title: A failsafe method to avoid injury to the great auricular nerve.
abstract: BACKGROUND
  The great auricular nerve (GAN) is the most commonly injured nerve during facelift surgery. Although rare, injury can result in long-term sequelae.
  
  
  OBJECTIVE
  Previous reports have described the nerve's location at the midbelly of the sternocleidomastoid muscle (SCM) or at its emergence from underneath the SCM. The purpose of our study was to identify the superior course of the great auricular nerve as it applies to facelift.
  
  
  METHODS
  Thirteen fresh cadavers were dissected. A vertical line through the midlobule was drawn perpendicular to the Frankfort's horizontal, acting as a reference to the course of the GAN. Transparent paper overlay tracings were then done to record each nerve's location. The distance from the bony external auditory canal (EAC) to the nerve was measured at the anterior muscle border, at the midbelly of the SCM, and as the nerve emerged from under the SCM. Branching patterns of the nerve and its relation to the external jugular vein were identified.
  
  
  RESULTS
  In 100% of the dissections, the superior course of the GAN fell within a 30-degree angle constructed using the vertical limb perpendicular to the Frankfurt horizontal and a second limb drawn posteriorly from the midlobule. The distance from the EAC to the nerve was 4.9 ± 1.1 cm at the anterior muscle border, 7.3 ± 1.0 cm at the midbelly of the SCM, and 9.8 ± 1.2 cm at the GAN's emergence from under the SCM. Four types of branching patterns were identified.
  
  
  CONCLUSIONS
  The 30-degree angle described above rapidly and accurately identifies the nerve's location.
authors: Dr C. N. Ozturk is an Aesthetic Surgery Fellow, Dr C. Ozturk is a Microsurgery Fellow, Dr Huettner is an Aesthetic Surgery Fellow, and Dr Zins is Chairman in the Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors: Cemile Nurdan
authors: CN
authors: Ozturk
authors: Can
authors: C
authors: Ozturk
authors: Franziska
authors: F
authors: Huettner
authors: Richard L
authors: RL
authors: Drake
authors: James E
authors: JE
authors: Zins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D002102:Cadaver; D054644:Ear Auricle / Q000294:innervation*; D004424:Ear Canal / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000033:anatomy & histology; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D015361:Rhytidoplasty / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome
keywords: SMAS; anatomic landmarks; anatomy; cadaver; danger zone; facelift; facelift complication; great auricular nerve; nerve injury; rhytidectomy