Topographic anatomy of the great auricular point: landmarks for its localization and classification

Raikos, Athanasios; English, Thomas; Yousif, Omar Khalid; Sandhu, Mandeep Singh; Stirling, Allan

doi:10.1007/s00276-016-1758-y

Cited by 14 publications

(15 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…18 It emerges from the posterior border of the SCM and crosses the muscle anteriorly as it courses toward the auricle. 26 In the posterior triangle, the point at which the GAN enters the posterior triangle is consistently caudal to that of the SAN-on average 10 mm below it with a range of 3 to 40 mm. 18,27 By limiting the caudal extent of our incision to avoid the SAN, our incision also generally avoids the GAN, minimizing risk of injury and sensory deficits.…”

Section: Nerve Anatomymentioning

confidence: 90%

Surgical “Safe Zone”: Rapid Anatomical Identification of the Lesser Occipital Nerve

Khavanin

Carl

Yang

et al. 2018

J reconstr Microsurg

View full text Add to dashboard Cite

Background Surgical intervention has established a vital role in the management of chronic headaches. The lesser occipital nerve (LON) is a common target in patients suffering from occipital neuralgia and is often resected as a first-line option. We endeavored to define the relationships of the LON in the posterolateral neck to facilitate its safe and rapid intraoperative identification. Methods Seven fresh cadavers (14 nerves) were dissected, and their relationships to the mastoid prominence and nearby spinal accessory nerve (SAN) and greater auricular nerve were noted. Results The distance from the mastoid to the emergence of the LON along the posterior sternocleidomastoid ranged from 36 to 51 mm (mean: 45.2 mm), with relative symmetry between the two nerves in the same cadaver. The SAN emerged an average of 54 mm from the mastoid prominence. Conclusion Exploration for the LON should begin at a point 40 mm from the mastoid prominence along the posterior border of the sternocleidomastoid muscle. If the point of exit of the LON is not identified within 10 mm of this exposure, our dissection continues cranially along the posterior border of the sternocleidomastoid, anterior to the trapezius. In rare cases the nerve may pierce the fibers of the muscle and ascend directly on top of the muscle belly. By limiting the caudal extend of the dissection, we can avoid exposure of the SAN and minimize the risk of iatrogenic nerve injury.

show abstract

Section: Nerve Anatomymentioning

confidence: 90%

Surgical “Safe Zone”: Rapid Anatomical Identification of the Lesser Occipital Nerve

Khavanin

Carl

Yang

et al. 2018

J reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…The great auricular nerve (GAN) originates from the cervical plexus at the levels of C 2 and C 3 , which is the largest sensory branch of superficial cervical plexus [21]. The applied anatomy of great auricular nerve is simple [22,23], but the nerve supply of the auricle is complex, which comes from the innervation of GAN, auricular branch of vagus nerve, auriculotemporal nerve and lesser occipital nerve. In addition, double innervation and innervation variation may exist in the nerve innervation of different areas of auricle [9].…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial evaluating the hemodynamic impact of ultrasound-guided great auricular nerve block in middle ear microsurgery

et al. 2020

View full text Add to dashboard Cite

Background The peri-operative effectiveness of ultrasound-guided great auricular nerve block (GANB) in patients, especially in adult patients undergoing middle ear microsurgery remains unclear. We hypothesized that ultrasound-guided GANB would decrease the hemodynamic responsiveness to incision and opioid consumption in middle ear microsurgery as well as the post-operative analgesia requirement. Methods Sixty patients undergoing middle ear microsurgery were randomized into two equal groups to receive either a GANB with 2 ml of 0.25% ropivacaine under ultrasound guidance (GANB group) or to receive a blank control intervention (without any performed injection) before general anesthesia inductions. The primary outcomes were hemodynamic changes of MAP (mean artery pressure) and HR (heart rate) to skin incision. The secondary endpoints were to determine the consumptions of propofol and remifentanil during the operation and the incidence of remedial analgesia 48 h post-operation to maintain VAS ≤ 3. Results The MAP post incision in GANB group was significantly lower than that in control group (GANB group 93.83 ± 11.72 mmHg vs. control group 100.87 ± 12.65 mmHg, P = 0.029). The increases for MAP and HR post incision were also lower in GANB group (∆MAP GANB group 11.90 ± 8.32 mmHg vs. control group 19.83 ± 10.37 mmHg, P = 0.002; ∆HR GANB group 3.67 ± 5.30 beat min− 1 vs. control group 8.23 ± 8.56 beat min− 1, P = 0.016). Remifentanil consumption was significantly decreased in GANB group (GANB group 401.55 ± 100.51 μg h− 1 vs. control group 697.34 ± 215.45 μg h− 1, P = 0.000). The incidence of remedial analgesia post-operation in GANB group (5/30) was significantly lower than that in control group (20/30, P = 0.000). Conclusion Ultrasound-guided GANB decreases the hemodynamic responsiveness to incision and remifentanil consumption in middle ear microsurgery as well as the post-operative analgesia requirement. Trial registration This trial was retrospectively registered at http://www.chictr.org.cn with the registration number of ChiCTR1800014333 on 6 January, 2018.

show abstract

“…Traditionally, the McKinney spot, which is 6.5 cm below the external auditory canal and 0.5 cm behind the external jugular vein, has been the anatomical marker for distinguishing the GAN during surgical localization ( McKinney and Katrana, 1980 ). The greater auricular point of the GAN at the posterior edge of the SCM has also been described as an important landmark ( Raikos et al, 2017 ). Another marker, Erb’s point, is situated 2–3 cm above the clavicle and at the same level as the carotid nodule ( Tubbs et al, 2007a ).…”

Section: Autograftsmentioning

confidence: 99%

Donors for nerve transplantation in craniofacial soft tissue injuries

Sun

Zhong

et al. 2022

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

Neural tissue is an important soft tissue; for instance, craniofacial nerves govern several aspects of human behavior, including the expression of speech, emotion transmission, sensation, and motor function. Therefore, nerve repair to promote functional recovery after craniofacial soft tissue injuries is indispensable. However, the repair and regeneration of craniofacial nerves are challenging due to their intricate anatomical and physiological characteristics. Currently, nerve transplantation is an irreplaceable treatment for segmental nerve defects. With the development of emerging technologies, transplantation donors have become more diverse. The present article reviews the traditional and emerging alternative materials aimed at advancing cutting-edge research on craniofacial nerve repair and facilitating the transition from the laboratory to the clinic. It also provides a reference for donor selection for nerve repair after clinical craniofacial soft tissue injuries. We found that autografts are still widely accepted as the first options for segmental nerve defects. However, allogeneic composite functional units have a strong advantage for nerve transplantation for nerve defects accompanied by several tissue damages or loss. As an alternative to autografts, decellularized tissue has attracted increasing attention because of its low immunogenicity. Nerve conduits have been developed from traditional autologous tissue to composite conduits based on various synthetic materials, with developments in tissue engineering technology. Nerve conduits have great potential to replace traditional donors because their structures are more consistent with the physiological microenvironment and show self-regulation performance with improvements in 3D technology. New materials, such as hydrogels and nanomaterials, have attracted increasing attention in the biomedical field. Their biocompatibility and stimuli-responsiveness have been gradually explored by researchers in the regeneration and regulation of neural networks.

show abstract

Topographic anatomy of the great auricular point: landmarks for its localization and classification

Abstract: The anatomical landmarks utilized in this study are helpful in predicting the location of the GAP relative to the midpoint of the SCM and can reduce neural injuries within the posterior triangle of the neck.

Cited by 14 publications

References 27 publications

Surgical “Safe Zone”: Rapid Anatomical Identification of the Lesser Occipital Nerve

Surgical “Safe Zone”: Rapid Anatomical Identification of the Lesser Occipital Nerve

A randomized controlled trial evaluating the hemodynamic impact of ultrasound-guided great auricular nerve block in middle ear microsurgery

Donors for nerve transplantation in craniofacial soft tissue injuries

Contact Info

Product

Resources

About