"A comprehensive study of the potential compression points of the third occipital nerve and its possible clinical interests"

Plast Reconstr Surg. 2024 Mar 26. doi: 10.1097/PRS.0000000000011431. Online ahead of print.

Abstract

Background: The anatomical features of the third occipital nerve (TON) are the least studied among the occipital nerves. This study aimed to analyze the anatomical features and potential compression points of the TON.

Methods: The posterior neck and scalp of 39 cadavers were dissected. The TON was carefully followed from the emerging point from C2-C3 vertebrae distally. Its muscular investments were detected. The determined points were marked superficially and measured according to external occipital protuberance with the Image J Software program.

Results: The TON revealed 4 different potential entrapment points along its course. The most proximal point was between the C2-C3 vertebrae. The second and third points were at their piercing points of semispinalis capitis and splenius capitis muscles, respectively. The final point was at its penetrating point of the trapezius muscle. Additionally, TON did not pierce the semispinalis capitis muscle on 6 sides and pierced this muscle from 3 different points by splitting into 3 branches on 1 side. Moreover, on 5 sides, the TON split into two branches and perforated the splenius capitis muscle from two different points.

Conclusion: There were 4 potential compression points regarding the TON. These entrapment points and variations of TON in this study may play a significant role in understanding the reason for TON-related headaches and the treatment of headaches caused by TON.