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Nervus

Trigeminus
(N. V)
Nervus trigeminus
 Nervus cranial terbesar
 3 cabang :
 n.optalmikus,
 n. maksilaris,
 n.mandibularis.
 Nervus trigeminus mengandung baik serabut sensoris (bagian
mayor) maupun serabut motoris (bagian minor)
 Ganglion trigeminal (gasserian)  sel-sel ganglion
pseudounipolar
 Prosesus perifernya ke reseptor raba, diskriminasi taktil, nyeri dan
suhu,
 Prosesus sentral ke nucleus prinsipalis sensorik nervus trigeminus di
batang otak (raba dan diskriminasi) dan nucleus spinalis nervus
trigeminus (nyeri dan suhu)
Ganglion
Ganglion gasserian

• Reseptor raba, tekan, deskriminasi taktil,


Prosesus nyeri dan suhu
Perifer

• Nukleus sensorik prinsipalis nervis trigemini


Prosesus • Untuk RABA & DESKRIMINASI
Sentral

• Nukleus spinalis nervis trigemini


Prosesus • Untuk NYERI & SUHU
Sentral
Tempat masuk cabang-
cabang n. trigeminus
Portio
Mayor

Portio
Minor

Lokasi : basis kranii


Percabangan Nervus Trigeminus

Divisi Sensorik Cornea, Kulit dahi, kulit kepala,


Opthalmicus kelopak mata dan hidung, juga
membrane mukosa sinus
paranasal dan cavum nasi
Divisi Sensorik Kulit wajah diatas maksila, gigi
maxillaris geligi rahang atas, membrane
mukosa hidung, sinus maksilaris
dan palatum
Divisi Motorik Otot-otot pengunyah, M.
Mandibularis mylohyoideus, M. digastikus venter
anterior, M. tensor veli palatine
dan M. tensor tympani
Sensorik Kulit pipi, kulit di atas mandibula
dan sisi kepala, gigi geligi rahang
bawah dan artikulatio
CABANG N. TRIGEMINUS

Nervus ophtalmicus •mensarafi dahi, mata, hidung, selaput otak, sinus paranasalis dan
sebagian dari selaput lendir hidung.

Nervus maxillaries •mensarafi rahang atas serta gigi-gigi rahang atas, bibir atas, pipi,
palatum durum, sinus maxillaries dan selaput lendir hidung.

Nervus •mensarafi rahang bawah, bibir bawah, mukosa pipi, lidah, sebagian
dari meatus accusticus externus, meatus accusticus internus dan
mandibularis, selaput otak
Serabut
saraf
sensorik
dan
motorik
Cabang nervus trigeminus
Nervus Opthalmikus
Nervus Maksilaris
Nervus Maksilaris
 Nervus maksilaris bercabang menjadi 14 cabang

 Parasympathetic Supply:
 Lacrimal gland: Post ganglionic fibres from the pterygopalatine
ganglion (derived from the facial nerve), travel with the zygomatic
branch of V2 and then join the lacrimal branch of V1. The fibres
supply parasympathetic innervation to the lacrimal gland.

 Nasal glands: Parasympathetic fibres are also carried to the


mucous glands of the nasal mucosa. Post-ganglionic fibres travel
with the nasopalatine and greater palatine nerves (branches of
V2)
Nervus Mandibularis

Mandibular nerve 
four terminal branches
in the infra-temporal
fossa:
• buccal nerve,
• inferior
alveolarnerve,
• auriculotemporal ne
rv
• lingual nerve.
Nervus Mandibularis
 These branches innervate the skin, mucous membrane
and striated muscle.
 Sensory supply:
 Mucous membranes and floor of the oral cavity
 External ear
 Lower lip
 Chin
 Anterior 2/3 of the tongue (only general sensation;
special taste sensation supplied by the chorda tympani,
a branch of the facial nerve)
 Lower molar, incisor and canine teeth and the
associated gingiva
 Motor Supply:
 Muscles of mastication; medial pterygoid, lateral pterygoid, masseter,
temporalis
 Anterior belly of the digastric muscle and the mylohyoid muscle
(these are suprahyoid muscles)
 Tensor veli palatini
 Tensor tympani

 Parasympathetic Supply:
 Submandibular and Sublingual glands: Post-ganglionic fibres from the
submandibular ganglion (derived from the facial nerve), travel with
the lingual nerve to innervate these glands.
 Parotid gland: Post-ganglionic fibres from the otic ganglion ganglion
(derived from the glossopharyngeal nerve, CN IX), travel with the
auriculotemporal branch of the V3 to innervate the parotid gland.
Jaras motorik nervus trigeminus
 Nukleus motorik
tepat di medial
nukleus sensorik
prinsipalis n.
trigeminus

 Saraf motorik ini


mempersarafi m.
masseter, temporalis,
pterigoideus lateral
dan medial, serta
tensor veli palatini,
tensor timpani, otot
milohioid dan venter
anterior otot
digastrikus

 Pusat kortikal (girus


presentral)  traktus
kortikonuklearis
(jaras supranuklear)
 nukleus motorik
dan otot-otot
pengunyah
(ipsilateral dan
kontralateral).
Arkus Refleks
Refleks kornea

N. optalmikus  serabut aferen 


bersinaps di nukleus sensorik prinsipalis 
nukleus nervus fasial  n. fasial  eferen
 m. orbikularis okuli
 Clinical Relevance: Corneal Reflex
 The corneal reflex is the involuntary blinking of the eyelids –
stimulated by tactile, thermal or painful stimulation of the
cornea.
 In the corneal reflex, the ophthalmic nerve acts as
the afferent limb – detecting the stimuli. The facial nerve is
the efferent limb, causing contraction of the orbicularis
oculi muscle.
 If the corneal reflex is absent, it is a sign of damage to the
trigeminal/ophthalmic nerve, or the facial nerve.
Refleks bersin

Mukosa nasal  serabut aferen 


nukleus trigeminus  serabut eferen
N. V, N. VII, N. IX, N. X.
Gangguan pada nervus
trigeminus
 Tumor pada bagian fosa posterior
 Neuralgia trigeminal atau tic douloureux
 Kelainan berupa lesi ensefalitis akut di pons.
 Gradenigo syndrome
Gasserian (trigeminal) ganglion
Trigeminal nerve
evaluation
1. Face sense – tactile, 3 branches
2. Painful nerve outputs- press 3 nerve terminals
3. Corneal reflex (n.V.- n.VII.)
4. Jawing muscles - trophy, symmetry
5. Masseter reflex (n.V.- n.V.)
Corneal reflex

• stimulus: afferent part via n.V. (touch of cornea)


• response: efferent part via n.VII. (blink)
n. V. evaluation
Trigeminal neuralgia – paroxyzmal severe pain
localized in trigeminal nerve innervation area
Herpes zoster – VZV infection of trigeminal nerve
Nervus Abducens
(N. VI)
Nervus Abducens
(Saraf Otak VI)
 Mempunyai nukleus
yang terletak pada
masing-masing sisi
garis tengah
bagian bawah
tegmentum pons
dekat medula
oblongata, tepat di
bawah dasar
ventrikel IV.
 Nervus abducens berfungsi motorik murni dan
mempersarafi musculus rectus lateralis.
 Berfungsi untuk menggerakkan bola mata ke
lateral.
 Paralisa total nervus III akan menampilkan gejala
sindroma yang terdiri dari :
 ptosis,
 fixed position, dan
 dilatasi pupil.
 Paralisa nervus IV terjadi bila pasien melihat ke
depan, jarang terjadi dan biasanya disebabkan
trauma akibat jatuh pada verteks.
 Paralisa nervus VI tampak pada penderita yang
sedang melihat ke arah depan mata yang paralisa
akan ke arah dalam atas karena predominasi
musculus obligus internus.
 Gangguan pada ketiga saraf mata (oftalmoplegia
totalis) akan menyebabkan mata tidak dapat
melirik ke semua arah, pupilnya dilatasi dan reaksi
cahaya negatif.
n. VI. lesion
Conjugate eye bulb movements, gaze
palsy
 Reflexive and voluntary eye
movements
 FLM - internuclear associative path,
Darkševič.nc., Cajali nc. - with brain
cortex, subcortical structures audio-
visual, cerebellum, vestibular
apparatus, spinal cord...

Coordinating centers of gaze:


 A) pontine - nc.paraabducens pontis
(PPRF)- reflexive involuntary bulb
movements
 B) cortical frontal - gy frontalis medius-
FEF- voluntar bulb movements
 C) cortical P-O - involuntary smooth
bulb movements
DIPLOPIA – double vision

OPHTHALMOPLEGIA (OP):
 OP interna- parasymp. muscles, mydriasis-FR loss+
loss accomodation
 OP externa - incompleta
- completa
 OP totalis= OP interna + OP ext. completa
TERIMAKASIH