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The Greater Occipital Nerve and Obliquus Capitis Inferior Muscle: Anatomical Interactions and Implications for Occipital Pain Syndromes

Scherer, Saja S. M.D.; Schiraldi, Luigi M.D.; Sapino, Gianluca M.D.; Cambiaso-Daniel, Janos M.D.; Gualdi, Alessandro M.D., Ph.D.; Peled, Ziv M. M.D.; Hagan, Robert M.D.; Pietramaggiori, Giorgio M.D., Ph.D.

Plastic and Reconstructive Surgery: September 2019 - Volume 144 - Issue 3 - p 730-736
doi: 10.1097/PRS.0000000000005945
Reconstructive: Head and Neck: Original Articles

Background: The compression/injury of the greater occipital nerve has been identified as a trigger of occipital headaches. Several compression points have been described, but the morphology of the myofascial unit between the greater occipital nerve and the obliquus capitis inferior muscle has not been studied yet.

Methods: Twenty fresh cadaveric heads were dissected, and the greater occipital nerve was tracked from its emergence to its passage around the obliquus capitis inferior. The intersection point between the greater occipital nerve and the obliquus capitis inferior, and the length and thickness of the obliquus capitis inferior, were measured. In addition, the nature of the interaction and whether the nerve passed through the muscle were also noted.

Results: All nerves passed either around the muscle loosely (type I), incorporated in the dense superficial muscle fascia (type II), or directly through a myofascial sleeve within the muscle (type III). The obliquus capitis inferior length was 5.60 ± 0.46 cm. The intersection point between the obliquus capitis inferior and the greater occipital nerve was 6.80 ± 0.68 cm caudal to the occiput and 3.56 ± 0.36 cm lateral to the midline. The thickness of the muscle at its intersection with the greater occipital nerve was 1.20 ± 0.25 cm. Loose, tight, and intramuscular connections were found in seven, 31, and two specimens, respectively.

Conclusions: The obliquus capitis inferior remains relatively immobile during traumatic events, like whiplash injuries, placing strain as a tethering point on the greater occipital nerve. Better understanding of the anatomical relationship between the greater occipital nerve and the obliquus capitis inferior can be clinically useful in cases of posttraumatic occipital headaches for diagnostic and operative planning purposes.

Lausanne, Switzerland; Graz, Austria; Milan, Italy; San Francisco, Calif.; and St. Louis, Mo.

From the Swiss Nerve Institute; the Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois; the Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz; the Dental School, Vita-Salute San Raffaele University; the Surgical Medical Group; Peled Plastic Surgery; and Neuropax Clinic.

Received for publication August 1, 2018; accepted January 31, 2019.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

Giorgio Pietramaggiori, M.D., Ph.D., Swiss Nerve Institute, Lausanne, Switzerland,

Robert Hagan, M.D., Neuropax Clinic, St. Louis, Mo.,

Copyright © 2019 by the American Society of Plastic Surgeons