Middle cervical ganglion

Last revised by Yoshi Yu on 15 Apr 2023

The middle cervical ganglion (plural: ganglia) is the smallest ganglion of the cervical sympathetic trunk and providing autonomic innervation to the head and neck region.

The middle cervical ganglion is formed by embryologically fused C5 and C6 sympathetic ganglia. It has superior connections to the superior cervical ganglion or may be fused with it.

It is bilaterally located at the level of C6 anterior to the transverse processes. Anterior to the longus capitis muscle and covered by the pre-vertebral fascia 5.

The middle cervical ganglion provides sympathetic innervation to the head and neck. 

A small thyroid branch follows the inferior thyroid artery and receives fibers from the external laryngeal nervevagal cardiac branches and recurrent laryngeal nerve.

A larger branch containing preganglionic efferent fibers forms the middle cardiac nerve, which courses inferiorly behind the common carotid artery to join the deep part of the cardiac plexus. It also receives fibers from the recurrent laryngeal nerve and the vagus nerve.

The ganglion supplies:

  • The middle cervical ganglion may be absent or fused with the superior cervical ganglion.

  • Variable location between C5-C7 5

  • Located within the carotid sheath (8-17%) 5

Horner syndrome can be caused by pathology of the cervical sympathetic ganglia.

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Cases and figures

  • Figure 1: cervical sympathetic ganglia (Gray's illustrations)
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