Superior cervical ganglion

Last revised by Travis Fahrenhorst-Jones on 28 Apr 2022

The superior cervical ganglion (plural: ganglia) is the largest ganglion of the cervical sympathetic trunk, providing 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 is bilaterally located at the level of C1-C2 vertebra 2-4, in the retrostyloid space 5, with the following relations:

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.

It 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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