What Is the Lobular Branch of the Great Auricular Nerve? Anatomical Description and Significance in Rhytidectomy

Background: Recent literature describes a distinct third branch of the great auricular nerve (GAN) named the lobular branch. Studies demonstrate preserving the lobular branch of the GAN has greater impact on sensory function at the auricle than preservation of the posterior branch during rhytidectomy. However, no methodology exists to efficiently and accurately determine the topographic location of the lobular branch.

Purpose: This study will describe the branching charactersitcs of the lobular branch and algorithmic surface markings to assist surgeons in preservation of this nerve during rhytidectomy flap elevation.

Methods: The lobular branch was dissected in fifty cadaveric necks. Measurements were taken from the lobular branch to conchal cartilage, tragus and antitragus. The anterior branch was measured to its SMAS insertion and the posterior branch was measured to the mastoid process. McKinney's point was marked and the GAN diameter was recorded. Branching pattern and location of branches withing the Ozturk et al. 30-degree angle were documented. Basic statistics were preformed.

Results: The lobular branch was present in all specimens and distributed to 3 regions. In 85% of specimens, the lobular branch resided directly inferior to the antitragus and in the remaining specimens it was located directly inferior to the tragus. Pre-operative markings consisting of two vertical lines from the tragus and anti-tragus to McKinney's point can be used to outline the predicted location of the lobular branch.

Conclusion: This study delineates the location of the lobular branch of the GAN. We translate these findings into a quick and simple intraoperative marking which can assist surgeons in avoiding lobular branch injury during rhytidectomy dissection.