3. From P. Raj. Textbook of Regional Anesthesia
a. Pterygopalatine fossa
b. Sella turcica
c. Maxillary sinus
d. Ramus of mandible
e. Hard palate
f. Base of skull
10. Supraorbital NeuralgiaSupraorbital Neuralgia
Confused with migraine,
cluster headaches, frontal
sinusitis
May be caused by trauma
(windshield, punch to face)
and may not present for many
years
Triggered by fluid retention
(perimenstrual)
Injured by poor fitting glasses
Entrapped by frowning,
squinting
May need to treat
supratrochlear as well
14. Mandibular NerveMandibular Nerve
Largest of the 3 trigeminal
branches
V3
Made up of 2 roots
A large sensory root from the
inferior edge of the trigeminal
ganglion
Small motor nerve
Supplies the myohyoid and
digastric muscles, anterior 2/3rds
of the tongue
26. Facial NerveFacial Nerve
7th
cranial nerve
Primarily motor but some
sensory fibers
Petrous temporal bone ->
the internal auditory meatus
-> stylomastoid foramen,
Through the parotid gland
Five major branches.
Though it passes through the
parotid gland, it does not
innervate the gland.
The facial nerve forms the
geniculate ganglion prior to
entering the facial canal.
28. Facial NeuralgiaFacial Neuralgia
Most common is
zygomatic
entrapment by
coronoid notch
Mimics ATN or
infraorbital neuralgia
Worse in am after
dentures have been
out all night
29. Posterior AuricularPosterior Auricular
NeuralgiaNeuralgia
Causes ear pain and
parietal headache
Triggered by
flexion/extension injuries
(esp if head turned at
impact) or blows to the
head
Pain pattern similar to
SCM (see TP section)
36. Lesser Occipital NerveLesser Occipital Nerve
Dorsal ramus of C2
and sometimes C3
Curves around and
ascends across the
posterior border of
the SCM
Considered part of
the superficial
cervical plexus
41. Greater Occipital InjectionGreater Occipital Injection
Classically taught large
volume injection at
nuchal ridge
But the entrapment is at
the base of the skull
50. Glossopharyngeal NerveGlossopharyngeal Nerve
Anatomy
Exists the skull through the jugular foramen located
posterior to the tip of the mastoid process
The nerve then passes anteriorly between the
internal jugular vein and internal carotid artery,
coursing medial to the styloid process and lateral to
the vagus and spinal accessory nerves
Supplies sensation to the posterior one-third of the
tongue, the palatine tonsils and the pharyngeal wall
88. Botulism ToxinBotulism Toxin
Two types of clinically
effective toxins
Botulism A (Botox)
Botulism B (Myobloc)
Work by blocking Ach
release (muscle paralysis)
Prevents entrapment
supraorbital, occipital, ATN
94. Radiofrequency LesionRadiofrequency Lesion
Used for facets and
enesthopathies (such
as ISL)
Creates a thermal
lesion which kills the
nerves and
potentially shrinks
the tissues
Pulsed RF
95. Occipital StimulatorOccipital Stimulator
Similar to spinal cord
stimulation
Exchanges pain for
tingling
Subq generator or
antenna
Primarily for
occipital pain, but
described for
supraorbital pain
97. If you would test the skillIf you would test the skill
of a young physician, giveof a young physician, give
him a patient with ahim a patient with a
headache to treat.headache to treat.
William Sunderman, MD
University of Michigan
1935
Notas do Editor
Usually considered a pure motor nerve, there are sensory fibers across all the branches
Usually considered a pure motor nerve, there are sensory fibers across all the branches
