Great Auricular Nerve

nervus auricularis magnus

The great auricular nerve is the largest branch of the cervical plexus, arising from C2 and C3, emerging at Erb's point on the posterior border of the sternocleidomastoid muscle and ascending over the SCM toward the ear. It supplies the skin of the parotid region, the earlobe, the lower half of the auricle (both surfaces), and the skin over the angle of the jaw and lower cheek.

Region: Neck

Clinical Relevance

Clinical Notes

The great auricular nerve is the sensory nerve most commonly injured during parotidectomy, with sacrifice producing permanent numbness of the earlobe and lower auricle. Preservation of the posterior branch of the great auricular nerve is attempted in nerve-sparing parotidectomy. The nerve is the most commonly used autologous nerve graft for short nerve defects in facial nerve reconstruction, providing 5-8 cm of graft accessible through the neck incision with sensory loss confined to the ear and jaw angle. Frey syndrome (gustatory sweating) involves the great auricular territory when parasympathetic fibres from the lesser petrosal nerve regenerate into great auricular territory sweat glands.

Pathology

Common Injuries & Conditions

Great Auricular Nerve Sacrifice in Parotidectomy

Parotidectomy inevitably encounters the great auricular nerve crossing the SCM surface toward the ear; the anterior branch supplying the parotid skin is sacrificed to access the gland while the posterior branch to the ear is preserved when feasible, producing earlobe and lower auricular numbness that patients should be counselled about pre-operatively.