engleski

The functional anatomy of orofacial innervation

Th e most essential element in the management of patient’s pain problem is an understanding of normal function of the system. Diff erent individuals receiving identical noxious stimulation feel pain in diff erent ways and react at diff erent levels of suff ering. Orofacial disorders are usually accompanied with pain felt in the mouth, jaws and the face and thus can aff ect the quality of life of the suff erer dramatically. Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures), making the trigeminal nerve the most important cranial nerve for pain. Although generally considered part of the somatosensory system, the trigeminal sensory system has unique anatomy of the pathways for orofacial sensations, involving the trigeminal ganglion and its associated nuclei within the brainstem. Th e glossopharyngeal and vagus nerves contribute also to somatic pain processing within orofacial region through trigeminal nuclei system, but their general aff erent innervation is mainly related with processing visceral sensations through solitary tract nucleus. Th ere is a minor contribution from the facial nerve to general somatic innervation, and its contribution to visceral pain processing needs clarifi cation. Although the sensory innervation to the ear and pharynx may appear fairly well defi ned, there is considerable overlap and ambiguity in the somatic and visceral innervation in the oropharynx, nasopharynx, Eustachian tube and middle ear. Th us, both pain processing systems, one passing through trigeminal nuclei and the other through solitary nucleus could transmit pain sensations from these regions. Th e orofacial region has certain peculiarities in comparison to fundamental pattern of innervation and information processing throughout the body. Consideration of the anatomy of craniofacial innervation can provide useful insights in the understanding of the unique pathophysiology of orofacial pain so that appropriate individual therapy can be designed

orofacial anatomy, pain

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