Occipital nerves

Greater occipital nerve

The greater occipital nerve is the largest of the three occipital nerves. It is a mixed nerve that arises as the medial branch of the posterior (dorsal) ramus of C2. Upon originating, the nerve runs between the obliquus capitis inferior and semispinalis capitis muscles. It then pierces the semispinalis capitis muscle and runs alongside the occipital artery.

The nerve emerges onto the posterior scalp region by perforating the aponeurotic fibers of the trapezius and the sternocleidomastoid muscle near their occipital attachment.

As it crosses the superior nuchal line, the greater occipital nerve gives rise to cutaneous branches that innervate the skin of the posterior scalp up to the coronal suture. Additionally, the nerve provides communicating branches that anastomose with the lesser and third occipital nerves.

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Lesser occipital nerve

The lesser occipital nerve arises from the anterior (ventral) rami of C2 and C3. Upon arising, the nerve runs superiorly towards the skull along the posterior aspect of the sternocleidomastoid muscle. After it pierces the deep cervical fascia, the nerve emerges onto the posterior aspect of the occipital bone.

The lesser occipital nerve gives off two types of branches: communicating and cutaneous. The communicating branches interconnect with the communicating branches of the greater occipital nerve. The cutaneous branches include the auricular, mastoid and occipital branches. These branches provide sensory supply to the skin of the lateral portion of the scalp and the skin around the external ear.

Third occipital nerve

The posterior (dorsal) ramus of the spinal nerve C3 divides into lateral and medial branches, while the medial branch further gives off superficial and deep branches. The superficial branch of the medial division is termed the third occipital nerve, also known as the least occipital nerve. This nerve curves superiorly, crossing the dorsal aspect of the C2/C3 zygapophyseal joint which it supplies. It then continues towards the skull, deep to the semispinalis muscle.

After passing the spinal process of C2, the nerve pierces the semispinalis muscle, splenius capitis and trapezius, and continues towards the skull superficially. The third occipital nerve then crosses the superior nuchal line of the occipital bone and terminates by giving off several cutaneous branches for the innervation of the skin overlying the nuchal region.

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