The great auricular nerve (C2, C3) and the lesser occipital nerve (C3) govern periauricular sensation. The great auricular nerve is a sensory nerve that arise from C2 and C3. It runs behind the sternocleidomastoid (SCM) muscle approximately 1 cm below the spinal accessory nerve. It emerges into the midbody of the SCM muscle, staying in the muscle fascia (
Fig. 5), and then crosses the SCM muscle, where it resides in its most superficial location (in the superficial investing fascia of the neck) before arborizing into 2 or 3 branches. As McKinney postulated, the nerve is most vulnerable to be compromised during retroauricular dissection in this area (the McKinney point) (
Fig. 5) [
3]. The anterior branch continues in a plane between the SCM muscle and the parotid gland prior to its terminal, which provides sensation to the skin overlying the parotid gland and anteroinferior aspect of the auricle [
6]. The posterior branch travels under the SMAS, namely the auricularis posterior muscle, before reaching the posterior auricle (
Fig. 5) [
7]. The lobular branch most frequently originates from a common trifurcation with the anterior and posterior branches. It gives sensation to the lobule, located in the center of the antitragus and directly inferior to the caudal edge of the tragus [
8]. Unlike the pathway of the anterior branch, the lobular branch seems not to go through the parotid gland, but rather travels through the superficial plane to reach the antitragus [
5]. The lesser occipital nerve is a purely sensory nerve from the ascending superficial branch of the second and, occasionally, the third ventral ramus of the cervical plexus. It curves lateral to the accessory nerve and ascends along the posterior border of the SCM muscle, sending anterior branches to the ear and posterior branches to the mastoid area. The anterior branches overlap with the posterior branches of the great auricular nerve, and the posterior branches of the lesser occipital nerve overlap with the great occipital nerve [
1]. The lesser occipital nerve, after piercing the deep cervical fascia, consistently emerges behind the posterior border of the SCM muscle superior to the great auricular nerve, then courses in an oblique-cephalic direction toward the ear and the mastoid, diverging in a fan-like fashion from the great auricular nerve. The nerve runs between the muscle fascia and the SMAS. It enters the subcutaneous plane at a proximal and variable level [
4], although in some patients it travels superficially throughout the entirety of its course, and thus stays in a position vulnerable to compromise during mastoid dissection.