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Great Auricular Nerve: Anatomy and Imaging in a Case of Perineural Tumor Spread

Lawrence E. GinsbergGo,a and Susan A. Eichera

a From the Departments of Diagnostic Radiology (L.E.G.) and Head and Neck Surgery (S.A.E.), The University of Texas M. D. Anderson Cancer Center, Houston, TX.



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  		FIG 1. Diagrammatic representation of the great auricular nerve and its origin from the cervical plexus. The nerve can be seen emerging from the posterior border of the sternocleidomastoid muscle and then coursing superiorly and anteriorly, dividing into anterior and posterior branches. The anterior branch provides cutaneous innervation to the skin over the parotid region



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  		FIG 2. A–E, Axial contrast-enhanced CT scans, from superior to inferior.

A, At level of parotid gland, cutaneous/subcutaneous tumor recurrence is indicated by enhancing mass (arrows). Note tumor is not extending into substance of parotid gland.

B, Image caudal to A shows bottom of main tumor (arrow). Posterior to parotid gland is a round soft-tissue structure not clearly present on the other side, representing the enlarged upper anterior branch of the great auricular nerve (arrowhead).

C, Image caudal to B shows GAN to be larger and clearly enhancing (arrowhead).

D, Image caudal to C shows GAN along the lateral aspect of the sternocleidomastoid muscle (arrowhead).

E, Image caudal to D shows GAN barely separable from lateral posterior aspect of sternocleidomastoid muscle (arrowhead). Below this level, the nerve could not be seen.



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  		FIG 3. Intraoperative photograph (anterior is shown on the right). A gauze pad is seen the overlying the tumor. The parotid gland (arrows) and sternocleidomastoid muscle (asterisks) are identified. The linear structure represents the anterior branch of the GAN (arrowheads).





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X