The greater (great) auricular nerve is the largest cutaneous branch of the cervical plexus, formed from C2 and C3. It winds around the posterior border of sternocleidomastoid at Erb's point and climbs across the muscle toward the ear, supplying the skin over the parotid gland, the angle of the jaw, the mastoid and the lower half of the auricle. Its exposed course over the muscle makes it the sensory nerve most often injured in parotidectomy, neck dissection and facelift surgery.
| Origin | Cervical plexus (C2, C3) |
|---|---|
| Course | Winds around the posterior border of sternocleidomastoid at Erb's point and ascends obliquely across the muscle, parallel and posterior to the external jugular vein, toward the angle of the mandible, then divides into anterior (parotid) and posterior (mastoid and auricle) branches |
| Motor |
|
| Sensory |
|
During parotidectomy the nerve is met crossing sternocleidomastoid toward the gland. The anterior (parotid) branch usually has to be divided, while the posterior (auricular) branch can often be preserved, which reduces the permanent numbness of the earlobe and lower auricle. Patients should be told before surgery that some ear numbness is likely. Because it is superficial, easy to reach through a neck incision and leaves only a small sensory deficit, it is a common donor graft for short facial nerve gaps. It is also at risk in facelift surgery, where it can be cut or caught in sutures as it crosses the muscle.
Division of the anterior branch during parotid surgery numbs the skin over the gland and jaw angle; if the posterior branch is also lost, the earlobe and lower auricle become permanently numb.
The nerve can be cut or entrapped in sutures as it crosses sternocleidomastoid during rhytidectomy, causing numbness or painful neuroma of the ear and jaw angle.
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