The Great Auricular Nerve Trigger Site: Anatomy, Compression Point Topography, and Treatment Options for Headache Pain

Abstract

Background: Peripheral nerve decompression surgery can effectively address headache pain caused by compression of peripheral nerves of the head and neck. Despite decompression of known trigger sites, there are a subset of patients with trigger sites centered over the postauricular area coursing. The authors hypothesize that these patients experience primary or residual pain caused by compression of the great auricular nerve. Methods: Anatomical dissections were carried out on 16 formalin-fixed cadaveric heads. Possible points of compression along fascia, muscle, and parotid gland were identified. Ultrasound technology was used to confirm these anatomical findings in a living volunteer. Results: The authors' findings demonstrate that the possible points of compression for the great auricular nerve are at Erb's point (point 1), at the anterior border of the sternocleidomastoid muscle in the dense connective tissue before entry into the parotid gland (point 2), and within its intraparotid course (point 3). The mean topographic measurements were as follows: Erb's point to the mastoid process at 7.32 cm/7.35 (right/left), Erb's point to the angle of the mandible at 6.04 cm/5.89 cm (right/left), and the posterior aspect of the sternocleidomastoid muscle to the mastoid process at 3.88 cm/4.43 cm (right/left). All three possible points of compression could be identified using ultrasound. Conclusions: This study identified three possible points of compression of the great auricular nerve that could be decompressed with peripheral nerve decompression surgery: Erb's point (point 1), at the anterior border of the sternocleidomastoid muscle (point 2), and within its intraparotid course (point 3). (Plast.

Single midline incision approach for decompression of greater, lesser and third occipital nerves in migraine surgery

“…The great auricular nerve (GAN) and spinal accessory nerve (SAN) can be encountered in this area, but course differently than the LON. The GAN and SAN also emerge posterior to the SCM, but the GAN courses more anterior than the LON, while the SAN runs inferiorly and obliquely to the LON and varies in caliber from 1 to 4 mm in size [20][21][22]. Following the LON to the superior posterior occiput can help confirm its identity.…”

Feasibility of Ultrasound Measurements of Peripheral Sensory Nerves in Head and Neck Area in Healthy Subjects

“… 5 , 23 For the auriculotemporal nerve, the compression point is the preauricular fascial band and the superficial temporal artery (ATN 1, 2). 6 , 10 , 24 The most proximal compression point to the origin of the greater occipital artery in its peripheral and noncervical trajectory is a fascial band along the border of the obliquus capitis inferior (GON 1). The most distal compression point crosses the occipital artery at the nuchal ridge (GON 2).…”

“…2 Possible compression points of these nerves are described in the current literature in anatomical studies. [3][4][5][6][7][8][9][10] Proper diagnosis of headache due to compression neuropathy is currently based on the patient's history, pain sketches, imaging findings, and the presentation of symptoms. 11,12 Additionally, diagnostic nerve blocks or a positive response to botulin toxin type A are used in determining the diagnosis; however, these are invasive procedures.…”

Introduction to VSI: Migraine surgery in JPRAS open

“… 50 Even more recent descriptions of the greater auricular nerve have been postulated as additional nuchal compression sites. 51 It would therefore not surprise me if other nerve targets (e.g., infratrochlear, infraorbital and zygomaticofacial nerves) are recognized as trigger points amenable to surgical intervention.…”