Human Unicorns—An Incidental Finding in 
Lateral Cephalogram

Cephalograms regularly disclose clinically noteworthy incidental findings to orthodontists who maintain a vigilant approach. In recent years, we have consistently identified a specific occurrence in the majority of lateral cephalograms, namely, the occipital spur. This refers to an enlarged external occipital protuberance, a protrusion at the rear of the skull which may manifest in either a smooth, crest, or spine-shaped configuration. Research suggests potential links to factors like brain expansion, adaptation to light levels, relief of neck muscle stress, and the influence of modern habits like smartphone usage in External occipital protuberance enlargement. Studies show a gender predilection, with smooth occipital spur more common in women and spine type more common in men, potentially aiding sex determination in forensics. Occipital spur influences on craniofacial measurements and the potential for causing occipital neuralgia, a condition characterized by pain in the posterior scalp. Management options range from conservative measures to surgical intervention, depending on symptom severity. Hence, this literature review compiles information concerning various types, prevalence, suspected etiology, clinical significance, and approaches to managing occipital spurs.