Superior cervical ganglion
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View Yoshi Yu's current disclosures- Superior cervical ganglia
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.
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Gross anatomy
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.
Location
It is bilaterally located at the level of C1 and C2 vertebra 2-4, anterior to the transverse processes in the retrostyloid space 5.
Relations
anterior: internal carotid arteries and internal jugular veins in the carotid sheath
posterior: longus capitis muscle
inferior and anteromedial: retropharyngeal lymph nodes 4
Arterial supply
branches of ascending pharyngeal arteries
Venous drainage
tributaries draining into the internal jugular veins 6
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Innervation
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:
superior tarsal muscle (the smooth muscle component of levator palpebrae superioris) via the superior branch of the oculomotor nerve
lacrimal glands via the lacrimal nerve
dilator muscle of the iris via short and long ciliary nerves which are branches of the nasociliary nerve
nasal cavity, palate and paranasal sinuses via palatine nerves and post-ganglionic branches of the pterygopalatine ganglion
parotid gland via parotid branches of the auricolotemporal nerve
submandibular glands via post-ganglionic fibers surrounding the facial artery (branch of external carotid artery) as it courses under the gland before giving off fibers to the lingual nerve
sublingual and minor salivary glands via branches of the lingual nerve
heart via a cardiac branch supplying the cardiac plexus
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
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Variant anatomy
The superior cervical ganglion is variably located from C1 to C5 vertebra levels 2-4.
Radiographic features
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.
MRI
retropharyngeal lymph nodes show lower ADC values and contrast-enhancement than superior cervical ganglia
Development
The superior cervical ganglion originates from neural crest cells 9.
Clinical importance
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.
See also
References
- 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
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- Pineal gland
- Ciliary ganglion
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- Alar fascia
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- Dilator pupillae muscle
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- Stellate ganglion block
- Submandibular ganglion
- Submandibular gland
- Oculomotor nerve
- Superior tarsal muscle
- Horner syndrome
- Cardiac plexus
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