Superior cervical ganglion
Citation, DOI, disclosures and article data
At the time the article was created Francesco Buemi had no recorded disclosures.View Francesco Buemi's current disclosures
At the time the article was last revised Craig Hacking had the following disclosures:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
These were assessed during peer review and were determined to not be relevant to the changes that were made.View Craig Hacking's current disclosures
The superior cervical ganglion (plural: ganglia) is the largest ganglion of the cervical sympathetic trunk, providing autonomic innervation to the head and neck region 1.
On this page:
The superior cervical ganglion is formed by embryologically fused C1 to C4 sympathetic ganglia. It is elongated, cylindric or oval shaped, ~1-3 cm in length 2,3. It has inferior connections to the middle cervical ganglion.
It is bilaterally located at the level of C1 and C2 vertebra 2-4, anterior to the transverse processes in the retrostyloid space 5.
anterior: internal carotid arteries and internal jugular veins in the carotid sheath
posterior: longus capitis muscle
inferior and anteromedial: retropharyngeal lymph nodes 4
branches of ascending pharyngeal arteries
tributaries draining into the internal jugular veins 6
The superior cervical ganglion provides sympathetic innervation to the head and neck. The lower pole of the ganglion is connected to the sympathetic trunk and receives preganglionic nerve fibers. Post-ganglionic fibers of superior cervical ganglion are contained in the internal carotid nerve (a.k.a. internal carotid plexus), which runs superiorly along the internal carotid artery to enter the cranial cavity through the carotid canal 7.
A medial branch containing preganglionic efferent fibers forms a cardiac branch which courses inferiorly between the common carotid artery and longus colli muscle to join the deep part of the cardiac plexus. It receives fibers as it descends in the mid neck from the external laryngeal nerve, vagal cardiac branches and in the root of the neck fibers from the recurrent laryngeal nerve.
The ganglion supplies 7:
lacrimal glands via the lacrimal nerve
submandibular glands via post-ganglionic fibers which runs along the external carotid artery
sublingual and lingual glands via branches of the lingual nerve
parotid gland via parotid branches of the auricolotemporal nerve
nasal cavity, palate and paranasal sinuses via palatine nerves and post-ganglionic branches of the pterygopalatine ganglion
dilator muscle of the iris via short and long ciliary nerves which are branches of the nasociliary nerve
superior tarsal muscle (the smooth muscle component of levator palpebrae superioris) via the superior branch of the oculomotor nerve
heart via a cardiac branch supplying the cardiac plexus
Several branches of the superior cervical ganglion have been reported 8:
communicating branch of the cervical nerve
communicating branch of the pharyngeal mucosa
internal carotid branch
communicating branch of the vagus nerve
communicating branch of the superior laryngeal nerve
communicating branch of the internal jugular vein
The superior cervical ganglion is variably located from C1 to C5 vertebra levels 2-4.
Superior cervical ganglia can be mistaken for pathological retropharyngeal lymph nodes; therefore differentiating them is critical 4. Discrimination between the two is possible on MRI considering the location and anatomical relations.
retropharyngeal lymph nodes show lower ADC values and contrast-enhancement than superior cervical ganglia
The superior cervical ganglion originates from neural crest cells 9.
Horner syndrome may result from the surgical damage of the superior cervical ganglion after an anterior cervical approach 1. Superior cervical ganglion block through local injections of opioids has been reported to relieve facial pain 10.
- 1. Fazliogullari Z, Kilic C, Karabulut A, Yazar F. A Morphometric Analysis of the Superior Cervical Ganglion and Its Surrounding Structures. Surg Radiol Anat. 2015;38(3):299-302. doi:10.1007/s00276-015-1551-3 - Pubmed
- 2. Kiray A, Arman C, Naderi S, Güvencer M, Korman E. Surgical Anatomy of the Cervical Sympathetic Trunk. Clin Anat. 2005;18(3):179-85. doi:10.1002/ca.20055 - Pubmed
- 3. Civelek E, Karasu A, Cansever T et al. Surgical Anatomy of the Cervical Sympathetic Trunk During Anterolateral Approach to Cervical Spine. Eur Spine J. 2008;17(8):991-5. doi:10.1007/s00586-008-0696-8 - Pubmed
- 4. Yokota H, Mukai H, Hattori S, Yamada K, Anzai Y, Uno T. MR Imaging of the Superior Cervical Ganglion and Inferior Ganglion of the Vagus Nerve: Structures That Can Mimic Pathologic Retropharyngeal Lymph Nodes. AJNR Am J Neuroradiol. 2018;39(1):170-6. doi:10.3174/ajnr.A5434 - Pubmed
- 5. Barral J & Croibier A. Autonomic Nervous System. Manual Therapy for the Cranial Nerves. 2009;:255-64. doi:10.1016/b978-0-7020-3100-7.50034-3
- 6. Tubbs R, Salter G, Wellons J, Oakes W. Blood Supply of the Human Cervical Sympathetic Chain and Ganglia. Eur J Morphol. 2002;40(5):283-8. doi:10.1076/ejom.40.5.283.28905 - Pubmed
- 7. Susan Standring. Gray's Anatomy. (2015) ISBN: 9780702063060 - Google Books
- 8. Mitsuoka K, Kikutani T, Sato I. Morphological Relationship Between the Superior Cervical Ganglion and Cervical Nerves in Japanese Cadaver Donors. Brain Behav. 2017;7(2):e00619. doi:10.1002/brb3.619 - Pubmed
- 9. Kameda Y, Saitoh T, Nemoto N, Katoh T, Iseki S. Hes1 is Required for the Development of the Superior Cervical Ganglion of Sympathetic Trunk and the Carotid Body. Dev Dyn. 2012;241(8):1289-300. doi:10.1002/dvdy.23819 - Pubmed
- 10. Siegenthaler A, Haug M, Eichenberger U, Suter M, Moriggl B. Block of the Superior Cervical Ganglion, Description of a Novel Ultrasound-Guided Technique in Human Cadavers. Pain Med. 2013;14(5):646-9. doi:10.1111/pme.12061 - Pubmed
- 11. Robert H. Whitaker, Neil R. Borley. Instant Anatomy. ISBN: 9780632054039