Sensory innervation in the orofacial region is mainly provided by the trigeminal cranial nerve. Trigeminal sensory afferent nerves do not relay information through the dorsal horn as their location is above the spinal cord. However, the nerve relay circuit is analogous to the dorsal horn system in function and anatomy. In the peripheral sensory system, primary afferent nerves have their cell bodies outside of the spin...
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...tex, where information is perceived in a somatotopic manner. This concept has been the basis of nociceptive pathway in both the periphery and the orofacial region. However, evidence in primates suggest the existence of an ipsilateral somatosensory pathway through the thalamus. Nash et al investigated this in human subjects, in which hypertonic saline is injected into the right masseter. Through the use of functional MRI, they found bilateral activation of neurons in the ventral posterior thalamus as well as the face region in the somatosensory cortex upon noxious stimulation (Nash et al 2010). If noxious information from the trigeminal sensory region is carried bilaterally to the brain, it is not difficult to postulate that a derangement of neurons through central sensitisation can cause referred pain and secondary hyperalgesia to the contralateral side of the face.
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