The great auricular nerve: an anatomic and surgical study

The great auricular nerve (GAN) originates from the cervical plexus at the levels of C2 and C3, supplying sensation to the skin overlying the lower aspect of the pinna and angle of the mandible. The GAN can be injured during many procedures in the head and neck, resulting in a significant negative impact on the patient's quality of life. There are no reliable anatomic studies of GAN in the area where it is most likely to get injured.

To determine the GAN relationship to the posterior border of the platysma and the external jugular vein (EJV).

Patients undergoing neck dissections were included in the study. Measurements were taken between the posterior border of the platysma relative to the nearest edge of the EJV and the GAN. The distance between the GAN and the EJV was also noted.

The posterior borders of the platysma and EJV are found, on average, 0.08 cm away from each other, and the free edge of the platysma was most often posterior to the EJV. The distance from the platysma to the GAN was, on average, 0.60 cm. The distance between the EJV and the GAN was 1.17 cm.

We have added a safe, reliable, and surgically relevant technique to the head and neck surgeon's armamentarium for identifying the GAN and avoiding attendant injury with long-term debilitating neurologic sequelae.