The meningeal branch of the mandibular nerve (also called the nervus spinosus) re-enters the skull through the foramen spinosum alongside the middle meningeal artery, to supply sensory innervation to the dura mater of the middle cranial fossa, the mastoid air cells via the mastoid canaliculus, and parts of the posterior cranial fossa dura. It is the main sensory nerve to the dura of the middle cranial fossa.
The nervus spinosus transmits pain afferents from the middle cranial fossa dura, which is why middle cranial fossa pathology, including extradural haematoma, meningioma, and dural metastasis, can produce referred pain in the temple and mandibular region innervated by V3. It also explains why pain at the root of the tongue and jaw is sometimes felt with middle meningeal artery haemorrhage. Neurosurgical procedures through the middle fossa approach traverse this nerve's territory, and its branches to the mastoid air cells are relevant in middle fossa approaches to the internal auditory canal.
Inflammatory or neoplastic processes affecting the middle cranial fossa dura cause temporoparietal headache and jaw pain through the meningeal branch of V3, a pain pattern that can be confused with temporomandibular joint disorder or dental pain until neuroimaging reveals the cranial pathology.
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