Superior cervical ganglion
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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.
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. 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:
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
- 12. Razipour S, Zarrintan S, Mathkour M, Iwanaga J, Dumont A, Tubbs R. Review of the External Carotid Plexus: Anatomy, Function, and Clinical Manifestations. Anat Cell Biol. 2021;54(2):137-42. doi:10.5115/acb.20.308 - Pubmed