In-Depth Look at the Anatomical Relationship Between the Lesser Occipital Nerve, Greater Auricular Nerve, and Spinal Accessory Nerve and Their Implication in Safety of Operations in the Posterior Triangle of the Neck.

Migraine surgery is an increasingly popular treatment option for migraine patients. The lesser occipital nerve (LON) is a common trigger point for headache pathologies, but there is a paucity of research regarding the LON and its intimate association with the spinal accessory nerve (SAN).
Six cadaver necks were dissected. The LON, great auricular nerve (GAN), and SAN were identified and systematically measured and recorded. These landmarks included the longitudinal axis (vertical line drawn in the posterior), the horizontal axis defined as a (line between the most anterosuperior points of the external auditory canals) and the earlobe. Mean distances and standard deviations were calculated to delineate the relationship between the SAN, LON, and GAN.
The point of emergence of the SAN was determined to be 7.17 ± 1.15 cm lateral to the y-axis and 7.77 ± 1.10 caudal to the x-axis. The LON emerges 7.5 ± 1.31 cm lateral to the y-axis and 8.47 ± 1.11 cm caudal to the x-axis. The GAN emerges 8.33 ± 1.31 cm lateral to the y-axis and 9.4 ±1.07 cm caudal to the x-axis. The decussation of the SAN and the LON was found to be 7.70 ± 1.16 cm caudal to the x-axis and 7.17 ± 1.15 lateral to the y-axis.
Understanding the close relationship between the LON and SAN in the posterior, lateral neck area is crucial for a safer approach occipital migraine headaches, occipital neuralgia, and new daily persistent headaches (NDPH) and other reconstructive or cosmetic surgeries.