Relevance of the lesser occipital nerve in facial rejuvenation surgery

Nerve injuries are possible during facial rejuvenation surgery. The great a uricular nerve has been studied; however, little is known about the lesser occipital nerve and its relevance in facial rejuvenation surgery. To unders tand the importance of the lesser occipital nerve in a face lift procedure, the specific anatomy of the serve was studied in the laboratory in 19 hemi faces, with additional nerve observations in the operating room. The course of the lesser occipital nerve, its branches, and the relationship with the surrounding structures were evaluated and re corded. The great auricular n erve was also dissected to compare the two nerve territories. In the majori ty of the dissections, the lesser occipital nerve supplied the superior ear and the mastoid area, whereas the great auricular nerve innervated the inf erior ear and a portion of the preauricular area. The nerves, however, were variable in size and distribution. Five lesser occipital nerves provided t he dominant supply to the ear, compensating for a small great auricular ner ve contribution. Therefore, injury to the lesser occipital nerve can result in a major sensory deficit of the ear. We also found the lesser occipital nerve to have a subcutaneous course at a proximal and variable level. These nerve branches can be superficial, and therefore postauricular flap dissec tion can injure the nerve if the Flap is dissected at the fascial level. We therefore suggest that the dissection be at a more superficial level to av oid nerve injury. And finally, if SMAS/platysma suspension sutures are plac ed, we suggest these be done in a vertical-oblique direction along the cour se of the lesser occipital nerve, because this should minimize the possibil ity of trapping terminal branches.