Great auricular nerve: sensation of the ear and jaw

The great auricular nerve is a sensory branch of the cervical plexus, formed by roots C2 and C3. It is the largest of the ascending branches of the plexus. It emerges at the posterior border of the sternocleidomastoid muscle, wraps around the lateral surface of that muscle and ascends toward the ear, dividing into anterior and posterior branches.

What is the sensory area?

The branches of the great auricular supply sensation to:

• the skin over the parotid gland and the jaw angle;
• the earlobe and parts of the outer ear;
• the area behind the ear (mastoid).

It is a neck nerve that reaches the face, and this course sets it apart from the trigeminal nerves, which arise from the skull.

How to locate it in practice?

The sternocleidomastoid works as a guide. The nerve crosses the muscle on its outer surface, roughly at its middle third, and ascends toward the ear. This point of emergence at the posterior border of the muscle is well known to surgeons, because the nerve is vulnerable to injury in neck surgery and in surgical facial rejuvenation, with numbness of the earlobe as a result.

Why does it matter in HOF?

In harmonization, the area of the jaw angle and parotid is frequently treated (jawline, masseter toxin, jaw line filler). Sensation in this skin depends on the great auricular, and this helps at two moments:

• Medical history: patients with previous neck or face surgery may have residual numbness in the ear and jaw angle, and this should be recorded so it is not attributed to the procedure.
• After the procedure: tingling or numbness in this area may be related to swelling, and the location helps work out which nerve is involved.

In the region, remember the neighboring marginal mandibular branch of the facial nerve (motor) and the platysma. Sensation and movement are different systems: the great auricular is sensory only.

How to advise the patient?

In Harmy

The Jawline marking point simulates filler along the jaw line, with the volume in ml entered, seen from the front. The app does not represent nerves or sensation. The projection is illustrative, and the professional takes the neurovascular anatomy of the contour into account in the clinic.

Also called: greater auricular nerve, N. auricularis magnus.