Parese of Trigeminal Nerve

8/12/2019 Parese of Trigeminal Nerve

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PARESE OF TRIGEMINAL NERVE

Oleh : Muh. Irfan Rasul

Pembimbing : Dr. Drg. Nuskah Sudjana, Sp.BM


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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


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Anatomy (sensory)

Ophtalmikus

Forehead &scalp

Eye (conj &cornea)

Nose (tip)

Meninges

frontal sinus

Mucosa nasal

Maxillaris

Upper jaw andteeth

Upper lip

cheek

Palatum

Maxillary,ethmoid &sphenoid sinus

Part meninges

Mandibularis

Lower jaw

Lower teeth tongue

Part of MAE

Meninges

Cheek mucosa


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Anatomy (motoric)

Masseter

temporalis

Median pterygoid

Lateral pterygoid

Muscle ofmastication

Tensor velli palatini

Mylohyoid

Anterior belly of digastric

Tensor tympani

Others


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Ophtalmic division


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Maxillary division


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Mandibular division


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Nucleus of Trigeminal Nerve

1. Motoric nuclei :

Medial pons

2. Mecencephalicusnuclei : lateral pons

3. Sensory nuclei :

dorsolateral pontine

tegmentum

4. Spine nuclei : medulla

spinailis, lower pons


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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 )


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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)


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Lesions affecting preganglionic trigeminal

nerve roots

Tumour ( meningioma, schwannoma,metastasis, nasopharyngeal ca )

Infection ( granulomatous, infectious ,

carcinomatous meningitis ) Trauma

Aneurysm


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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


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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.


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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


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Clinical examination

motor functions

Weakness of muscles ofmastication with inabilityto close the mouth

Bulk & power ofmasseters & pterygoids palpating as pt clinchesthe jaw

Ask pt

to protrude &retract the jaw


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Support Examinaton

Neuroimaging (CT-Scan & MRI)

Elektrophysiology (elektroencephalografi) Fluid and tissue analysis

Evaluation cerebrospinal fluid


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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


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Parese of Trigeminal Nerve