Great auricular nerve

Structure

The great auricular nerve is the largest of the ascending branches of the cervical plexus.

Origin

It arises from the second and third cervical (spinal) nerves (C2-C3), with the predominant contribution coming from C2.****

Course and relations

The great auricular nerve is a large trunk that ascends almost vertically over the sternocleidomastoid.**** It winds around the posterior border of the sternocleidomastoid muscle, then perforates the deep fascia before ascending alongside the external jugular vein upon that sternocleidomastoid muscle beneath the platysma muscle to the parotid gland. Upon reaching the parotid gland, it divides into an anterior branch and a posterior branch.

Branches

Anterior branch

The anterior branch (or facial branch) is distributed to the skin of the face over the parotid gland.

It communicates with the facial nerve (CN VII) inside the parotid gland.

Posterior branch

The posterior branch (or mastoid branch) innervates the skin over the mastoid process, on the back of the auricle (save for its upper part), of the lobule, and of the lower part of the concha.

The posterior branch communicates with the lesser occipital nerve, the auricular branch of the vagus, and the posterior auricular branch of the facial.

Distribution

The great auricular nerve is distributed to the skin of the face over the angle of the mandible**** and parotid gland (via anterior branch),**** skin over of the mastoid region**** (i.e. skin over the mastoid process) (via posterior branch), parts of the auricle (posterior branch),**** and the parotid gland and parotid fascia.****

Clinical significance

The great auricular nerve may be damaged during surgery on the parotid gland, reducing sensation to the face.

Pain resulting from parotitis is caused by an impingement on the great auricular nerve.

The intermingling of the great auricular nerve and the facial nerve (CN VII) is thought to be responsible for the pathogenesis of Frey's syndrome following parotidectomy.

Additional images

File:Gray784.png|Dermatome distribution of the trigeminal nerve, also showing the sensory distribution of the great auricular, lesser occipital, and greater occipital nerves. File:Gray1210.png|Side of neck, showing chief surface markings.

References

References

1. Standring, Susan. (2020). "Gray's Anatomy: The Anatomical Basis of Clinical Practice".
2. Sinnatamby, Chummy S.. (2011). "Last's Anatomy". Elsevier Australia.
3. (1 December 1989). "Preserving the great auricular nerve in parotid surgery". British Journal of Oral and Maxillofacial Surgery.
4. (2024-02-10). "Understanding Great Auricular Nerve Pain: Causes, Symptoms, and Treatment – The Auricular Nerve".