Superior cervical ganglion

Last revised by Yoshi Yu on 15 Apr 2023

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.

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.

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. Postganglionic fibers emerging from the superior cervical ganglion ascend to the head via nerve plexuses surrounding arteries, primarily via the internal carotid plexus and external carotid plexus 12.

One or more medial branches containing preganglionic efferent fibers forms the superior cardiac nerve which courses inferiorly between the common carotid artery and longus colli muscle to join the deep part of the cardiac plexus. As it descends in the mid neck, it receives nerve fibers from the external laryngeal nerve and vagal cardiac branches, and in root of the neck fibers from the recurrent laryngeal nerve.

The ganglion supplies 7:

Several branches of the superior cervical ganglion have been reported 8:

  • pharyngeal branch

  • 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

  • laryngeal branch

  • 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.

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Cases and figures

  • Figure 1: cervical sympathetic ganglia (Gray's illustrations)
    Drag here to reorder.