Greater superficial petrosal nerve and its surgical importance: a review

Santosh Kumar Swain


The greater superficial petrosal nerve (GSPN) is an important but often underappreciated branch of the facial nerve. The GSPN is a mixed nerve which contains both sensory and parasympathetic fibers. It serves as the motor root of the pterygopalatine (sphenopalatine) ganglion. GSPN has a long course which passes across the middle skull base between the petrous bone and dura mater and running through the foramen lacerum. It then incorporates to the deep petrosal nerve and crosses along the pterygoid canal to the pterygopalatine ganglion. The postganglionic nerve fibers innervates the lacrimal glands, nasal mucosa and palatal mucosal glands via branches of the zygomatic nerve/zygomaticotemporal branch, sphenopalatine, greater palatine, lesser palatine nerves and pharyngeal nerve. Surgical anatomy of the GSPN nerve is often unfamiliar to many clinicians. As this nerve is usually unrecognized without use of high resolution microscope or endoscope, its anatomical knowledge is essential for surgeons basically otologists and other head and neck surgeon to minimize the risk of injury during surgical intervention. This review article surely increases the precise knowledge of the GSPN including its embryology, surgical anatomy, blood supply, relations with other structures and imaging.


Greater superficial petrosal nerve, Facial nerve, Geniculate ganglion, Schwannoma

Full Text:



Martinez Pascual P, Maranillo E, Vazquez T, Simon de Blass C, Lasso JM, Sanudo JR. Extracranial course of the facial nerve revisited. Anatomic Rec. 2019;302(4):599-608.

Swain SK, Das A, Mohanty JN. Acute otitis media with facial nerve palsy:our experiences at a tertiary care teaching hospital of eastern India. J Acute Dis. 2019;8:204-7.

Fan Z, Fan Z, Wang H. New surgical approach to migraine. Otol Neurotol. 2006;27:713-5.

Swain SK, Das A, Munjal S. A rare cause of bilateral facial nerve paralysis due to acute otitis media in a 52 year old man. Medic J Dr. D Y Patil Vidyapeeth. 2020;13(6):688.

Prasad S, Lee TC, Chiocca EA, Klein JP. Superficial greater petrosal neuropathy. Neurol Clin Pract. 2014;4(6):505-7.

Tubbs RS, Menendez J, Loukas M, Shoja MM, Shokouhi G, Salter EG, Cohen-Gadol A. The petrosal nerves: anatomy, pathology, and surgical considerations. Clin Anat. 2009;22(5):537-44.

Ginsberg LE, De Monte F, Gillenwater AM. Greater superficial petrosal nerve: anatomy and MR findings in perineural tumor spread. Am J Neuroradiol. 1996;17(2):389-93.

Shao YX, Xie X, Liang HS, Zhou J, Jing M, Liu EZ. Microsurgical anatomy of the greater superficial petrosal nerve. World Neurosurg. 2012;77(1):172-82.

Susan S. Clinically oriented anatomy.6th ed. Churchill Livingstone London: Lippincort Williams and Wilkins; 2010:977.

Ichimura S, Yoshida K, Sutiono AB, Horiguchi T, Sasaki H, Kawase T. Greater petrosal nerve schwannomas—analysis of four cases and review of the literature. Neurosurg Rev. 2010;33:477-82.

Shao YX, Xie X, Liang HS, Zhou J, Jing M, Liu EZ. Microsurgical anatomy of the greater superficial petrosal nerve. World Neurosurg. 2012;77(1):172-82.

Khonsary SA, Ma Q, Villablanca P, Emerson J, Malkasian D. Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: A review. Surg Neurol Int. 2013;4(6):422-8.

Tubbs SR, Curtis JW, E Geroge S, Sheetz J, Zehren S. Landmarks for the greater petrosal nerve. Clinic Anat. 2005;18:210-4.

Fukushima T. The middle fossa approach. In: Nonaka Y, ed. Fukushima Manual of Skull Base Dissection. 3rd ed. Raleigh, NC: AF-Neuro Video, Inc; 2010:230-48.

du Ru JA, van Benthem PP, Bleys RL, Lubsen H, Hordijk GJ. Landmarks for parotid gland surgery. J Laryngol Otol. 2001;115:122-5.

Gebarski SS, Telian SA, Niparko JK. Enhancement along the normal facial nerve in facial canal: MR imaging and anatomical correlation. Radiol. 1992;183:391-4.

Natekar PE, De Souza FM. Clinical anatomy of greater petrosal nerve and its surgical importance. Indian J Otol. 2013;19:20-2.

Moneta LB, Quintanilla-Dieck L. Embryology and anatomy of the ear. Otolaryngol Head Neck Surg. 2017;28(2):66-71.

Swain SK, Behera IC, Sahu MC. Bell’s palsy among infants-our experiences in a tertiary care hospital of eastern India. Asian J Pharm Clin Res. 2017;10(9):85-7.

Shao YX, Xie X, Liang HS, Zhou J, Jing M, Liu EZ. Microsurgical anatomy of the greater superficial petrosal nerve. World Neurosurg. 2012;77(1):172-82.

Jager LJ, Muller-Lisse U, Reiser M, Grevers G: High resolution magnetic resonance tomography of the temporal bone. Laryngorhinootologie. 1994;73:385-9.

Portmann D, Gharbi F, Darrouzet V, Bebear JP, Portmann M. Post-traumatic facial paralysis without any fracture of the petrous bone. Rev Laryngol Otol Rhinol.1991;112:441-3.

Paullus WS, Pait TG, Rhoton AL Jr. Microsurgical exposure of the petrous portion of the carotid artery. J Neurosurg. 1977;47:713-26.

Espinosa-Medina I, Outin E, Picard CA, Chettouh Z, Dymecki S, Consalez GG, et al. Neurodevelopment. Parasympathetic ganglia derive from Schwann cell precursors. Science. 2014;345(6192):87-90.

Aihara N, Yamada K, Matsuda F, Murakami S. Neurinoma of the greater superficial petrosal nerve developed acute facial palsy: case report and review of the literature. Skull Base. 2001;11:77-80.

Ayberk G, Ozveren MF, Uzum N, Tosun O, Akcay EK. Cellular schwannoma of the greater superficial petrosal nerve presenting with abducens nerve palsy and xerophthalmia: case report. Neurosurgery. 2008;63:813-4.

Amirjamshidi A, Hashemi SM, Abbassioun K. Schwannoma of the greater superficial petrosal nerve. J Neurosurg. 2010;113:1093-8.

Swain SK, Samal S. An unusual location of schwannoma in a 4 year old child. Medic J Dr. D Y Patil Vidyap. 2020;13(4):406.

Vescan AD, Snyderman CH, Carrau RL, Mintz A, Gardner P, Branstetter B et al. Vidian canal: analysis and relationship to the internal carotid artery. Laryngoscope. 2007;117:1338-42.

De Paulis D, Di Cola F, Marzi S, Ricci A, Coletti G, Galzio RJ. A rare case of greater petrosal nerve schwannoma. Surg Neurol Int. 2011;2:60.

Ginsberg LE, De Monte F, Gillenwater AM. Greater Superficial Petrosal Nerve: Anatomy and MR Findings in Perineural Tumor Spread. Am J Neuroradiol. 1996; 17:389-93.

Swain SK, Choudhury J, Acharya S. Herpes zoster oticus among pediatric patients:our experiences at a tertiary care teaching hospital. Ind J Heal Sci Biomed Res. 2020;13(3):215.

Campos MS, Oliveira CA, Dias LAMD, Barbosa BA, Jr FB. Greater Superficial Petrosal Nerve Schwannoma: Case Report and Literature Review. Neurooncol Open Acc. 2016;1:1.