Superior cervical ganglion
Ganglion · C2–C3 level Input from T1–T3
Largest chain ganglion, lying at the level of C2–C3 behind the carotid sheath. It receives preganglionic fibres that ascended from T1 (and T2–T3) and is the relay for all sympathetic supply to the head: eye, face, salivary glands, nasal mucosa and pineal.
Traced from the start
- Sympathetic (thoracolumbar) outflow
- Intermediolateral cell column T1–L2 via white rami communicantes
- Superior cervical ganglion
Detail
- Position
- Opposite C2–C3 transverse processes, posterior to the internal carotid artery, anterior to longus capitis
- Branches
- Internal carotid nerve → internal carotid plexus; external carotid plexus; grey rami to C1–C4; superior cardiac nerve; pharyngeal branches
- Fibres passing through to ganglia
- Deep petrosal nerve to the pterygopalatine ganglion and sympathetic root of the ciliary ganglion pass through those ganglia without synapsing
- Other cervical ganglia
- Middle (C6) and inferior (C7, usually fused with T1 as the stellate ganglion)
When it goes wrong
Internal carotid artery dissection, skull base tumour or cavernous sinus lesion damaging fibres distal to the ganglion
Postganglionic (third-order) Horner syndrome with ipsilateral neck pain or headache; facial sweating is spared because sudomotor fibres left with the external carotid — a painful Horner is a dissection until proven otherwise
Stellate ganglion block for upper limb pain or after central line/brachial plexus procedures
Transient Horner syndrome signals a successful block or an iatrogenic sympathetic injury
Practise this structure
1 question in the bank tagged Autonomic.