[Disease Science] Where are the branches and distribution of the trigeminal nerve?

   From the trigeminal nerve node, there are three large branches composed of peripheral processes, which are the ophthalmic nerve, the maxillary nerve and the mandibular nerve. Ophthalmic nerve trigeminal nerve [lateral] The ophthalmic nerve (n.ophthalmicus) is the smallest of the three branches and contains only general somatosensory fibers. The ocular nerve enters the lateral wall of the cavernous sinus forward, and enters the orbit through the supraorbital fissure, and is distributed on the top of the forehead. The skin of the upper eyelid and the back of the nose, as well as the eyeball, lacrimal gland, conjunctiva and part of the nasal mucosa).   (1) The lacrimal gland nerves are small and run along the lateral orbital wall and the upper edge of the lateral rectus muscle to the lacrimal glands and the skin of the upper eyelid.   (2) The frontal nerve is relatively thick, located above the levator palpebral muscle, divided into 2 to 3 branches, of which the supraorbital nerve is larger, passing through the supraorbital notch, and branching into the skin on the top of the frontal.  (3) The nasociliary nerve is on the deep surface of the superior rectus muscle, passing over the optic nerve and reaching the medial orbital wall. This nerve divides into many branches, which are distributed in the eyeball, sphenoid sinus, ethmoid sinus, lower eyelid, lacrimal sac, nasal mucosa, and skin of the back of the nose. Maxillary nerve The maxillary nerve (n.maxillaris) is also a general somatosensory nerve. It enters the lateral wall of the cavernous sinus immediately after it is emitted from the trigeminal ganglion, then exits the skull through the circular foramen, enters the pterygopalatine fossa, and then enters the orbit through the infraorbital fissure. It is the infraorbital nerve. The maxillary nerve branches are distributed in the maxillary teeth, gums, maxillary sinuses, nasal cavity and oral mucosa, facial skin between palpebral fissures and part of the dura mater.   (1) The infraorbital nerve is the terminal branch of the maxillary nerve, passing through the infraorbital groove, infraorbital canal, and out of the infraorbital foramen to the face, and is divided into several branches distributed on the skin of the lower eyelid, nose and upper lip.   (2) The zygomatic nerve is sent out in the pterygopalatine fossa, enters the orbit through the infraorbital fissure, passes through the lateral orbital wall to the face, and branches in the zygomatic and temporal skin. During the stroke, the zygomatic nerve sends out a small branch composed of parasympathetic postganglionic nerve fibers to coincide with the lacrimal nerve. This branch enters the lacrimal gland and controls the secretion of the lacrimal gland.   (3) The upper alveolar nerve is divided into the anterior, middle and posterior branches of the upper alveolar. There are 2 to 3 posterior branches, which are sent out from the maxillary nerve in the pterygopalatine fossa and penetrate the back of the maxillary body into the bone. Medical Education|Education Network collects and organizes the anterior and middle branches of the upper alveolar nerve which are separated from the infraorbital nerve. The three branches are anastomosed in the maxillary alveolar bone to form an upper plexus. The branches are distributed in the maxillary sinus, maxillary teeth and gums. (4) The pterygopalatine nerve, also known as the ganglion branch, is a branch of 2 to 3 nerves that originates from the main trunk of the maxillary nerve, passes through the upper section of the pterygopalatine fossa, connects to the pterygopalatine ganglion, and then distributes in the palate and nasal cavity. Mucosa and palatine tonsils.   mandibular nerve    mandibular nerve (n. mandibularis) is a mixed nerve, which is the thickest branch of the three branches. After the trigeminal ganglion is sent out, the cranial cavity reaches the infratemporal fossa through the foramen ovale, and it immediately divides into many branches. Among them, special visceral movement fibers innervate the masticatory muscles. Generally, somatosensory fibers are distributed in the teeth of the mandible, the gums, the anterior 2/3 of the tongue, the mucosa of the floor of the mouth, the ear-temporal area and the facial skin below the cleft.   (1) Auritemporal nerve starts with two roots, surrounds the middle meningeal artery backwards and forms a trunk, penetrates into the parotid gland parenchyma, accompanies the superficial temporal artery, and branches upwards on the front of the auricle, the skin of the temporal area and the parotid gland.   (2) The buccal nerve runs along the outside of the buccal muscle, and after passing through this muscle, it is distributed in the buccal mucosa and the skin of the buccal area to the corner of the mouth.  (3) The tongue nerve is in front of the inferior alveolar nerve and descends deep through the lateral pterygoid muscle. On the way, the tympanic cord of the facial nerve joins this nerve from the back. After that, it crosses the superficial surface of the pterygoid muscle to the upper part of the submandibular gland, and then runs along the surface of the hyoid hyoid muscle to the tip of the tongue. The lingual nerve branches are distributed in the mucosa of the bottom of the mouth and the anterior 2/3 of the tongue, and receive general somatosensory stimulation.   (4) The inferior alveolar nerve is a mixed nerve, containing general somatosensory fibers and special visceral motor fibers. The inferior alveolar nerve is located behind the lingual nerve and descends along the lateral surface of the pterygoid muscle. Special visceral motor fibers branch out to innervate the mandibular hyoid muscle and the anterior abdomen of the digastric muscle. Generally, somatosensory fibers enter the mandibular canal through the mandibular foramen. In the mandibular canal, the branches constitute the lower plexus, and the branches are distributed in the teeth and gums of the mandible. Its terminal branch passes through the mental foramen called the mental nerve, which is distributed on the skin and mucous membrane of the chin and lower lip.  (5) The masticatory muscle nerve is a special visceral motor nerve, and the score innervates all the masticatory muscles.

Double eyelid repair type

&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. Double eyelid repair type First: Eye function&nbsp.&nbsp.bn&nbsp.n .&nbsp.&nbsp. Eye function repair includes: closed eyes, tears in the wind, dry eyes (eyes without tears), lower eyelid valgus, &nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. Difference in the tail of the eye, lacrimal gland leakage, lacrimal gland occlusion, the second type: eye shape &nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. Eye shape repair includes: double eyelid shape (flat fan, open fan , Parallel, European style, crescent), wide and narrow double eyelids , The third eye lift: mechanical repair &nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. balance muscle interaction force fourth: comprehensive repair&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. &nbsp.&nbsp. Eye function, eye shape, mechanical repair

Swollen eyes

There are 4 types of swollen eyes: Orbital septal fat type: Orbital septal fat hernia caused by excessive orbital septal fat development or orbital septal slack; this type is often associated with skin laxity and requires surgery to remove part of the orbital septum Remove a small amount of upper eyelid skin while fat. 2. & nbsp. Tissue hypertrophy type: common in the skin of the upper eyelid and the orbicularis muscle hypertrophy, the fat layer behind the orbicularis oculi muscle of the upper eyelid (that is, we often say ROOF) is developed. This type of eye undergoes double eyelid surgery. Thin muscles and retroorbicular fat (ROOF); these patients tend to have darker skin and look thicker. 3. Lacrimal gland prolapse type: There is also a special type of lacrimal gland prolapse that causes the bulge on the outside of the upper eyelid. We often say that “swollen eye” does not necessarily have prolapse of lacrimal gland, but patients with prolapse of lacrimal gland have swollen eye. This type of patient is not uncommon in clinical practice. It is usually bilateral and usually occurs in women before the age of 25. It often coexists with blepharoderma. The etiology is not clear, and occasionally an autosomal dominant genetic family. 4. Other types: eyelid edema caused by hypoproteinemia or heart and kidney disease, bleed of upper eyelid caused by tear gland inflammation or lacrimal gland mass. & nbsp. Although lacrimal gland prolapse is not uncommon, it is easily overlooked by beauty seekers and is often ignored by inexperienced physicians, affecting the effect of double eyelid surgery. What is lacrimal gland prolapse? The lacrimal gland is located in the lacrimal gland fossa of the frontal bone above the outer orbit, about 20mm long and 12mm wide. It is fixed to the orbital periosteum by connective tissue, and the lateral aponeurosis of the upper eyelid muscle passes through The lacrimal gland is divided into a larger orbital lacrimal gland and a smaller bleb lacrimal gland. Under normal circumstances, the lacrimal gland cannot be touched on the eyelid. The levator eyelid muscle, Lockwood ligament and inferior support ligament play an important role in lacrimal gland fixation. If the tension of the ligament or levator levator muscle is weakened, the lacrimal gland moves forward and downward to the outside of the eyeball in front of the orbital margin, and the lacrimal gland will appear after leaving the lacrimal gland Prolapse. When the lacrimal gland prolapses and swells, causing circulation disorders, causing eyelid vascular neuroedema; the prolapse and swelling of the lacrimal gland can stimulate the orbital diaphragm to relax further, making the lacrimal gland prolapse intensified, and the skin can also relax and change, and a vicious circle appears. The main function of the lacrimal gland is to secret tears, lubricate and protect the eyeballs, maintain the health of the cornea and conjunctiva, and defend against external infections. & nbsp. Third, what are the clinical manifestations of lacrimal gland prolapse & nbsp. 1. Double lateral upper eyelid is bloated, the skin is atrophy and loose, and some can see dilated capillaries and pigmentation; 2. The upper lateral eyelid is full, showing “swollen eye bubble” ; 3. Some patients have mild blepharoptosis, often covering the cornea of ​​the upper temporal portion; 4. The upper eyelid can be palpated with a hard, almond-sized lobes that can move freely, easy to push back and reset In the lacrimal gland fossa, but often prolapsed again as usual; no pain, neurotic tears. Actors who perform crying scenes and those who are easily moved to tears also often have prolapsed tear glands. 5. The swollen upper eyelid becomes worse and feels heavy in the morning and when it is tired. It occurs mostly in young women and gives people a feeling of lack of energy and sleep. 4. Diagnosis and differentiation: It needs to be differentiated from lacrimal gland inflammation, eyelid skin laxity, orbital septal fat prolapse, inflammatory pseudotumor and lacrimal gland mixed tumor. Fifth, the treatment plan: & nbsp. The main treatment is surgery, which can be done through the incision operation of double eyelid (double eyelid) or eyebrow lifting, separating the tissues around the lacrimal gland and constricting the ligament, and then reset the lacrimal gland into the lacrimal fossa. & nbsp. There are two common internal fixation methods: & nbsp.1. & nbsp. & nbsp. Use a non-injury suture to pass through the posterior inferior edge of the lacrimal gland in a U-shape or an 8-shape and fix it to the periosteum of the lacrimal fossa of the orbital bone , So that the anterior edge of the free lacrimal gland is closely attached to the lacrimal gland fossa to achieve anatomical reduction and fixation. 2. The lacrimal fossa microbone hole fixes the prolapsed lacrimal gland. This method is to use the temporal orbital bone margin ostomy method to fix the lacrimal gland tissue in the lacrimal gland fossa through the microbone hole. Sixth, the operation should pay attention to: & nbsp. The lacrimal gland tissue is pink in color, lobulated, rough in surface, tough in texture, and needs to be distinguished from the adipose tissue. The reduction and fixation of the lacrimal gland must achieve the anatomical reduction of the lacrimal gland and the suture. It will not cut the gland and damage the duct of the lacrimal gland and affect the normal secretory function of the lacrimal gland. If the lacrimal gland prolapses severely, it is difficult to reset all, and partial resection can be done, at most no more than 1/3 of all lacrimal glands [2],