Blood supply to the teeth. Lymphatic drainage from teeth

Sensitive innervation of teeth, jaw, soft tissue the oral and facial cavities are derived almost entirely from the trigeminal nerve. Some part in the transmission of painful irritations from the oral cavity, pharynx and partly the skin of the face takes n. glossopharyngeus, n. vagus and branches extending from the cervical plexus (V.F. Voino-Yasenetsky).

From the lunar node ( gangl. semilunare) there are three branches:

• 1) the orbital nerve ( n. ophthalmicus) - sensitive;
• 2) the maxillary nerve ( n. maxillaris) - sensitive;
• 3) the mandibular nerve ( n. mandibularis) - mixed (Fig. 4).

The first, sensitive, branch of the trigeminal nerve - the orbital nerve (n. ophthalmicus), - comes out of the cranial cavity into the orbit through the upper orbital fissure... Before that, it divides into three branches: the lacrimal nerve ( n. lacrimalis), frontal nerve ( n. frontalis) and a nerve. nasal ( n. nasociliaris).

The orbital nerve does not participate in the innervation of the jaws and soft tissues of the oral cavity.

The second branch of the trigeminal nerve - the maxillary nerve (n. maxillaris) - contains, like the first branch, only sensitive branches. It exits the cranial cavity through a round opening ( foramen rotundum) and goes further through the upper part of the pterygopalatine fossa ( fossa pterygopalatina) obliquely forward and outward, heading through the lower orbital fissure ( fissura orbitalis inferior) into the infraorbital groove ( sulcus infraorbitalis). In the region of this groove and infraorbital canal ( canalis infraorbitalis) the branch is already called the infraorbital nerve ( n. infraorbitalis). The infraorbital nerve, leaving the infraorbital foramen, divides into its terminal branches, branching in the region of the corresponding half of the upper lip (skin and mucous membrane), lower eyelid, wings of the nose and the cutaneous part of the nasal septum.

Even in the pterygopalatine fossa, just before the entry of the maxillary nerve into the orbit, two or three, less often four branches of the upper posterior alveolar branches ( rami alveolares superiores posteriores). They walk along the tubercle of the maxillary bone ( tuber maxillare) down and forward, pass through the holes available here into the thickness of the upper jaw and, together with other branches, take part in the formation of the posterior part of the upper dental plexus.

In the posterior part of the infraorbital groove from the infraorbital nerve passing here (the infraorbital nerve is separated by the upper middle alveolar branch ( ramus alveolaris superior medius). From here, it passes downward and forward in the bony tubule in the thickness of the outer wall of the upper jaw and takes part in the formation of the middle section of the upper dental plexus.

In the anterior part of the infraorbital canal, before the nerve reaches the anterior surface of the upper jaw, the upper anterior alveolar branches branch off from the infraorbital nerve ( rami alveolares superiores anteriores). They go down in the thickness of the anterior wall of the upper jaw and take part in the formation of the anterior part of the upper dental plexus.

The posterior, middle and anterior branches, passing through the thickness of the outer and front walls of the upper jaw, anastomose among themselves and form the upper alveolar, or dental, plexus ( plexus alveolaris s. dentalis superior), which anastomoses with the same plexus of the other side. Branches extend from the upper dental plexus to upper teeth (rami dentales superiores), to the upper gum ( rami gingivales superiores) and branches innervating the mucous membrane and bony walls of the maxillary sinus. Branches extending from the posterior part of the dental plexus branch out in the molar region, from the middle part in the bicuspid area and from the anterior part in the canine and incisor area.

In the pterygopalatine fossa from the upper part of the maxillary nerve, earlier than the alveolar branches, the zygomatic nerve departs ( n. zygomaticus), further dividing into two branches, branching in the skin of the zygomatic and partially temporal regions.

From the lower surface of the maxillary nerve, also in the pterygo-palatine fossa, the base-palatine nerves ( nn. sphenopalatinegoing down and to the main palatine node ( ganglion sphenopalatinum). A significant part of the fibers only passes along the outer surface of the node without being interrupted in it (Fig. 5).

Motor and sympathetic fibers enter the node in the form of a nerve in the pterygoid canal ( n. canalis pterygoidei). Motor fibers in the form of the upper large stony nerve ( n. petrosus superficial major) move away from the knee joint ( gangl. geniculi), facial nerve ( n. facialis), the sympathetic fibers in the form of a deep stony nerve depart from the sympathetic plexus of the internal carotid artery... Passing through the pterygoid canal, both of these nerves join to form the nerve of the pterygoid canal.

Branches extending from the palatal node: orbital nerves ( nn. orbitales), posterior nasal nerves ( nn. nasales posteriores) and palatine nerves ( nn. palatini), for the most part are a continuation of the palatal nerves extending from the maxillary nerve, only reinforced by a known number of fibers from the node itself.

Upper posterior nasal branches ( rami nasales superiores posteriores) enter the nasal cavity through the palatine opening ( foramen sphenopalatinum) and are divided into outer branches ( rami laterales), branching in the mucous membrane of the upper and middle turbinates, and internal branches ( rami mediates), innervating the mucous membrane of the posterior nasal septum. The largest of these branches is the nasopalatine nerve ( n. nasopalatine) goes along the nasal septum down and forward to the incisal canal, anastomoses in the canal with the same nerve on the other side and goes to the hard palate, innervating the mucous membrane in its anterior section (Fig. 6).

Palatine nerves ( nn. palatini) go down through the pterygopalatine canal ( canalis pterygopalatine) and palatine canals ( canales palatini) and split into three branches. The largest of them is the anterior palatine nerve ( n. palatinus anterior s. major) enters the hard palate through the anterior (large) palatine opening ( foramen palatinum majus), goes forward and innervates the glands and mucous membrane of the hard and soft palate, as well as the palatine surface of the gums. In the anterior section hard palate it anastomoses with the branches of the noeopalatine nerve. Middle palatine nerve ( n. palatinus medius) comes out through the small palatine opening ( foramen palatinum minus) and innervates the mucous membrane of the soft palate and the tonsils. Posterior palatine nerve ( n. palatinus posterior) comes out through one of the small palatine openings, goes back and innervates the mucous membrane of the posterior part of the soft palate. There are indications that the posterior palatine nerve contains motor fibers that innervate the muscle that lifts the soft palate ( m. levator veli palatine) and unpaired uvula muscle ( t. levator uvulae s. T. azygos), going from the facial nerve to the palatal node in the superior large petrosal nerve.

The third, mixed, branch of the trigeminal nerve - the mandibular nerve (n. mandibularis) contains sensory and motor fibers, leaves the cranial cavity through the foramen ovale ( foramen ovale) and is divided into anterior, smaller, mainly motor, and posterior, large, almost exclusively sensitive branches and further into a number of branches. Motor fibers from the third branch go to the masticatory muscle group ( nn. massetericus, temporales profundi, pterygoideus externus, pterygoideus internus), as well as to the maxillary-hyoid muscle and the muscle that stretches the soft palate.

The sensitive branches of the mandibular nerve are: the buccal nerve ( n.buccinatorius), ear-temporal nerve ( n. auriculotemporalis), the lower alveolar nerve ( n. alveolaris inferior), lingual nerve ( n. lingualis).

Buccal nerve (n. buccinatorius), separated from the anterior branch below the foramen ovale, goes down, forward and outward, passes between the two heads of the external pterygoid muscle or between the external and internal pterygoid muscles, then lies on the outer surface of the buccal muscle ( m. buccinator). This nerve branches in the skin and mucous membrane of the cheek and gives branches to the area of \u200b\u200bthe mucous membrane of the lower gum.

Ear-temporal nerve (n. auriculotemporalis) contains sensory fibers, as well as secretory fibers that innervate the parotid salivary gland. Moving away from n. mandibularis under the foramen ovale, the ear-temporal nerve first goes back along the inner surface of the external pterygoid muscle, then goes outward, bending around the back of the neck of the articular process lower jaw, after which it rises almost vertically upward and branches in the skin of the temporal region into the terminal trunks. In addition to the secretory branches to the parotid gland and sensitive branches to the skin of the temporal region, it gives sensitive branches to the external auditory canal, the tympanic membrane and to the skin of the auricle.

Inferior alveolar nerve (n. alveolaris inferior), mixed, the thickest branch of the mandibular nerve, passes first on the inner surface of the external pterygoid muscle, and then goes down to the mandibular opening ( foramen mandibulare), located between the internal pterygoid muscle and the branch of the lower jaw (Fig. 7).

From the lower alveolar nerve in front of its entrance into the mandibular opening, a branch departs - the maxillary-hypoglossal nerve ( n. mylohyoideus) - to the muscle of the same name and the anterior abdomen of the digastric muscle. Along the length of the mandibular canal, a number of thin branches (posterior, middle and anterior) depart from the lower alveolar nerve, forming, as in the upper jaw, the lower dental plexus ( plexus dentalis inferior), located slightly above the main trunk of the inferior alveolar nerve (see Fig. 4). A row of thin branches - lower dental branches ( rami dentales inferiores) and branches of the lower gum, innervating soft tissues from the vestibular side, covering the alveolar process of the half of the jaw ( rami gingivales inferiores), - they are already moving away from the dental plexus At the level of the small molars, from the lower alveolar nerve, a large branch - the chin nerve ( n. mentalis), innervating the skin of the chin, skin and mucous membrane of the lower lip. The section of the lower alveolar nerve, which was severely thinned after this, located in the region of the canine and incisors, is called the incisal branch of the lower alveolar nerve ( ramus incisivus nervi alveolaris inferioris). It innervates the incisors, the canine and partially the anterior surface of the alveolar process in the area of \u200b\u200bthese teeth, in the midline area it anastomoses with the nerve branches of the other side of the lower jaw.

Lingual nerve (n. lingualis), starting at the same level with the lower alveolar nerve, passes in front of it and somewhat inside along the inner surface of the external pterygoid muscle, and then, bending down and forward, is located between the internal pterygoid muscle and the branch of the lower jaw (see Fig. 7).

In front of the anterior edge of the internal pterygoid muscle, the lingual nerve runs above the submandibular salivary gland, being covered by the mucous membrane of the sublingual region, then bends around the Varton duct outside and below and branches into a series of branches innervating the anterior two-thirds of the tongue, the mucous membrane of the sublingual region and the lingual surface of the alveolar process the lower jaw, and also gives thin branches to the pharynx.

The maxillary nerve leaves the cranial cavity through a round opening ( f. rotundum) into the pterygopalatine fossa ( fossa pterygopalatina) where gives a number of branches:

Branch	Topography	Innervation zone
Infraorbital nerve (n. Infraorbitalis)	It begins in the pterygopalatine fossa after opening from the maxillary nerve of the zygomatic and pterygopalatine nerves, leaves the infraorbital foramen and branches into the terminal branches, forming a small crow's feet.	The area of \u200b\u200binnervation of the posterior, middle and anterior upper alveolar branches, the lesser crow's feet.
Lesser crow's feet: lower secular branches, external nasal branches, internal nasal branches, upper labial branches	The terminal branches of the infraorbital nerve branch in the area of \u200b\u200bthe skin and mucous membrane of the upper lip, lower eyelid, infraorbital region, wing of the nose and the cutaneous part of the nasal septum.	The skin of the lower eyelid and infraorbital region of the wing of the nose and the skin part of the nasal septum, the mucous membrane of the vestibule of the nose., The skin and mucous membrane of the upper lip to the corner of the mouth.
Posterior superior alveolar branches ( rami alveolaris superiores posteriores)	They move away from the infraorbital nerve in the pterygopalatine fossa. A smaller part of them spreads along the outer surface of the tubercle and ends in the periosteum of the upper jaw, adjacent to the alveolar process, the mucous membrane of the cheek and gums from the vestibular side at the level of molars and premolars. Most of the posterior superior alveolar branches through foramina alveolaris penetrates into canalis alveolaris, from which they exit to the outer surface of the upper jaw and enter its bone canals.	The tubercle of the upper jaw, the mucous membrane of the maxillary sinus, the upper molars, the mucous membrane and periosteum of the alveolar process in the redistribution of these teeth.
Middle superior alveolar branch (ramus alveolaris superiores medius)	They depart from the infraorbital nerve in the pterygo-palatine fossa or in the posterior part of the infraorbital sulcus. It passes through the thickness of the anterior wall of the upper jaw and branches in the alveolar process. Has anastomoses with the anterior and posterior superior alveolar branches.	It innervates the upper premolars, the mucous membrane of the alveolar ridge and the gums from the vestibular side in the area of \u200b\u200bthese teeth.
Anterior upper alveolar branches (rami alveolaris superiores anteriores)	They move away from the infraorbital nerve in the anterior part of the infraorbital canal, but can occur throughout the infraorbital canal or groove, at the level of the infraorbital foramen and even after the main trunk leaves it. These branches can exit through the infraorbital foramen or in a separate bone canal. From the anterior superior alveolar branches, the nasal branch departs to the mucous membrane of the anterior fundus of the nose.	Incisors and canines, the mucous membrane and periosteum of the alveolar process and the gingival silica from the vestibular side in the area of \u200b\u200bthese teeth.
Zygomatic nerve ( n zygomaticus)	Departs in the pterygopalatine fossa from the maxillary nerve. Penetrates into the orbital through the lower orbital fissure, where it is divided into two branches - zygomatic-facial ( ramus zygomaticofacialis) and zygomatic ( ramus zygomaticoorbitale). These branches enter the thickness of the zygomatic bone through foramen zygomaticoorbitale, and then through the holes of the same name they leave it, branching into the skin of the zygomatic region, the upper part of the cheek and the outer corner of the palpebral fissure, the anterior temporal and posterior part of the frontal region.	The skin of the zygomatic region, the upper cheek and the outer corner of the eye, the anterior temporal and lateral regions of the frontal region.
Nasopalatine nerve (n. Nasopalatinus)	Departs from the pterygopalatine node. It goes between the periosteum and the mucous membrane of the nasal septum down and forward to the incisal canal, where it anastomoses with the nerve of the same name on the opposite side and through the incisal opening it goes to the hard palate. In the incisal canal, sometimes before entering it, the nerve gives several anastomoses to the anterior portion of the superior dental plexus.	A triangular area of \u200b\u200bthe mucous membrane of the hard palate in its anterior part between the canines (from the middle of the canine to the middle of the canine)
Great palatine nerve ( n. palatinus major)	It departs from the pterygopalatine node, goes to the hard palate through foramen palatinus major	The posterior and middle sections of the mucous membrane of the hard palate to the middle of the canine and the small salivary glands, the mucous membrane of the gums from the palatine side, partially the mucous membrane of the soft palate.
Small palatine nerves ( nn. palatine minor)	They move away from the pterygopalatine node, go out through the palatine openings and branch in the mucosa of the soft palate and palatine tonsil	The mucous membrane of the soft palate, palatine tonsils, the muscle lifting the soft palate, the muscle of the uvula
Lower posterior lateral nasal branches ( rami nasals posteriores inferiors laterales)	Move away from the pterygopalatine node, enter canalis palatinus major leave it through small holes, then penetrate into the nasal cavity	The mucous membrane of the inferior turbinate, the mucous membrane of the lower and middle nasal passage and the maxillary sinus.

1 - pes anserinus minor; 2 - rr. labiales superiores; 3 - rr. nasales externi; 4 - rr. palpebrales inferiores: 5 - for. infraorbitales; 6 - n. infraorbitalis iv. 7 - n. zygomaticofacialis: 8 - for zygomaticofaciale; 9 - n. zygomaticotemporal; 10 - for. zygomaticotemporale; 11 - for zygomaticoorbitale; 12 - n. lacrimalis; 13 - r. communicans cum n. lacrimalis; 14 - fissura orbitalis inferior; 15 - n. zygomaticus; 16 - nn. pterygopalatine 17 - for. rotundum; 18 - r. meningeus medius; 19 - gangl. pterygopalatinum; 20 - nn. palatini; 21 - nn. nasales posteriores; 22 - rr. orbitales; 23 - rr. alveolares superiores posteriores; 24 - rr. alveolares superior medius et anteriores; 25 - pl. dentalis superior; 26 - rr. den tales superiores.

Methods of anesthesia in the upper jaw:

• Blockade of the superior posterior alveolar nerve - tuberal anesthesia;
• Bocade of the infraorbital, upper anterior alveolar and upper middle alveolar nerves - infraorbital (infraorbital) anesthesia:
• Intraoral method;
• Extraoral method.
• Big palatine nerve block - palatal anesthesia;
• Nasopalatine nerve block - incisor anesthesia:
• Intraoral method;
• Extraoral method.

Tuberal anesthesia:

The patient's mouth is half-open, the cheek is removed with a mirror. The needle is placed at 45 ° to the crest of the alveolar process. The needle is injected at the level of the second molar, 5 mm away from the transitional fold (in the absence of lateral teeth, the injection is made behind the zygomatic-alveolar ridge) - (Fig. 1). The needle is advanced upward, backward and inward to a depth of 2.5 cm without losing contact with the bone. At the point reached, anesthetic is injected, thereby turning off the upper posterior alveolar branches.

Blood supply to the teeth of the upper jaw.

Anterior superior alveolar arteries (from the infraorbital artery) - for the frontal group of teeth.

Posterior superior alveolar arteries (from the maxillary artery) - for the lateral group of teeth

Dental branches - to the teeth.

Gingival branches - to the gums.

Interalveolar branches - to the walls of the alveoli.

Blood supply to the teeth of the lower jaw.

Inferior alveolar artery (from the maxillary artery).

Dental branches - to the teeth.

Interalveolar branches - to the walls of the alveoli and to the gums.

Outflow of blood - veins of the same name into the pterygoid venous plexus.

Innervation of the teeth.

It is carried out by sensitive fibers of the trigeminal nerve and sympathetic fibers extending from the upper cervical node of the sympathetic trunk.

Innervation of the teeth of the upper jaw.

Superior alveolar nerves (from the infraorbital nerve (a branch of the maxillary nerve)).

Incisors and canines are anterior branches.

Premolars are middle branches.

Molars are posterior branches.

Dental plexus.

The upper dental branches are to the teeth.

The upper gingival branches - to the gums and walls of the alveoli.

Innervation of the teeth of the lower jaw.

Inferior alveolar nerve.

Lower dental plexus.

Lower dental branches - to the teeth.

Lower gingival branches - to the gums and alveolar walls.

Tooth \u003e\u003e dentoalveolar segment \u003e\u003e dental arch \u003e\u003e dentoalveolar system \u003e\u003e chewing and speech apparatus.

A tooth is an organ.

Characteristic shape and structure.

A certain position in the dentition.

Constructed from special fabrics.

Has its own nervous apparatus, circulatory and lymphatic vessels.

Tooth functions:

Located in the alveoli of the jaws;

Mechanical processing of food (biting, crushing, crushing and rubbing);

Articulation;

Aesthetic function;

Phylogenetically, human teeth belong to:

To the diphyodontic type (one change of teeth).

To a heterodont (different in shape) system;

To the thecodont (reinforced in the cells of the jaws) system;

Anatomical structure of the tooth.

Crown of the tooth;

Tooth neck;

Tooth root;

Tooth root apex;

Tooth cavity, cavitas dentis (crown cavity and root canal);

Top hole;

The bottom of the crown cavity;

The arch of the crown cavity.

Tooth tissue structure.

Dentin is the main supporting tissue of the tooth.

Enamel is the most durable tissue of the human body.

Cement is similar in composition to bone.

Tooth pulp - consists of connective tissue (pre-collagen and collagen fibers), cellular elements (odontoblasts, fibroblasts, histiocytes, etc.), vessels and nerves.

Periodontium - a complex of tissues, including collagen fibers, collected in bundles, between which are the main substance of connective tissue, cellular elements (fibroblasts, histiocytes, osteoblasts, osteoclasts, etc.), nerve fibers, blood and lymphatic vessels, located between the wall of the alveoli and cement root.

Tooth crown surfaces.

The surface of the teeth facing towards the vestibule of the oral cavity is the vestibular surface. In the incisors and canines - labial, in premolars and molars - buccal.

The surface of the teeth facing the oral cavity is lingual or oral. The teeth of the upper jaw are palatal, the teeth of the lower jaw are lingual.

The surface of the tooth facing the teeth of the opposite jaw is called the occlusion surface in premolars and molars, facies occlusalis, or chewing, facies masticatorica. In the incisors of the upper and lower jaw, the vestibular and lingual surfaces converge, form an incisal edge, margo incisalis, in the canines, a cutting tubercle, tuber incisalis.

The adjoining surfaces of adjacent teeth are contact surfaces. The group of the anterior teeth has the medial and distal surfaces, while the premolars and molars have the anterior and posterior surfaces.

Tooth norm - the position of the tooth, established during the study.

When describing and examining teeth, the terms are used:

vestibular rate, chewing rate, medial rate, lingual rate.

ANATOMICAL FEATURES OF THE STRUCTURE AND INERVATION OF THE MAXILLOFACIAL REGION. GENERAL AND LOCAL ANALYSIS IN DENTAL. Innervation of teeth and jaws. General anesthesia. Local anesthesia. Anesthetics used for local anesthesia. Anesthesia instruments.

Most dental procedures are accompanied by a painful reaction. It is no coincidence that anesthesia was first used in dentistry. Modern dentistry provides for the use of anesthesia when performing any dental intervention.

Distinguish between general (anesthesia, neuroleptanalgesia) and local anesthesia. A combination of them is possible. For the correct implementation of anesthesia, it is first of all necessary to know the features of the anatomical structure and innervation of the maxillofacial region.

Innervation of teeth and jaws

The innervation of the teeth and jaws is carried out by motor and sensory nerves.

Sensory nerves: trigeminal, glossopharyngeal, vagus and nerves coming from the cervical plexus (auricular and small occipital) - innervate the skin of the face, soft tissues and organs of the oral cavity, jaw. (SL Sineln T3, S. 143, fig. 819) In the area of \u200b\u200bthe face along the branches of the trigeminal nerve, there are five vegetative nodes: 1) ciliary (gangl. Ciliare); 2) pterygopalatine (gangl. Pterigopalatinum); 3) ear (gangl.oticum); 4) submandibular (gangl. Submandibulare); 5) sublingual (gangl. Sublinguale). The ciliary node is connected with the first branch of the trigeminal nerve, with the second - the pterygopalatine, with the third - the ear, submandibular and sublingual vegetative nodes.

Sympathetic nerves to the tissues and organs of the face go from the upper cervical sympathetic node.

(SL Sineln. T3, S. 135, Fig. 812) The trigeminal nerve (item trigeminus) is mixed. It contains motor, sensory and parasympathetic secretory nerve fibers. The branches of this nerve are mainly responsible for the sensory innervation of the organs and tissues of the oral cavity. 3 branches depart from the trigeminal node: 1) the optic nerve (item ophtalmicus), sensitive; does not take part in the innervation of the jaws and tissues of the oral cavity; 2) maxillary (n. Maxillaris); 3) mandibular (n. Mandibularis).

The maxillary nerve is sensitive, leaves the cavity of the Skull through a round hole (foramen rotundum) and head to the pterygopalatine fossa (fossa pterigopalatinum), where it gives off several branches: infraorbital nerve (item infraorbitalis), posterior superior alveolar branches (rr.alveolores), superiores posteri , middle alveolar branch (r. alveolaris superior medius), anterior upper alveolar branches (rr.alveolares). In addition, the zygomatic nerve (item zygomaticus), pterygopalatine nerves (nn. Pterigopalatini) and palatine nerves (nn. Palatine) depart from the maxillary nerve. Let's consider the anatomical and topographic features of each of them in more detail.

The infraorbital nerve (item infraorbitalis) is a continuation of the maxillary nerve. From the pterygopalatine fossa through the lower orbital fissure, it enters the orbit, where it lies in the infraorbital sulcus (sulcus infraorbitalis), and through the infraorbital opening (foramen infraorbitalis) leaves the orbit. Then it divides into terminal branches, forming a small crow's foot (pes anserinus minor), which branches in the area of \u200b\u200bthe skin and mucous membrane of the upper lip, lower eyelid, infraorbital region, wing of the nose and the cutaneous part of the nasal septum. In the pterygopalatine fossa from the infraorbital nerve, the posterior upper alveolar branches (rr. Alveolares superiores posteriores) in an amount from 4 to 8. A smaller part of them does not enter the thickness of the bone tissue, but spreads down the outer surface of the tubercle of the upper jaw towards the alveolar process ... Branches end in the periosteum of the upper jaw, adjacent to the alveolar process, in the mucous membrane of the cheek and gums from the vestibular side at the level of the molars and premolars of the upper jaw. Most of the posterior upper alveolar branches enter through the holes on the surface of the maxillary tuberosity into the bony canals of the upper jaw, taking part in the formation of the posterior part of the upper dental plexus. These nerves innervate the tubercle of the upper jaw, the mucous membrane of the maxillary sinus, the molars of the upper jaw, the mucous membrane and the periosteum of the alveolar process in the region of these teeth from the vestibular side. The posterior upper alveolar branches take part in the formation of the posterior part of the upper dental plexus.

In the pterygopalatine fossa, less often in the posterior part of the infraorbital sulcus, the middle upper alveolar branch (r. Alveolaris superior medius) departs from the infraorbital nerve. It passes through the thickness of the anterior wall of the upper jaw and branches into the alveolar process. This branch takes part in the formation of the middle section of the upper dental plexus, has anastomoses with the anterior and posterior upper alveolar branches. The middle upper dental plexus innervates bone tissue the anterior wall of the upper jaw, the alveolar ridge, the premolars of the upper jaw, the mucous membrane of the alveolar ridge and the gums from the vestibular side in the area of \u200b\u200bthese teeth.

In the anterior part of the infraorbital canal, the anterior upper alveolar branches (alveolares superiores anteriores) - 1-3 trunks depart from the infraorbital nerve. These branches form the anterior portion of the superior dental plexus. They innervate the incisors and canines, the mucous membrane and periosteum of the alveolar process, the mucous membrane of the gums from the vestibular side in the area of \u200b\u200bthese teeth. From the anterior alveolar branches, the nasal branch departs to the mucous membrane of the anterior fundus of the nose, which anastomoses with the nasopalatine nerve. The posterior, middle and anterior upper alveolar branches, passing in the thickness of the walls of the upper jaw, anastomosing with each other, form the upper dental plexus (plexus dentalis superior). It anastomoses with the same plexus on the other side. The plexus is located in the thickness of the alveolar process of the upper jaw along its entire length above the tops of the roots of the teeth and near the mucous membrane of the maxillary sinus.

A number of branches depart from the upper dental plexus: a) dental (rr. Dentales) to the pulp of the teeth; b) periodontal and gingival (years periodontales et gingivales), innervating the periodontium and gum tissue; c) interalveolar, going to the interalveolar partitions, from which branches branch off to the periodontium of the teeth and the periosteum of the jaw; d) to the mucous membrane and bony walls of the maxillary sinus. The lower branches of the eyelids (palpebrales inferiores), which innervate the skin of the lower eyelid, extend from the infraorbital nerve upon its exit from the infraorbital foramen; external nasal branches (rr. nasales externi); internal nasal branches (rr. nasales interni), innervating the mucous membrane of the vestibule of the mouth; upper lip branches (rr. labiales superiores), innervating the skin and mucous membrane of the upper lip to the corner of the mouth. These branches have connections with the branches of the facial nerve.

In the pterygopalatine fossa, the zygomatic nerve (n. Zygomaticus) departs from the maxillary nerve, which penetrates into the orbit through the lower orbital fissure, where it divides into 2 branches - the zygomaticofacial (zigomaticofacialis) and the zygomaticotemporalis (zigomaticotemporalis). These branches enter the thickness of the zygomatic bone through the zygomatic foramen (foramen zigomaticoorbitale), and then leave it, branching into the skin of the zygomatic region, the upper part of the cheek and the outer corner of the palpebral fissure, the anterior temporal and posterior part of the frontal regions. The zygomatic nerve has a connection with the facial and lacrimal nerves.

From the lower surface of the maxillary nerve in the pterygopalatine fossa, the pterygopalatine nerves (nn. Pterigopalatini) depart. They go to the pterygopalatine ganglion, transmitting sensory fibers to the nerves starting from it. Pterygopalatine ganglion (gang.terigopalatinum) is the formation of a vegetative nervous system... He receives parasympathetic fibers from the knot of the knee (gang, geniculi) of the facial nerve in the form of a large stony nerve (item petrosus major). The node receives sympathetic fibers from the sympathetic plexus of the internal carotid artery in the form of a deep stony nerve (item petrosus profundus). Passing through the pterygopalatine canal, the large and deep stony nerves join and form the nerve of the pterygoid canal. Branches depart from the node, including secretory (parasympathetic, sympathetic) and sensory fibers: orbital (rr. Orbitales), upper and lower posterior nasal branches (rr. Nasales posteriores superiores et inferiores), palatine nerves. The orbital branches branch in the mucous membrane of the posterior cells of the ethmoid labyrinth and the sphenoid sinus.

The upper posterior nasal branches (rr.nasales posteriores superiores) enter the nasal cavity from the pterygopalatine fossa through the foramen sphenopalatinum and are divided into 2 groups - lateral and medial. Lateral branches branch in the mucous membrane of the posterior portions of the superior and middle turbinates and nasal passages, posterior cells of the ethmoid sinus, the superior surface of the choanas and the pharyngeal foramen auditory tube... The medial branches branch into the mucous membrane of the nasal septum. The largest of them - the nasopalatine nerve (n. Nasopalatinus) - goes between the periosteum and the mucous membrane of the nasal septum down and forward to the incisal canal, where it anastomoses with the nerve of the same name on the other side and through the incisal opening goes to the hard palate. Passing along the incisal canal, sometimes before entering it, the nerve gives a series of anastomoses to the anterior part of the dental plexus. The nasopalatine nerve innervates the anterior mucous membrane of the hard palate of a triangular shape from canine to canine.

The lower posterior lateral nasal branches (rr.nasales poteriores inferiores laterales) enter the large palatal canal (canalis palatinus major) and leave it through small openings. They penetrate into the nasal cavity, innervating the mucous membrane of the inferior turbinate, the inferior and middle nasal passages, and the maxillary sinus. Motor fibers run from the facial nerve through the petrosal major nerve.

Palatine nerves (nn. Palatini) go from the pterygopalatine node through the greater palatine canal. These include the great palatine nerve and the lesser palatine nerves.

The large palatine nerve (n. Palatinus major) is the largest branch, extends to the hard palate through the large palatine opening, where it innervates the posterior and middle sections of the mucous membrane of the hard palate (up to the canine), small salivary glands, the mucous membrane of the gums from the palatal side, partially the mucous membrane of the soft palate.

Small palatine nerves (nn. Palatini minores) leave through the small palatine openings. They branch out in the mucous membrane of the soft palate, palatine tonsil. In addition, they innervate the muscle that lifts the soft palate and the muscle of the uvula (m. Levator veli palatini, m. Uvulae).

The mandibular nerve (n. Mandibularis) - the third branch of the trigeminal nerve - mixed. (SL Sineln. T3, p. 141, fig. 816) It contains sensory and motor fibers, leaves the cranial cavity through the foramen ovale and branches into a number of branches in the infratemporal fossa. With some of its branches, nodes of the autonomic nervous system are associated: with the internal pterygoid nerve and the ear-temporal - the ear node (gangl. Oticum), with the lingual nerve - the submandibular (gangl. Submandibulare); with the hypoglossal nerve (item sublingualis), the branch of the lingual nerve is associated with the sublingual node (gangl. sublingualis). From these nodes, postganglionic parasympathetic secretory fibers go to the salivary glands and taste fibers to the taste buds of the tongue. The sensory nerves make up the majority of the mandibular nerve. Motor fibers from the third branch of the trigeminal nerve go to the muscles that raise the lower jaw (masticatory muscles).

The chewing nerve (item massetericus) is predominantly motor, often it has a common origin with other nerves of the masticatory muscles. Having separated from the main trunk, the masseter nerve goes outward under the upper head of the lateral pterygoid muscle, then along its outer surface and through the notch of the lower jaw it enters the masseter muscle. Branches extend from the main trunk to the muscle bundles. Before entering the muscle, the masticatory nerve gives off a thin sensitive branch to the temporomandibular joint.

To other groups of masticatory muscles, motor nerves of the same name extend from the main trunk. The temporal muscle is innervated by deep temporal nerves (nn. Temporales profundi), the lateral and medial pterygoid muscles are innervated by the same nerves (nn. Pterigoidei lateralis et medialis). The jaw-hypoglossal muscle and the anterior abdomen of the digastric muscle are innervated by the jaw-hypoglossal nerve (item mylochyoideus).

The following sensory nerves branch off from the mandibular nerve. The buccal nerve (item buccalis) goes down, forward and outward. Having separated below the foramen ovale from the main trunk, it passes between the two heads of the lateral pterygoid muscle to the inner surface of the temporal muscle, then, passing at the anterior edge of the coronoid process, at the level of its base it branches along the outer surface of the buccal muscle to the corner of the mouth, in the skin and mucous membrane of the cheek , in the skin of the corner of the mouth. The nerve gives off branches to the area of \u200b\u200bthe mucous membrane of the gums of the lower jaw (between the second small and second large molars). Has anastomoses with the facial nerve and ear node.

The auriculotemporal nerve (item auriculotemporalis) contains sensitive and prasympathetic secretory fibers. Having separated under the oval opening, it goes back along the inner surface of the lateral pterygoid muscle, then goes outward, bending around the back of the neck of the condylar process of the lower jaw. Then it goes up, penetrating through the parotid salivary gland, approaches the skin of the temporal region, branching into terminal branches.

The lingual nerve (item lingualis) begins near the foramen ovale at the same level as the inferior alveolar nerve. Located between the pterygoid muscles. At the upper edge of the medial pterygoid muscle, a tympanic string (chorda tympani) is attached to the lingual nerve, which contains secretory and taste fibers. Further, the lingual nerve passes between the inner surface of the lower jaw and the medial pterygoid muscle, then over the submandibular salivary gland, bending around the excretory duct of this gland outside and below, and is woven into the lateral surface of the tongue. In the oral cavity, the lingual nerve gives off a number of branches: branches of the throat isthmus, hypoglossal nerve, lingual branches. The lingual nerve innervates the mucous membranes of the pharynx, the sublingual region, the lower jaw from the lingual side, the anterior 2/3 of the tongue, the sublingual salivary gland and papillae of the tongue.

The lower alveolar nerve (item alveolaris inferior) is mixed, is the largest branch of the mandibular nerve. Its trunk lies on the inner surface of the external pterygoid muscle behind and lateral to the lingual nerve. It takes place in the pterygo-jaw cellular tissue space formed by the lateral and medial pterygoid muscles. Through the mandibular foramen (foramen mandibulare), the nerve enters the mandibular canal (canalis mandibularis) and gives off branches, which, anastomosing with each other, form the lower dental plexus (plexus dentalis inferior), located slightly above the main trunk. The lower dental and gingival branches extend from it to the teeth, the mucous membrane of the alveolar part and the gums of the lower jaw from the vestibular side. At the level of the small molars, a large branch departs from the lower alveolar nerve - the chin nerve (item mentalis), which exits through the chin foramen and innervates the skin and mucous membrane of the lower lip, the skin of the chin. The area of \u200b\u200bthe lower alveolar nerve, located in the thickness of the bone in the area of \u200b\u200bthe canine and incisors, after the chin nerve departs, is called the incisal branch of the lower alveolar nerve (r. Incisivus n. Alveolaris inferioris). The incisor branch innervates the canine and incisors, the mucous membrane of the alveolar part and the gums from the vestibular side in the area of \u200b\u200bthese teeth. It anastomoses with the branch of the same name on the opposite side in the midline region. From the lower alveolar nerve, before entering the mandibular canal, a motor branch departs - the maxillary-hypoglossal nerve (item mylohyoideus), which innervates the muscle of the same name.

The maxillofacial region receives innervation from motor, sensory and autonomic (sympathetic, parasympathetic) nerves. Of the twelve pairs of cranial nerves, the fifth (trigeminal), seventh (facial), ninth (lingopharyngeal), tenth (vagus) and twelfth (sublingual) pairs are involved in the innervation of the maxillofacial region. The sense of taste is associated with the first pair - the olfactory nerve.

Sensory nerves include the trigeminal, glossopharyngeal, vagus nerves, and branches extending from the cervical plexus (the greater auricular nerve and the small occipital nerve). Nerve fibers go from the motor nuclei (located in the brain stem) to the masseter muscles (trigeminal nerve), to the facial muscles (facial nerve), to the muscles of the palate and pharynx (vagus nerve), to the muscles of the tongue (hypoglossal nerve).

The following vegetative ganglia are located along the branches of the trigeminal nerve:

1) ciliary;
2) pterygopalatine;
3) submandibular;
4) sublingual;
5) ear.

The ciliary node is connected with the first branch of the trigeminal nerve, with the second - the pterygopalatine, and with the third - the submandibular, hyoid and ear ganglia.

Sympathetic nerves to the tissues and organs of the face go from the upper cervical sympathetic node.

Trigeminal nerve (fig. 1) is mixed. Sensory nerve fibers carry information about pain, tactile and temperature sensitivity from the skin of the face, mucous membranes of the nasal cavities and mouth, as well as impulses from the mechanoreceptors of the chewing muscles, teeth, temporomandibular joints. Motor fibers innervate the following muscles: chewing, temporal, pterygoid, maxillary-hyoid, anterior abdomen of the digastric muscle, as well as the muscle that strains the eardrum and lifts the palatine curtain. Three sensory nerves branch off from the trigeminal node: the orbital, maxillary and mandibular. Motor fibers that do not participate in the formation of the trigeminal (Gasser) node join the mandibular nerve and make it a mixed (sensory and motor) nerve.

Orbital nerve is the first branch of the trigeminal nerve. It passes along with the oculomotor and blocky nerves in the thickness of the outer wall of the cavernous (cavernous) sinus and enters the orbit through the superior orbital fissure. Before entering this cleft, the nerve is divided into three branches: frontal, nasal and lacrimal.

Frontal nerve in its middle part, it is divided into the supraorbital (branches in the skin of the forehead), supra-block (comes out at the inner corner of the eye and goes to the skin of the upper eyelid, the root of the nose and the lower medial part of the frontal region) and the frontal branch (innervates the skin of the medial half of the forehead).

Nasal nerve enters the orbit together with the optic nerve and the ophthalmic artery through the common tendon ring. Its branches are the long and short ciliary nerves, which go to the eyeball from the ciliary node, as well as the anterior ethmoid nerve (innervates the mucous membrane of the anterior part of the lateral wall of the nasal cavity, the skin of the apex and wings of the nose) and the posterior ethmoid nerve (to the mucous membrane of the sphenoid and the posterior wall of the ethmoid sinus).

Lacrimal nerve approaching the lacrimal gland is divided into upper and lower branches. The latter at the outer wall of the orbit anastomoses with the zygomatic nerve coming from the maxillary branch of the trigeminal nerve. It innervates the lacrimal gland, conjunctiva, the outer corner of the eye and the outer part of the upper eyelid.

Maxillary nerve - the second sensitive branch of the trigeminal nerve. It leaves the cranial cavity through a round opening and enters the pterygopalatine fossa. In the latter, the maxillary nerve is divided into the zygomatic, infraorbital, and branches heading towards the pterygopalatine node.

Zygomatic nerve enters the orbit through the lower orbital fissure and is divided in the zygomatic canal into the zygomatic and zygomatic branches, which exit through the corresponding holes in the zygomatic bone and are directed to the skin of this area.

Infraorbital nerve innervates the skin of the lower eyelid, the mucous membrane of the vestibule of the nose, the wings of the nose, the upper lip, the skin, the mucous membrane and the anterior surface of the gums.

Superior alveolar nerves depart over a considerable distance from the infraorbital nerve. The posterior upper alveolar branches extend even before the entrance of the infraorbital nerve into the orbit, then descend along the tubercle of the upper jaw and enter it through the corresponding openings. The middle upper alveolar branch departs in the region of the infraorbital sulcus, through the hole at its bottom it penetrates into the middle alveolar canal, along which it descends into the thickness of the lateral wall of the maxillary sinus. The anterior upper alveolar branches branch off in the anterior parts of the infraorbital canal, through the corresponding holes they penetrate into the alveolar canals and descend along them in the thickness of the anterior wall of the maxillary sinus. All of these upper alveolar branches anastomose each other (through numerous bone canals), forming the upper dental plexus. Branches extend from the latter for innervation of the teeth and the mucous membrane of the upper jaw gums.

Mandibular nerve is the third branch of the trigeminal nerve. Mixed, as it consists of a smaller (front) part, almost exclusively motor and a larger (rear) part, almost exclusively sensitive. From the anterior branch, the masticatory nerve (motor branches to the masseter muscle and the temporomandibular joint), deep temporal nerves (to the temporal muscle), the lateral pterygoid nerve (goes to the lateral pterygoid muscle), the buccal nerve (sensitive branches that innervate the skin and mucosa shell of the cheek). Thus, the anterior part (branch) of the mandibular nerve is predominantly motor. The posterior part (branch) of the mandibular nerve consists of both motor fibers - the medial pterygoid nerve (to the muscle that pulls the soft palate), the nerve that strains the palatine curtain and the nerve of the muscle that strains the tympanic membrane, and three large sensory nerves - the ear-temporal, inferior alveolar and lingual.

Ear-temporal nerve (auriculotemporal) contains both sensitive branches (innervate the skin of the temporal region), and postnodal sympathetic and secretory parasympathetic fibers from the ear node (provide autonomic innervation of the parotid gland and vessels of the temporal region). Having separated under the oval opening, it is directed along the inner surface of the lateral pterygoid muscle, and then goes outward, bending around the back of the neck of the condylar process of the lower jaw. Then it goes up, penetrating through the parotid gland, it approaches the skin of the temporal region, where it branches into terminal branches.

Inferior alveolar nerve (mandibular) is the largest branch of the mandibular nerve. Contains mainly sensitive fibers. Its motor branches is the maxillary-hypoglossal nerve (it branches into the maxillary-hyoid and anterior abdomen of the digastric muscle). In the mandibular canal, a large number of lower dental branches depart from the lower alveolar nerve, forming the lower dental plexus. When leaving the canal of the lower jaw through the chin hole, this nerve is already called the chin.

Facial nerve (Fig. 2) - the seventh pair of cranial nerves. It is a motor nerve that innervates the facial muscles of the face, the muscles of the cranial vault, the stapes muscle, the subcutaneous muscle of the neck, the stylohyoid muscle and the posterior abdomen of the digastric muscle. In addition to motor fibers, the nerve carries taste (for the tongue) and secretory fibers (for the salivary glands of the floor of the mouth). The facial nerve leaves the skull through the stylo-mastoid opening, goes below the external auditory canal and laterally from the posterior abdomen of the digastric muscle, the external carotid artery to the parotid gland, which it pierces. In the skull, the facial nerve gives off the following branches:

1) to the auditory nerve;
2) a large stony nerve that goes to the pterygopalatine ganglion;
3) the drum string - to the lingual nerve;
4) to the vagus nerve;
5) to the stapes muscle.

After leaving the skull, the facial nerve gives off the following branches:

1) the posterior auricular nerve - for the occipital muscle and muscles that change the position of the auricle;
2) a branch for the posterior abdomen of the digastric muscle, which is divided into the stylohyoid branch (goes to the muscle of the same name) and the anastomosing branch to the glossopharyngeal nerve.

Deep in the parotid gland, the facial nerve is divided into the upper (thicker) temporofacial and lower (smaller) cervicofacial branches. Branches of the facial nerve that radiate outward in the parotid gland are called the great crow's feet. All branches are divided into three groups:

1) upper - temporal and zygomatic branches (for the muscles of the outer ear, forehead, zygomatic and circular muscles of the orbit);
2) middle - buccal branch (for the buccal muscle, muscles of the nose, upper lip, circular muscle of the mouth, triangular and square muscles of the lower lip);
3) the lower - the marginal branch of the lower jaw (for the square muscle of the lower lip, chin muscle), the cervical branch (for the subcutaneous muscle of the neck).

The facial nerve anastomoses with the following sensory nerves: ear-temporal, zygomatic, buccal, infraorbital, lingual, chin, auditory and vagus nerves.

Glossopharyngeal nerve

Glossopharyngeal nerve (ninth pair) is mainly sensitive. Motor fibers innervate only one stylopharyngeal muscle. The branches of the nerve innervate the mucous membrane of the tonsils and the arches of the soft palate. Lingual (terminal) branches branch in the mucous membrane of the posterior third of the tongue, lingual-epiglottis, pharyngeal-epiglottis folds and the lingual surface of the epiglottis. The lingual branches, which innervate the posterior third of the tongue, contain both sensory and taste fibers.

Nervus vagus

The vagus nerve (tenth pair) innervates the face, the pharyngeal cavity and the upper larynx. It is a mixed nerve, because contains motor, sensory and autonomic (parasympathetic) fibers. The auricular branch of the vagus nerve is connected to the facial nerve. The vagus nerve anastomoses with the superior cervical sympathetic ganglion and other nodes that are located in the neck. The area of \u200b\u200bthe epiglottis and the surrounding mucous membrane - sensitive innervation is carried out by the vagus nerve. The soft palate is innervated by three nerves: vagus - its muscles, trigeminal and, partially, glossopharyngeal - its mucous membrane. Only the muscle straining the soft palate receives double innervation - from the vagus nerve and the third branch of the trigeminal nerve.

Lingual nerve

The lingual nerve runs arcuate from the mandibular nerve between the inner pterygoid muscle and the medial surface of the mandibular branch. It goes down and forward, taking in its initial part the tympanic string (branch of the facial nerve), which includes secretory fibers for the submandibular, hyoid glands and taste fibers for the anterior two-thirds of the dorsal surface of the tongue. Above the submandibular gland, the lingual nerve runs along the outer surface of the hyoid-lingual muscle, bending outside and below the excretory duct of the submandibular gland, and is woven into the lateral surface of the tongue. The lingual nerve gives off a number of branches (hypoglossal and lingual branches, as well as the throat isthmus), which innervate the mucous membrane of the gums of the lower jaw from the lingual side, the sublingual fold, the mucous membrane of the anterior two-thirds of the tongue, the sublingual gland, papillae of the tongue, the mucous membrane of the pharynx. The terminal branches of the lingual nerve anastomose with the hypoglossal and glossopharyngeal nerves.

Hyoid nerve

The hypoglossal nerve (twelfth pair) innervates only the muscles of the tongue (both its own and the skeletal muscles woven into it). The descending part of the nerve arch passes between the internal carotid artery and the internal jugular vein, and then the nerve crosses the course of the external carotid artery, usually being between it and the cervical part of the facial vein, and the ascending part of the arc is directed to the maxillofacial muscle. Between the posterior edge of the maxillary-hyoid, stylohyoid muscles, the posterior abdomen of the digastric muscle and the hypoglossal nerve is Pirogov's triangle, in which the lingual artery can be found. Having entered the upper surface of the jaw-hyoid muscle, the hypoglossal nerve enters the tongue, where it innervates all the muscles of the half of the tongue.

Vegetative innervation

Autonomic innervation of the maxillofacial region is carried out through the nodes of the autonomic nervous system, closely associated with the trigeminal nerve.

Ciliary node (ganglion) is associated with the first branch of the trigeminal nerve. Three roots are involved in the formation of this ganglion: sensitive - from the nasal nerve (the connecting branch with the nasal nerve); oculomotor (with prenodal parasympathetic fibers) - from oculomotor nerve - III pair of cranial nerves; sympathetic - from the internal sleepy plexus. The ganglion is located in the fatty tissue surrounding the eyeball, on the lateral surface of the optic nerve. From the ciliary (ciliary) node, there are short ciliary nerves that run parallel to the optic nerve to the eyeball and innervate the sclera, retina, iris (sphincter and pupil dilator), ciliary muscle, as well as the muscle that lifts the upper eyelid.

Winged knot (ganglion) is associated with the second branch of the trigeminal nerve. Located in the pterygopalatine fossa, closely adjacent to the pterygopalatine foramen, near which, from the side of the nasal cavity, this ganglion is covered only by a layer of mucous membrane. The pterygopalatine node is a formation of the parasympathetic nervous system. He receives parasympathetic fibers through the large petrosal nerve, which goes from the knee node of the facial nerve. Sympathetic fibers - from the sympathetic plexus of the internal carotid artery in the form of a deep stony nerve. The last and large stony nerve, passing through the pterygoid canal, join and form the nerve of the pterygoid canal. Secretory (sympathetic and para-sympathetic) and sensory fibers depart from the pterygopalatine node:
- orbital (innervate the mucous membrane of the sphenoid sinus and ethmoid labyrinth);
- posterior superior nasal branches (lateral and medial branches - innervate the mucous membrane of the posterior portions of the superior and middle turbinates and passages, the ethmoid sinus, the upper surface of the choanas, the pharyngeal opening of the auditory tube, the upper section of the nasal septum;
- the nasopalatine nerve - innervates the triangular section of the mucous membrane of the hard palate in its anterior part between the canines);
- lower posterior lateral nasal branches (enter the large palatine canal and exit through small openings, innervating the mucous membrane of the inferior turbinate, the lower and middle nasal passage and the maxillary sinus);
- large and small palatine nerves (innervates the mucous membrane of the hard palate, gums, soft palate, tonsil).
Motor fibers to the muscles that lift the soft palate and the muscle of the uvula go from the facial nerve through the large stony nerve.

Ear node (ganglion) - lies below the foramen ovale on the medial side of the mandibular nerve. Receives preganglionic fibers from the small petrous nerve (glossopharyngeal nerve - the ninth pair of cranial nerves). The auricular ganglion is connected with the trigeminal nerve through the ear-temporal nerve. The node receives sympathetic fibers through a branch of the sympathetic plexus of the middle meningeal artery. It gives fibers to the parotid salivary gland, to the muscles that stretch the eardrum, the muscle that stretches the soft palate, to the internal pterygoid muscle, to the tympanic string.

Submandibular ganglion located next to the submandibular gland, below the lingual nerve. Receives branches:
a) sensitive - from the lingual nerve;
b) secretory or parasympathetic - from the drum string (from the facial nerve), which is part of the lingual nerve;
c) sympathetic - from the sympathetic plexus of the external carotid artery.
The ganglion gives off branches to the submandibular gland and its duct.

Sublingual ganglion located next to the sublingual gland. It receives fibers from the lingual nerve, the tympanic string (from the facial nerve), and gives it to the sublingual salivary gland.

A.A. Timofeev
Guide to Oral and Maxillofacial Surgery and Surgical Dentistry