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THE FIFTH OR TRIFACIAL NERVE.


Emerging from the upper end of the valve of Vieussens. the nerve is directed outward across the superior peduncle of the cerebellum, and then winds forward round the outer side of the crus cerebri, immediately above the pons Varolii, pierces the dura mater in the free border of the tentorium cerebel1i. just behind, and external to, the posterior clinoid process, and passes forward in the outer wall of the cavernous sinus, between the third nerve and the ophthalmic division of the fifth. It crosses the third nerve and enters the orbit through the sphe¬noidal fissure. It now becomes the highest of all the nerves, lying at the inner extremity of the fissure internal to the frontal nerve. In the orbit it passes inward, above the origin of the Levator palpebrse, and finally enters the orbital surface of the Superior oblique muscle. In the outer wall of the cavernous sinus this nerve is not infrequently blended with the ophthalmic division of the fifth.

Branches of Communication.-In the outer wall of the cavernous sinus it receives some filaments from the cavernous plexus of the sympathetic. In the sphenoidal fissure it occasionally gives off a branch to assist in the formation of the lachrymal nerve.

Branches of IJistribution.-It gives off a recurrent branch, which passes back¬ward between the layers of the tentorium, dividing into two or three filaments which may be traced as far back as the wall of the lateral sinus.

Surgical Anatomy.-The fourth nerve when paralyzed causes loss of function in the Superior oblique, so that the patient is unable to turn his eye downward and outward. Should the patient attempt to do this, the eye on the affected side is twisted inward, producing diplopia or double vision. Accordingly, it is said that the first symptom of this disease which presents itself is giddiness when going down hill or in descending stairs, owing to the double vision induced by the patient looking at his steps while descending.

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The Fifth Nerve

The Fifth or Trifacial Nerve (n. trigeminus) is the largest cranial nerve. It resembles a spinal nerve (1) in arising by two roots; (2) in having a ganglion developed on its posterior root; and (3) in its function, since it is a compound nerve. It is the great sensory nerve of the head and face and the motor nerve of the muscles of mastication. Its upper two divisions are entirely sensory; the third division is partly sen.sory and partly motor. It arises by two roots: of these the anterior is the smaller, and is the motor root; the posterior, the larger and sensory. Its superficial origin is from the side of the pons Varolii, nearer to the upper than the lower border. The smaller root consists of three or four bundles; the larger root consists of numerous bundles of fibres, varying in number from,seventy to a hundred. The two roots are separated from one another by a few of the transverse fibres of the pons. 'I'he deep origin of the larger or sensory root is chiefly from a ...