The great auricular nerve is a cutaneous (sensory) nerve of the head. It originates from the second and third cervical (spinal) nerves (C2-C3) of the

cervical plexus The cervical plexus is a nerve plexus of the anterior rami of the first (i.e. upper-most) four cervical spinal nerves C1-C4. The cervical plexus provides motor innervation to some muscles of the neck, and the diaphragm; it provides sensory inne ...

. It provides sensory innervation to the skin over the

parotid gland The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the m ...

and the

mastoid process The mastoid part of the temporal bone is the posterior (back) part of the temporal bone, one of the bones of the skull. Its rough surface gives attachment to various muscles (via tendons) and it has openings for blood vessels. From its borders, t ...

, parts of the

outer ear The outer ear, external ear, or auris externa is the external part of the ear, which consists of the auricle (also pinna) and the ear canal. It gathers sound energy and focuses it on the eardrum ( tympanic membrane). Structure Auricle The ...

, and to the

and its

fascia A fascia (; : fasciae or fascias; adjective fascial; ) is a generic term for macroscopic membranous bodily structures. Fasciae are classified as superficial, visceral or deep, and further designated according to their anatomical location. ...

. Pain resulting from

parotitis Parotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation. Etymology From Greek παρωτῖ ...

is caused by an impingement on the great auricular nerve.

Structure

The great auricular nerve is the largest of the ascending branches of the

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 The sternocleidomastoid muscle is one of the largest and most superficial cervical muscles. The primary actions of the muscle are rotation of the head to the opposite side and Anatomical terms of motion#Flexion and extension, flexion of the neck. ...

, then perforates the

deep fascia Deep fascia (or investing fascia) is a fascia, a layer of dense connective tissue that can surround individual muscles and groups of muscles to separate into fascial compartments. This fibrous connective tissue interpenetrates and surrounds the m ...

before ascending alongside the external jugular vein upon that

beneath the platysma muscle to the

. 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

. 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

, on the back of the auricle (save for its upper part), of the

lobule In anatomy, a lobe is a clear anatomical division or extension of an organ (as seen for example in the brain, lung, liver, or kidney) that can be determined without the use of a microscope at the gross anatomy level. This is in contrast to the mu ...

, 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 __NOTOC__ The angle of the mandible (a.k.a. gonial angle, Masseteric Tuberosity, and Masseteric Insertion) is located at the posterior border at the junction of the lower border of the ramus of the mandible. The angle of the mandible, which may ...

and

(via anterior branch), skin over of the mastoid region (i.e. skin over the

) (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

, reducing sensation to the face. Pain resulting from

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 Frey's syndrome (also known as Baillarger's syndrome, Dupuy's syndrome, auriculotemporal syndrome, or Frey-Baillarger syndrome) is a rare neurological disorder resulting from damage to or near the parotid glands responsible for making saliva, and ...

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

External links

Diagram at aapmr.org
* - "Diagram of the cervical plexus." {{Authority control Nerves of the head and neck