Localization of the greater occipital nerve through palpation of bony landmarks: A cadaveric study.

Autor: Mason NL; Department of Medical Education, Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755, USA. Electronic address: nenalundgreen@gmail.com., Savage J; Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT 84738, USA., Turney JP; Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT 84738, USA., Bomben J; Rocky Vista University College of Osteopathic Medicine - Colorado, 8401 South Chambers Road, Englewood, CO 80112, USA., Landis BC; Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT 84738, USA., Degenhart A; Rocky Vista University College of Osteopathic Medicine - Colorado, 8401 South Chambers Road, Englewood, CO 80112, USA., Bains MS; Rocky Vista University College of Osteopathic Medicine - Colorado, 8401 South Chambers Road, Englewood, CO 80112, USA., Berry A; Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT 84738, USA., Hanson J; Rocky Vista University College of Osteopathic Medicine - Colorado, 8401 South Chambers Road, Englewood, CO 80112, USA., Hopley H; Department of Medical Education, Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755, USA., Reed J; Department of Medical Education, Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755, USA., Woodbury D; Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT 84738, USA.
Jazyk: angličtina
Zdroj: Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2024 Aug; Vol. 243, pp. 108355. Date of Electronic Publication: 2024 May 24.
DOI: 10.1016/j.clineuro.2024.108355
Abstrakt: Objective: to provide anatomic confirmation that standard methods which practitioners skilled in palpation use, can reliably identify the most likely site of emergence of the greater occipital nerve in most patients. The location and frequency of subcutaneous emergence of the greater occipital nerve and occipital artery with respect to the external occipital protuberance-mastoid line are reported.
Methods: The external occipital protuberance and the mastoid processes were identified by palpation bilaterally on 57 body donors and the medial trisection point of a line connecting these bony landmarks was identified. A 4 cm circular dissection guide divided into 4 quadrants was centered on the trisection point and used to guide the removal of a circle of skin. The in-situ location of the nerve and artery were exposed by deep dissection within the circle. The frequency of the emergence and occurrence of the nerve and artery by quadrant were analyzed.
Results: In 114 total dissections the greater occipital nerve was found to emerge within the circle 96 times (84%) and the occipital artery 100 times (88%). The nerve (90%) and artery (81%) emerged from the two inferior quadrants most of the time with no difference noted between male and female donors. The greater occipital nerve and occipital artery were found to emerge together most commonly in inferior lateral quadrant. Branches of the nerve and artery traveled together most frequently through the two lateral quadrants.
Conclusion: This study confirmed that the medial trisection point of the external occipital protuberance-mastoid line can be located via palpation and reliably used to pinpoint the subcutaneous emergence of the greater occipital nerve and occipital artery in most individuals. When relying on palpation alone to identify the trisection point in the clinic, infusion of nerve block inferior and lateral to this point is most likely to bathe the greater occipital nerve in anesthetic.
Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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