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The auriculotemporal nerve in etiology of migraine headaches: a cadaveric study
Chim H, Okada H, Brown MS, Alleyne B, Liu MT, Zwiebel S, Guyuron B
Department of Plastic Surgery, Case Western Reserve University
2012-01-19
Presenter: Chim H
Affidavit:
The above work was entirely done by the resident.
Director Name: Arun Gosain
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
How does this presentation meet the established conference educational objectives?
This presentation will help conference participants to understand compression points along the auriculotemporal nerve.
How will your presentation be used by practicing physicians in the audience?
This is translated clinically to migraine surgery, where the auriculotemporal nerve has been described as a trigger point. Knowing the distances of possible compression points from an established landmark will enable practicing physicians to perform this surgery.
Background: The auriculotemporal nerve has been identified as one of the peripheral
trigger sites for migraine headaches. However, its distal course is poorly mapped
following emergence from the parotid gland. In addition, a reliable anatomical landmark
for locating the potential compression points along the course of the nerve during surgery
has not been sufficiently described. The aim of this anatomical study was to dissect the
auriculotemporal nerve (ATN) along its entire course after emergence from the parotid
gland and to determine the relationship of potential compression points to a fixed
anatomical landmark.
Methods: Twenty hemi-faces on ten fresh cadaver heads were dissected to trace the course of
the ATN from the inferior border of the zygomatic arch to its termination in the temporal
scalp. The compression points were mapped and the distances were measured from the
most anterosuperior point of the external auditory meatus (AS-EAM), which was used as
a fixed anatomical landmark.
Results: Three potential compression points along the course of the ATN were identified.
Compression points (CP) 1 and 2 corresponded to preauricular fascial bands. CP1 was
centered 13.1 +/- 5.9 mm anterior and 5.0 +/- 7.0 mm superior to the AS-EAM, while CP2
was centered 11.9 +/- 6.0 mm anterior and 17.2 +/- 10.4 mm superior to the AS-EAM. A
significant relationship was found between the ATN and superficial temporal artery
(CP3) in 80 percent of hemi-faces, with three patterns of interaction: single site of
artery crossing over the nerve (62.5 percent); helical intertwining relationship (18.8
percent) and nerve crossing over artery (18.8 percent).
Conclusions: Findings from this study provide information relevant to operative localization of potential compression points along the ATN.
