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Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The cervical nerves also provide sensory innervation for two true (i.e., branchiomeric) head muscles via the cervical plexus: nerve C2 and C3 to the sternocleidomastoid and nerves C3 and C4 to the trapezius. The cervical nerves also provide cutaneous innervation to the skin of the neck and posterior region of the head. The lesser occipital nerve, great auricular nerve, transverse cervical nerve, and the supraclavicular nerve are branches of the cervical plexus that enter the superficial fascia posteriorly to the sternocleidomastoid to supply distinct areas: the scalp, the skin of the lower part of the ear and angle of mandible and mastoid process, the skin of the anterior triangle of the neck, and the skin of the superior region of the shoulder, respectively. In contrast, the dorsal rami of the cervical spinal nerves mainly pierce the trapezius and go superficially to innervate the back of the head and neck. One of these nerves is the greater occipital nerve, hence the name “lesser occipital nerve” for the nerve coming from the cervical plexus.
The Bladder (BL)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Greater occipital nerve (C2): Supplies cutaneous sensation to the posterior scalp. Arises from the dorsal root of the second cervical spinal nerve. A communicating branch from C3 may join the GON. The nerve ascends in the caudal neck and head over the dorsal surface of the rectus capitis posterior major muscle. It pierces the fleshy fibers of the semispinalis capitis, runs a short distance rostrad and laterad but remains deep at this point to the trapezius muscle. It becomes subcutaneous just caudal to the superior nuchal line by passing above an aponeurotic “sling,” close to the midline, consisting of the combined origins of the trapezius and sternocleidomastoid muscles, medial to the occipital artery.4 (The occipital artery appears in Figure 7-17 lateral to BL 9.) As the GON passes through these various layers of muscle and fascia, the risk of entrapment increases.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
A greater occipital nerve block is frequently performed. The greater occipital nerve is present at 1/3 along the foramen magnum on the line that connects greater occipital protuberance and mastoid process, while lesser occipital nerve is present at the distance of 2/3 of the line. The needle is inserted at the position of lesser occipital nerve. The needle tip is directed toward the foramen magnum, and local analgesics are infiltrated from the site of greater occipital nerve. Alternatively, local analgesics are infiltrated at each site.
A device review of Relivion®: an external combined occipital and trigeminal neurostimulation (eCOT-NS) system for self-administered treatment of migraine and major depressive disorder
Published in Expert Review of Medical Devices, 2021
Oved Daniel, Roni Sharon, Stewart J. Tepper
In the treatment of migraine, PNS commonly targets one of two large pericranial nerves that can be electrically modulated to abort, minimize, or avert migraine episodes [24]. The frontal portion of the head contains four branches of the trigeminal nerve (Ophthalmic division, V1), and the back of the head contains the left and right branches of the greater occipital nerve derived from upper cervical nerve roots (Figure 1). Previous studies have shown that PNS of both nerves has a converging clinical effect that exceeds the effects of PNS of each nerve alone [24,25]. However, concurrent bilateral stimulation of these nerves, separately or in tandem, is challenging. As the excitation thresholds of nerves fluctuate, the left and right branches may not be excited equally [22]. The distance between the nerve and the electrode, impedance (opposition to current flow) of the overlying tissues, and diameters of each nerve branch also vary.
Efficacy and safety of greater occipital nerve block for the treatment of cluster headache: a systematic review and meta-analysis
Published in Expert Review of Neurotherapeutics, 2020
Raffaele Ornello, Giorgio Lambru, Valeria Caponnetto, Ilaria Frattale, Chiara Di Felice, Francesca Pistoia, Simona Sacco
Study characteristics are summarized in Table 1. Overall, the studies included 365 subjects, 34 of which were recruited in RCTs. Studies mostly included male patients (range, 63% to 94%), with an age range of 15–76 years. Ten studies had an observational design [11,13–18,20–22], while the remaining two were RCTs [12,19]. There were substantial differences among studies; most studies enrolled patients with both ECH and CCH [11–14,16,17,19,20,22], while three studies only included patients with CCH [15,18,21]; GONBs were strictly ipsilateral to the side of the pain in all studies but one [16]; nine studies used steroids plus local anesthetics [11–13,16–18,20–22], two used steroids only [14,19], and one a local anesthetic only [15] (Table 1). All studies performed GONBs in a single session, with the exception of one RCT which performed the injections thrice in a week [19]. The most used steroid was methylprednisolone (4 studies), while the most used local anesthetic was lidocaine (five studies; Table 1). All studies injected the common accepted point of emergence of the greater occipital nerve on the scalp without the use of imaging techniques.
Corneal Neurotization: Review of a New Surgical Approach and Its Developments
Published in Seminars in Ophthalmology, 2019
Natalie Wolkow, Larissa A. Habib, Michael K. Yoon, Suzanne K. Freitag
Modern corneal neurotization was first described in 2009.5 An earlier but more complicated approach to corneal neurotization was described in the neurosurgical literature by Samii in 1972 and 1981, but it did not gain traction due to the complexity of the procedure and its limited benefits.6,7 Samii described performing the procedure in three patients, with outcomes of improved corneal health but without restoration of corneal sensation.6 The surgical approach in these cases involved first isolating the greater occipital nerve. Next, a frontal craniotomy was performed, the orbital roof was exposed and opened, the periorbita was incised and the ophthalmic nerve (V1) was identified. The poorly-functioning ophthalmic nerve was transected proximally in the superior orbit and a sural nerve graft was used as an interpositional graft to link the isolated occipital nerve to the distal portion of the transected ophthalmic nerve.6