Third occipital nerve
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View Daniel J Bell's current disclosuresAt the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose.
View Rohit Sharma's current disclosures- Third occipital nerves
- Third occipital nerve (TON)
The third occipital nerve (TON) is a branch of the posterior root of C3, which provides cutaneous sensation to a small portion of the occipital scalp and innervates the C2/3 facet joints.
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Gross anatomy
Location
Occipital region of the scalp close to the midline.
Origin
The posterior root of C3 (the third cervical nerve) gives off a medial branch which traces a path between the semispinalis capitis and cervicis muscles, before passing through the splenius capitis and trapezius muscles. Subjacent to the trapezius the medial branch gives off the third occipital nerve.
Course
The third occipital nerve runs as thin fibres vertically, medial to the greater occipital nerve 2, for a short distance, before passing laterally, crossing the greater occipital nerve and running as far as the retroauricular line, where there may be overlap with small twigs from the lesser occipital nerve. Vertically the fibres do not extend beyond the superior nuchal line.
Branches
There are no named branches of the third occipital nerve, however, multiple small twigs intercommunicate with branches of the greater occipital nerve. Far laterally, the branches may overlap with small twigs from the lesser occipital nerve.
Some of the branches transverse medially, across the midline, and intercommunicate with the contralateral third occipital nerve 1.
Supply
The third occipital nerve supplies an area of the medial occipital scalp, overlapping with areas supplied by the greater and lesser occipital nerves. It also supplies the C2/3 facet joints 4.
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Clinical importance
third occipital nerve block
third occipital neurolysis or neurectomy
occipital nerve stimulation
Related pathology
occipital neuralgia, implicated with the greater and lesser occipital nerves
migraine, implicated with the greater and lesser occipital nerves
References
- 1. Tubbs RS, Mortazavi MM, Loukas M, D'Antoni AV, Shoja MM, Chern JJ, Cohen-Gadol AA. Anatomical study of the third occipital nerve and its potential role in occipital headache/neck pain following midline dissections of the craniocervical junction. (2011) Journal of neurosurgery. Spine. 15 (1): 71-5. doi:10.3171/2011.3.SPINE10854 - Pubmed
- 2. Kwon HJ, Kim HS, O J, Kang HJ, Won JY, Yang HM, Kim SH, Choi YJ. Anatomical analysis of the distribution patterns of occipital cutaneous nerves and the clinical implications for pain management. (2018) Journal of pain research. 11: 2023-2031. doi:10.2147/JPR.S175506 - Pubmed
- 3. Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febiger, 1918; Bartleby.com, 2000. www.bartleby.com/107/.
- 4. Honorio Benzon, Srinivasa N. Raja, Spencer S. Liu, Scott M. Fishman, Steven P. Cohen. Essentials of Pain Medicine. (2017) ISBN: 9780323401968
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