BMJ Case Reports 2017; doi:10.1136/bcr-2017-220506
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Occipital spur: understanding a normal yet symptomatic variant from orthodontic diagnostic lateral cephalogram

  1. Minoo Pothen Dr, Literature review and proof reading4
  1. 1Paediatric Dentistry, Faculty of Dentistry, Melaka-Manipal Medical College, Bukit Baru, Malaysia
  2. 2Orthodontics, Faculty of Dentistry, Melaka-Manipal Medical College, Bukit Baru, Malaysia
  3. 3Oral Medicine, Faculty of Dentistry, Melaka-Manipal Medical College, Melaka, Malaysia
  4. 4Department of Psychiatry, Faculty of Medicine, Melaka-Manipal Medical College, Bukit Baru, Malaysia
  1. Correspondence to Dr Renu Sarah Samson Dr, renusamson{at}, renusarah.samson{at}
  • Accepted 8 May 2017
  • Published 22 May 2017


Occipital spurs, also called as occipital knob, occipital bun, chignon or inion hook, is an exaggerated external occipital protuberance (EOP). It is frequently discussed in anthropological literature as a Neanderthal trait but hardly reported and considered as a normal variant in medical literature. It is a frequent finding among males and hence a prominent occipital spur is often used in gender determination in forensic investigations.1 EOP can be of three different types: type I, smooth; type II, crest form; type III, spine form.

Even though a normal variant, such hyperostoses can become symptomatic and cause much concern to patients. Most patients complain of a tender bony swelling at the back of the neck causing pain especially while lying down. Pain may be present at rest and during neck movements. It often presents in late adolescence due to the …

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