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The Trigeminal Nerve Pathways and Their Central Projections

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Abstract

The major part of the trigeminal sensory hodology systematically follows the three-stage nerve pattern: periphery to brainstem, brainstem to diencephalon, and diencephalon to telencephalon. Trigeminal afferents project also to various non-trigeminal nervous areas, for instance, nucleus of the solitary tract, reticular formation, vestibular nuclei, superior colliculus, and medulla. Pathological conditions may explain how abnormal excessive and/or nociceptive trigeminal inputs (muscular but may be also periodontal, articular, etc.) could follow these connecting pathways and perturb the normal function of these different nervous centers. Clinicians should no longer be puzzled by unexplained irregular heart rate, digestive problems, dizziness, lumbar pain, or painful calf spasms in stressed and introverted patients who clench their teeth tightly and/or durably and/or frequently.

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Notes

  1. 1.

    Cortex cerebri.

  2. 2.

    Please see Fig. 4 in chapter “Useful Physiological Reminders” about the factors of reticular activity and Fig. 8 in chapter “The Behavioral Side of Clenching” about “on-off” reticular units under psycho-emotional influences.

  3. 3.

    Projections from the (VIIb), (IX), and (X) nerves and C1–C3 sensory roots to the (NS) [12, 24, 30, 50, 75, 79, 96, 101], the area postrema to the ipsilateral (MeN) [60]. Vagal and glossopharyngeal inputs project to the nucleus paratrigeminalis dorsalis; this nucleus and adjacent areas can be a convergence zone for intraoral, mandibular, and dental trigeminal afferents [21, 45, 46, 99] and vagal, glossopharyngeal, and oropharyngeal afferents [2, 100, 101]. This mixed projection zone can be largely involved in trigemino-spinal reflexes, in trigemino-visceral integrated phenomena, and in orofacial reflexes and oral motor behaviors such as swallowing. What’s more different integrative modalities for trigeminal nociceptive inputs between males and females [9, 10] have been noted at the level of SnC which can explain some clinical human gender discrepancies in TMD. The projections to the trigeminal motor nucleus (MoN) may connect oral receptors and stomatognathic muscles; they facilitate masticatory and swallowing reflexes [2, 3, 27, 30, 38, 46, 48, 53, 57, 58, 65, 69, 93, 112]. In this way, human periodontal receptors can initiate positive or negative feedback [2, 35, 45, 46, 48, 70].

  4. 4.

    They terminate at the central areas which direct visceral and vegetative inputs. These play a role in intensifying painful sensations and/or associated autonomic manifestations of cardiac and respiratory rhythmic variations.

  5. 5.

    They terminate at various levels of the bulbar and pontine reticular formation: they are involved in motor and vasomotor reactions and in awakening, alertness, and behavioral and motor expressions (avoidance reactions, taking flight, muscle tone adaptation, etc.) which are linked to the nociceptive component.

  6. 6.

    They terminate at the level of the controlateral superior colliculus [6, 31, 40, 52, 113, 118]: they are involved in orientation reflexes. Other studies [6, 88] have shown that some orofacial fibers relayed into the rostral part of the trigeminal SN project to the controlateral colliculus superior. This colliculus also receives visual, auditive, and somatosensory inputs. These afferents have a behavioral role in eye control, head, and body movements [23, 95]. Some EOM and nuchal muscle afferents project to the cervical chord (C1 à C3), suggesting that there are possible interactions between these two sensory afferent groups [83]. All these scientific data can shed light on clinical symptoms such as vertigo when classical investigations remain ineffective.

  7. 7.

    They reach several thalamic and hypothalamic nuclei. Most somesthetic thalamus projections (ventro-posteromedial, VPM) may originate from the NP, SnO, and SnI, which corresponds to a fine localization and discrimination of the stimuli [108]. The SnC inputs have more complex thalamic projections with nociceptive integration. Trigemino-hypothalamic projections have been confirmed by some electrophysiological recordings [102–105] particularly in the ventromedial nucleus which regulates eating behavior. Ventromedial cells were activated by both periodontal and gastric stimulations. This projection can come directly from the TBNC [43] or be relayed by the parabrachial area [7, 20, 90, 119]. The parabrachial nucleus also receives trigeminal nociceptive inputs relayed by the SnC [55]. Just note that the parabrachial nucleus receives from the brainstem a number of inputs that project to the amygdala [73], that is, nervous center mainly implicated in aggressive behavior (see chapter “The Behavioral Side of Clenching”). There are collateral projections of the trigemino-hypothalamic tractus neurons to the colliculus [123], substantia nigra, nucleus pretectalis anterior, and hypothalamic nuclei [59]. After passing through these subcortical relays and integrations, the trigeminal inputs end in the telencephalon (cerebral cortex). The identified areas are somesthetic SI and SII [4, 7, 66, 74, 98] near the fissure of Rolando; they receive thalamic ventro-posteromedial and posterior group nuclei inputs [7]. This cortical representation participates in the somatotopic organization (body scheme) previously pointed out [78] and includes dental afferents [89].

  8. 8.

    A controlateral cerebellar projection originating from the SnI and relayed in the principal and dorsal accessory subnuclei of the inferior olive was identified [40]. The periodontal inputs can inform the cerebellum about the occlusal mandibular position as they modulate stomatognathic antagonistic muscle activity. More recently, tactile cutaneous trigeminal stimulations have been found to project to deep cerebellar nuclei, inferior olive, and cerebral cortex, perhaps to control the timing of behavior [87]. The cerebellum is a major integrating and controlling center of mandibular synergical movements during mastication in mammals [44, 56, 111]. In effect the stomatognathic system must perform several complex functions about alimentary behavior from prehension to swallowing.

  9. 9.

    In the vestibular nuclei, cervical proprioceptive afferents come mainly from the central cervical nucleus, but vestibular projections to TBNC and to C1–C2 medulla also exist [106]. The nucleus paratrigeminalis receives sensory inputs from trigeminal, glossopharyngeal, and vagus nerves. It projects to bulbar, pontine, and possibly thalamic structures associated with nociception, thermoregulation, and cardiovascular control. This nucleus can act as a medullar relay interposed between sensory afferents and different structures related to homeostatic functions [19]. The visceral convergence of the nucleus paratrigeminalis dorsalis can be functionally extended according to cystitis-related recorded activations [13]; it might be implicated in some TMD puzzling clinical symptoms such as unexplained prolonged fever. The projections from the trigeminal spinal subnuclei to the spinal cord [64, 65, 76, 80, 88, 109] will be described in Sect. 7 of chapter “Pathophysiological Conditions”.

  10. 10.

    After crossing the superior cerebellar peduncle [45, 46, 95], they are ipsilaterally distributed to cerebellar cortex or to cerebellar subcortical nuclei (interpositus and lateralis).

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  1. Université de la Méditerranée Aix-Marseille, Marseille, France

    Francis Hartmann & Gérard Cucchi

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Hartmann, F., Cucchi, G. (2014). The Trigeminal Nerve Pathways and Their Central Projections. In: Stress and Orality. Springer, Paris. https://doi.org/10.1007/978-2-8178-0271-8_7

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