

WHAT ARE THE SENSORY AND MOTOR DISTRIBUTIONS OF THE TRIGEMINAL NERVE?

The motor and sensory distribution (Figs. 7-31 and 7-32) of the trigeminal nerve and its branches are described in Table 7-2.

image

FIGURE 7-31 Trigeminal nerve (CN V).

(Drake R, Vogl W and Mitchell A: Gray’s Anatomy for Students. Churchill Livingstone, 2004. Fig. 8-58)

image

FIGURE 7-32 Cutaneous distribution of the trigeminal nerve (CN V).

(Drake R, Vogl W and Mitchell A: Gray’s Anatomy for Students. Churchill Livingstone, 2004. Fig. 8-59)

TABLE 7-2 Sensory and Motor Distribution of the Trigeminal Nerve

Division Branch of Division Distribution
Ophthalmic nerve Lacrimal nerve (smallest of the main branches of the ophthalmic nerve) Sensory to lacrimal gland, adjoining conjunctiva, and upper eyelid
Ophthalmic nerve Frontal nerve (largest branch of the ophthalmic nerve)
Sensory via supratrochlear nerve to conjunctiva, skin of upper eyelid, and skin of inferior forehead near midline

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Jun 16, 2016 | Posted by in ANATOMY | Comments Off on 60

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