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Review Article
The lesser occipital nerve: A review of an often forgotten entity in head and neck surgery
1 Department of Otolaryngology-Facial Plastic Surgery, Henry Ford Macomb Hospital, Clinton Township, MI, USA
2 Otolaryngology-Head and Neck Surgery, Department of Surgery Division, William Beaumont Hospital, Troy, MI, USA
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Richard Arden
MD, Otolaryngology-Head and Neck Surgery, Department of Surgery Division, William Beaumont Hospital, Troy, MI,
USA
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Article ID: 100018Z18YM2025
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How to cite this article
Mansour Y, Arden R, Vidovich A. The lesser occipital nerve: A review of an often forgotten entity in head and neck surgery. J Case Rep Images Otolaryngol 2025;4(2):13–18.ABSTRACT
Introduction: The lesser occipital nerve arises from the ventral rami of C2 and C3 and relates closely to the spinal accessory nerve along the posterior border of the sternocleidomastoid muscle. Unlike spinal accessory nerve reports of injury, attention to lesser occipital nerve causes and mechanisms of injury are uncommon, yet often result in a concern to the patient.
Case Report: We present a case of a 36-year-old female with metastatic papillary thyroid carcinoma and subsequent lesser occipital nerve injury. Our objective is to review the relevant anatomical relationships, variations, and strategies to avoid injury to this often unrecognized and/or under-reported entity. Principal findings of this review demonstrate the lesser occipital nerve possesses a highly variable branching pattern, size, and sensory distribution rendering it susceptible to injury within the neck or occipital scalp.
Conclusion: The close anatomic relationship of the lesser occipital nerve and spinal accessory nerve along the posterior border of the sternocleidomastoid muscle presents a “dual threat” for injury during neck dissection. Landmark-based skin incisional design and dissection has relevance to head and neck, neurosurgical/neurootologic, and facial rejuvenation surgeons. The vertical distance along the sternocleidomastoid muscle from the mastoid tip provides the most useful reference point for surgery within the neck, while the horizontal distance from mastoid tip to the external occipital protuberance provides valuable reference for occipital scalp incisions. A sub-sternocleidomastoid muscle approach, medial to lateral cervical rootlet dissection, selective judicious use of bipolar cautery, and avoidance of excessive retraction trauma, contribute to a safer surgical strategy around the lesser occipital nerve.
Keywords: Lesser occipital nerve, Neck dissection, Nerve injury, Spinal accessory nerve
SUPPORTING INFORMATION
Acknowledgments
The authors would like to acknowledge the patient RM for the consent and their contribution to this article.
Author ContributionsYusra Mansour - Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Richard Arden - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Aleksandra Vidovich - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Yusra Mansour et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
