Prevention of injury to the great auricular nerve during rhytidectomy

The great auricular nerve is the one most commonly injured during rhytidectomy. The main trunk is closest to the surface over the midtransverse belly of the sternocleidomastoid muscle. At this point, the nerve is 6.5 cm below the caudal edge of the bony external auditory canal. The external jugular vein is parallel and 0.5 cm ventral to the nerve at the same point. A simple technique using these fixed anatomic landmarks helps the surgeon avoid injury to the great auricular nerve and the jugular vein.