Third occipital nerve

Changed by Daniel J Bell, 12 Nov 2018

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The third occipital nerve (TON) is a branch of the posterior root of C3, which provides cutaneous sensation to a small portion of the occipital scalp.

Gross anatomy

Location

Occipital region of the scalp close to the midline.

Origin

The posterior root of C3 (the third cervical nerve) gives off a medial branch which traces a path between the semispinalis capitis and cervicis muscles, before passing through the splenius capitis and trapezius muscles. Subjacent to the trapezius the medial branch gives off the third occipital nerve.

Course

The third occipital nerve runs as thin fibres vertically, medial to the greater occipital nerve², for a short distance, before passing laterally, crossing the greater occipital nerve and running as far as the retroauricular line, where there maybe overlap with small twigs from the lesser occipital nerve. Vertically the fibres do not extend beyond the superior nuchal line.

Branches

There are no named branches of the third occipital nerve, however multiple small twigs intercommunicate with branches of the greater occipital nerve. Far laterally, the branches may overlap with small twigs from the lesser occipital nerve.

Some of the branches transverse medially, across the midline, and intercommunicate with the contralateral third occipital nerve ¹.

Supply

The third occipital nerve supplies an area of the medial occipital scalp, overlapping with areas supplied by the greater and lesser occipital nerves.

Related pathology

~~-<p>The <strong>third occipital nerve</strong> (<strong>TON</strong>) </p>~~
+<p>The <strong>third occipital nerve</strong> (<strong>TON</strong>) is a branch of the posterior root of C3, which provides cutaneous sensation to a small portion of the occipital <a href="/articles/scalp-1">scalp</a>. </p><h4>Gross anatomy</h4><h5>Location</h5><p>Occipital region of the scalp close to the midline.</p><h5>Origin</h5><p>The posterior root of C3 (the third cervical nerve) gives off a medial branch which traces a path between the <a href="/articles/transversospinalis-group">semispinalis capitis</a> and <a href="/articles/transversospinalis-group">cervicis</a> muscles, before passing through the <a href="/articles/splenius-capitis-muscle">splenius capitis</a> and <a href="/articles/trapezius-muscle">trapezius</a> muscles. Subjacent to the trapezius the medial branch gives off the third occipital nerve.</p><h5>Course</h5><p>The third occipital nerve runs as thin fibres vertically, medial to the <a href="/articles/greater-occipital-nerve">greater occipital nerve</a> <sup>2</sup>, for a short distance, before passing laterally, crossing the greater occipital nerve and running as far as the <a href="/articles/retroauricular-line">retroauricular line</a>, where there maybe overlap with small twigs from the <a href="/articles/lesser-occipital-nerve">lesser occipital nerve</a>. Vertically the fibres do not extend beyond the <a href="/articles/superior-nuchal-line">superior nuchal line</a>.</p><h5>Branches</h5><p>There are no named branches of the third occipital nerve, however multiple small twigs intercommunicate with branches of the greater occipital nerve. Far laterally, the branches may overlap with small twigs from the lesser occipital nerve.</p><p>Some of the branches transverse medially, across the midline, and intercommunicate with the contralateral third occipital nerve <sup>1</sup>.</p><h5>Supply</h5><p>The third occipital nerve supplies an area of the medial occipital scalp, overlapping with areas supplied by the greater and lesser occipital nerves.</p><h4>Related pathology</h4><ul>
+<li><a href="/articles/occipital-neuralgia">occipital neuralgia</a></li>
+<li><a href="/articles/occipital-origin-migraines">occipital origin migraines</a></li>
+</ul>

References changed:

1. Tubbs RS, Mortazavi MM, Loukas M, D'Antoni AV, Shoja MM, Chern JJ, Cohen-Gadol AA. Anatomical study of the third occipital nerve and its potential role in occipital headache/neck pain following midline dissections of the craniocervical junction. (2011) Journal of neurosurgery. Spine. 15 (1): 71-5. <a href="https://doi.org/10.3171/2011.3.SPINE10854">doi:10.3171/2011.3.SPINE10854</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21495817">Pubmed</a> <span class="ref_v4"></span>
2. Kwon HJ, Kim HS, O J, Kang HJ, Won JY, Yang HM, Kim SH, Choi YJ. Anatomical analysis of the distribution patterns of occipital cutaneous nerves and the clinical implications for pain management. (2018) Journal of pain research. 11: 2023-2031. <a href="https://doi.org/10.2147/JPR.S175506">doi:10.2147/JPR.S175506</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30310306">Pubmed</a> <span class="ref_v4"></span>
3. Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febiger, 1918; Bartleby.com, 2000. www.bartleby.com/107/.

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