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Pain part 2a: trigeminal anatomy related to pain Tara Renton Obi Egbuniwe Dental Update 2024 42:3, 707-709.
Authors
TaraRenton
BDS, MDSc, PhD
Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London
Honorary Clinical Researcher, Department of Oral Surgery, King's College London Dental Institute, King's College Hospital London, Bessemer Road, London SE5 9RS, UK
In order to understand the underlying principles of orofacial pain it is important to understand the corresponding anatomy and mechanisms. Paper 1 of this series explains the central nervous and peripheral nervous systems relating to pain.
The trigeminal nerve is the ‘great protector’ of the most important region of our body. It is the largest sensory nerve of the body and over half of the sensory cortex is responsive to any stimulation within this system. This nerve is the main sensory system of the branchial arches and underpins the protection of the brain, sight, smell, airway, hearing and taste, underpinning our very existence. The brain reaction to pain within the trigeminal system has a significant and larger reaction to the threat of, and actual, pain compared with other sensory nerves. We are physiologically wired to run when threatened with pain in the trigeminal region and it is a ‘miracle’ that patients volunteer to sit in a dental chair and undergo dental treatment.
Clinical Relevance: This paper aims to provide the dental and medical teams with a review of the trigeminal anatomy of pain and the principles of pain assessment.
Article
The trigeminal nerve supplies general sensory supply to the face, scalp and mouth (Figure 1). A vast proportion of the sensory cortex represents the trigeminal input (over 50%).1
The trigeminal nerve, or 5th cranial nerve, was first described by Galen (200 AD) as being two separate pairs of cranial nerves, owing to its large peripheral branches. It was not until the Italian anatomist and physician Fallopius (1523–1562) discovered that these branches merged as one, that the 5th cranial nerve was created. In 1732, the Danish anatomist Jacques-Bénigne Winslow (1669–1760) ascribed the name ‘nerf trijumeau’, referring to the three peripheral branches of this nerve, and the name ‘trigeminal nerve’ was born meaning ‘three twins’. The trigeminal nerve is the largest of the cranial nerves and the largest sensory nerve. It is a mixed sensory nerve made up of both sensory and motor axons, and it plays a particularly important role in sensations of the face and head regions.
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