Facial Pain And Sensory Loss

The fifth cranial nerve subserves facial sensation and innervates the muscles of mastication. Anatomy

The anatomical arrangement of the trigeminal central connections are complex.

Proprioceptive fibres terminate in the MESENCEPHALIC NUCLEUS Light touch fibres terminate in the

Pain and temperature fibres terminate in the NUCLEUS of the DESCENDING TRIGEMINAL TRACT Motor fibres arise from the TRIGEMINAL MOTOR

NUCLEUS

Pons

Medial lemniscus

NUCLEUS

Pons

Medial lemniscus

Longitudinal arrangement of the trigeminal nuclei (sensory paths)

The separate location of the main sensory nucleus and nucleus of the descending trigeminal tract account for dissociated sensory loss, i.e. a low pontine or medullary lesion will result in loss of pain and temperature sensation with preservation of light touch.

Trigeminal descending tract and nucleus (not to scale)

Cervical (C2)

Note the topographical arrangement of the descending nucleus. Low pontine, medullary and cervical lesions produce a --characteristic 'onion skin' distribution of pinprick and temperature loss. An ascending lesion spares the muzzle area until last.

Trigeminal descending tract and nucleus (not to scale)

Cervical (C2)

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