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Local Infiltration Anesthesia
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
Christie T. Ammirati, George J. Hruza
There are several nerves that supply sensation to the scalp. The supraorbital and supratrochlear nerves, which innervate the forehead, also supply the anterior scalp. The zygomaticotemporal, auriculotemporal, and lesser occipital nerves supply the parietal portion and innervation to the occipital scalp is through the greater occipital and third occipital nerves. These sensory nerves extend in a superior direction, and a ring of anesthesia that begins at the level of the eyebrows continues across the superior auricular sulcus toward the occiput and back around to the starting point will anesthetize the entire scalp above it (46). This path crosses several large blood vessels such as the temporal artery; care must be taken to avoid intravascular injection or laceration of the artery with the bevel of the needle.
Orofacial Pain Syndromes and Other Facial Neuralgias
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Occipital neuralgia is a paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves or of the third occipital nerve. It may be accompanied by decreased sensation or dysesthesias in the affected areas. It may also be associated with tenderness over the nerve causing the difficulty.
The Bladder (BL)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Third occipital nerve (TON): This dorsal branch of the 3rd cervical spinal nerve must make its way through several layers of deep nuchal musculature, raising the potential for nerve entrapment and irritation. Thus, this nerve likely produces occipital neuralgia more than has been previously recognized.14 Neuralgia originating from TON disorders mimics GON neuralgia. The superficial medial branch of the C3 spinal nerve, also called the 3rd or least occipital nerve, travels around the dorsolateral surface of the C2-3 zygapophysial (facet) joint that it supplies. The site of this nerve branching is at BL 10. While facet joints caudal to C2-3 receive innervation by the dorsal rami above and below the joint, the C2-3 facets only receive TON innervation. After supplying the facet joint, the TON continues on to supply the semispinalis capitis muscle, traveling deeply along this muscle until it sends a communicating branch to the greater occipital nerve. The risk of third occipital neuralgia increases as a result of its vulnerability to entrapment at the level of the intervertebral disk behind the intervertebral joints. Osteophytes in these joints can produce nerve compression and chronic headache that may remain undiagnosed as a result of clinicians’ unfamiliarity with this nerve entrapment syndrome. Review the proximity of BL 10 to the anatomy just discussed in Figure 7-20.
Ultrasound-guided axial facet joint interventions for chronic spinal pain: A narrative review
Published in Canadian Journal of Pain, 2023
Michael J. Wong, Manikandan Rajarathinam
Facet joint sensory innervation is provided by the medial branches, which are terminal divisions of each nerve root’s dorsal ramus (Figure 2).33–36 In general, each facet joint receives dual innervation, from the same level and also the level above (e.g., the C3–C4 facet joint is innervated by the C3 and C4 medial branches, and the L2–L3 facet joint is innervated by the L1 and L2 medial branches); therefore, both contributing medial branches must be targeted to block sensation for a given facet joint. The localization of the medial branches varies depending on the region of the spine.29,37,38 Most cervical medial branches are found on the lateral waist of their respective vertebrae’s articular pillars. However, the superficial medial branch of C3 (third occipital nerve; TON) crosses the lateral surface of the C2–C3 joint, which it innervates, and the C7 medial branch is found at the junction of the C7 superior articular process and transverse process. Medial branches arising from T1 to T4 and T9 to T10 cross the superolateral margins of the transverse process below and then continue inferomedially. From T5 to T8, the medial branches are suspended just superior to the transverse process, in the intertransverse space. The T11 and T12 medial branches follow a course similar to that of the lumbar medial branches, which reliably pass over the junction of the transverse process and superior articular process of the level below. The L5–S1 facet joint is unique in that its innervation is thought to arise from the L5 dorsal ramus itself, rather than a discrete medial branch.29
Cervical myelitis presenting as occipital neuralgia
Published in International Journal of Neuroscience, 2018
Occipital neuralgia refers to a unilateral headache associated with the greater occipital nerve, lesser occipital nerve or third occipital nerve [1]. Although occipital neuralgia is often idiopathic, it can be induced by external injury, nerve compression or nerve pathway inflammation [2,3]. We describe an elderly patient with episodic occipital neuralgia for 10 years, who was eventually diagnosed with cervical myelitis presenting as occipital neuralgia.