Maxillary nerve

At a glance

English

Maxillary nerve

Latin (TA2)

Nervus maxillaris

System

Nerve

Region

Head

Side

Paired, left and right

About the maxillary nerve

The maxillary nerve, V2, is the second of the three divisions of the trigeminal nerve. It is purely sensory and sits between the ophthalmic and mandibular divisions in both position and size. Its territory is the middle of the face: the skin between the lower eyelid and upper lip, the upper teeth and gums, the nasal cavity, the maxillary sinus and the palate.

Its origin is the centre of the trigeminal ganglion's convex front border, from which it sets out as a flat band. It runs forwards low in the outer wall of the cavernous sinus and exits the cranial cavity by the foramen rotundum, becoming rounder and firmer as it does so. It then crosses the top of the pterygopalatine fossa, where two short roots tie it to the pterygopalatine ganglion, bends outwards across the rear surface of the maxilla and passes into the orbit by way of the inferior orbital fissure. From here on it is usually called the infraorbital nerve. It runs forward in the floor of the orbit, outside the periosteum, lying in a groove and then a canal, both named infraorbital, with the infraorbital artery and vein, and emerges on the face at the infraorbital foramen.

Its branches are grouped by where they leave. Inside the skull it gives a meningeal branch to the dura of the middle cranial fossa. In the pterygopalatine fossa it gives the zygomatic nerve, whose zygomaticotemporal and zygomaticofacial branches supply the temple and cheek; the posterior superior alveolar nerves to the molars; and, through the ganglion, the greater and lesser palatine nerves, the nasopalatine nerve and the pharyngeal nerve. Within the canal come the middle and anterior superior alveolar nerves to the premolars, canine and incisors. On the face it ends in palpebral, nasal and superior labial branches.

Clinically, the nerve is tested by touch over the cheek. Upper teeth are numbed by local infiltration or by blocking the alveolar or infraorbital branches. Fractures of the orbital floor or cheekbone often injure the infraorbital nerve, leaving the cheek, side of the nose and upper lip numb, and maxillary sinus disease can be felt as toothache in the upper teeth. Trigeminal neuralgia commonly affects this division.

Course and supply

Arises from

The central part of the trigeminal ganglion in the middle cranial fossa; it exits the cranium by the foramen rotundum.

Ends in

Continues as the infraorbital nerve and ends on the face, after the infraorbital foramen, in inferior palpebral, external nasal and superior labial branches.

Supplies

Sensory to the skin of the mid-face, the upper teeth and gums, the nasal cavity, the maxillary sinus, the palate and the dura of the middle cranial fossa; carries parasympathetic fibres from the pterygopalatine ganglion to the lacrimal, nasal and palatine glands.