Surgical Treatment of the Auriculotemporal Nerve

The auriculotemporal nerve (ATN) has a complex anatomic course as it exits the central nervous system. This anatomy makes it susceptible to irritation and compression, hence its potential involvement in the generation of chronic headaches and its role as a target for surgical intervention. It is a branch of the mandibular division of the trigeminal nerve which exits the skull through the foramen ovale. The mandibular branch then splits into anterior and posterior divisions, the latter of which includes the auriculotemporal nerve. As it ascends cephalically beyond the inner aspect of the mandibular condyle, it travels alongside the superficial temporal artery deep to the parotid gland. Cephalic to the gland, the nerve passes superficial to the zygomatic arch and travels superficial to the temporomandibular joint (TMJ). The ATN subsequently branches to provide innervation to the parotid, external auditory meatus, the TMJ, base of the auricle, and the skin of the posterior temporal region. The latter of these nerves is known to communicate with branches of the zygomaticotemporal nerve, a fact that has important clinical relevance in the treatment of temporal headaches. Anatomy of this nerve, and the superficial temporal artery with which it frequently interacts with, has been elucidated. There are three potential anatomic compression points for the ATN that have been described relative to the external auditory meatus. The two proximal-most compression points consist of fascial bands and the third the interaction point(s) between the ATN and the superficial temporal artery (STA). The compression points occur from 13.1 mm anterior and 5 mm superior to the most anterosuperior aspect of the EAM caudally to the interaction points of the nerve with the STA more cephalically.