Cervical Sympathetic Trunk and Distribution

Question 1

Where does the cervical sympathetic trunk lie?

Answer 1

The cervical sympathetic trunk lies on the prevertebral fascia behind the carotid sheath

Question 2

What does the cervical sympathetic trunk contain?

Answer 2

The cervical sympathetic trunk contains three interconnected ganglia, the superior, middle and inferior (stellate or
cervicothoracic)

Question 3

Where do the spinal preganglionic fibres of the cervical sympathetic trunk emerge and descend?

Answer 3

The spinal spinal preganglionic fibres[cervical sympathetic trunk] emerge in the white rami communicantes of the
upper five thoracic spinal nerves (mainly the upper three), and ascend in the
sympathetic trunk to synapse in the cervical ganglia.

Question 4

What do the grey rami communicantes do in their course?

Answer 4

In their course, the grey rami communicantes may pierce longus capitis or
scalenus anterior

Question 5

The superior cervical ganglion is the…

Answer 5

Largest of the three ganglia

Question 6

Where does the superior cervical ganglion?

Answer 6

The superior cervical ganglion lies on the transverse processes of C2 and C3

Question 7

What is the superior cervical ganglion formed from?

Answer 7

The superior cervical ganglion is formed from 4 fused ganglia judging by its grey rami to C1–4.

Question 8

What unites the lower end of the ganglion and the middle cervical ganglion?

Answer 8

The Lower end of the ganglion is united by a connecting trunk to the middle
cervical ganglion.

Question 9

Where are the postganglionic branches distributed?

Answer 9

Postganglionic branches are distributed in the internal carotid nerve, which
ascends with the internal carotid artery into the carotid canal to enter the cranial
cavity

Question 10

What does the superior cervical ganglion supply?

Answer 10

The superior cervical ganglion supplies the dilator pupillae and smooth muscle in the eyelids and orbitalis.

Question 11

Where are the postganglionic branches also distributed?

Answer 11

Postganglionic branches are also distributed along the external carotid artery

Question 12

What does the plexus on the external carotid artery do?

Answer 12

The plexus on the external carotid artery accompany all its branches.

Question 13

What does the superior cervical ganglion supply?

Answer 13

In addition, the superior cervical ganglion supplies the sympathetic fibres to the pharyngeal plexus,
submandibular and otic ganglia.

Question 14

What nerves does the superior cervical ganglion supply to the face and neck?

Answer 14

The superior cervical ganglion supplies the vasoconstrictor and sudomotor nerves to the face and neck

Question 15

The middle cervical ganglion is the…

Answer 15

the smallest of the three, and is occasionally absent

Question 16

Where is the middle cervical ganglion usually found?

Answer 16

The middle cervical ganglion is usually found at the level of the sixth cervical vertebra, anterior or just
superior to the inferior thyroid artery

Question 17

What does the middle cervical ganglion represent?

Answer 17

The middle cervical ganglion represents a coalescence of the ganglia of the fifth and sixth cervical
segments

Question 18

What does the middle cervical ganglion give off?

Answer 18

The middle cervical ganglion gives off thyroid branches that accompany the inferior thyroid artery to the
thyroid gland

Question 19

What does the middle cervical ganglion communicate with?

Answer 19

The middle cervical ganglion communicates with the superior cardiac, external laryngeal and recurrent
laryngeal nerves, and send branches to the parathyroid glands.

Question 20

Describe the fibres to both glands[thyroid & parathyroid]

Answer 20

Fibres to both glands are largely vasomotor but some reach the secretory cells.

Question 21

Where do the fine branches from the middle cervical ganglion pass?

Answer 21

Fine branches from the middle cervical ganglion also pass to the trachea and oesophagus.

Question 22

Describe the inferior[or cervicothoracic/stellate] ganglion.

Answer 22

The inferior[or cervicothoracic/stellate] are irregular in shape and much larger than the middle cervical ganglion

Question 23

What is the inferior[or cervicothoracic/stellate] ganglion formed by?

Answer 23

The inferior[or cervicothoracic/stellate] ganglion is formed by a fusion of the lower two cervical and first thoracic segmental ganglia

Question 24

Describe the state of the first thoracic ganglion?

Answer 24

The first thoracic ganglion may be separate, leaving an inferior cervical ganglion above it

Question 25

Where does the ganglion lie?

Answer 25

The ganglion lies on or just lateral to the lateral border of longus colli between the base of the seventh cervical transverse process and the neck of the first rib

Question 26

What does the inferior[or cervicothoracic/stellate] ganglion send?

Answer 26

The inferior[or cervicothoracic/stellate] ganglion sends grey rami communicantes to the seventh and eighth cervical and first thoracic spinal nerves

Question 27

What do the inferior[or cervicothoracic/stellate] ganglion give off?

Answer 27

The inferior[or cervicothoracic/stellate] ganglion gives off a cardiac branch, branches to nearby vessels and sometimes a branch to the vagus nerve.

Question 28

What do the branches to blood vessels form?

Answer 28

The branches to blood vessels form plexuses on the subclavian artery and its branches

Question 29

What does each ganglion give?

Answer 29

Each ganglion gives a cardiac branch

Question 30

Where do the branches from the upper left ganglion run down?

Answer 30

The branches from the upper left ganglion runs down to the superficial cardiac plexus

Question 31

Where do the other branches pass?

Answer 31

The others all pass to the deep plexus

Question 32

What is Horner’s syndrome?

Answer 32

Horner’s syndrome is any condition or injury that destroys the sympathetic trunk ascending from the thorax
through the neck into the face

Question 33

What is Horner’s syndrome characterized by and what simulates its occurrence?

Answer 33

Horner’s syndrome is characterized by a drooping eyelid (ptosis), sunken globe (enophthalmos),
narrow palpebral fissure, contracted pupil (meiosis),
vasodilatation and lack of thermal sweating (anhydrosis) on the affected side - this occurs classically when a bronchial carcinoma invades the sympathetic trunk

Question 34

What does Horner’s syndrome occur as?

Answer 34

Horner’s syndrome occurs as a complication of cervical sympathectomy or a radical neck dissection.

Question 35

How may the avulsion of the first thoracic nerve from the spinal cord be diagnosed?

Answer 35

Avulsion of the first thoracic nerve from the spinal cord may be diagnosed by development of the syndrome after closed traction lesion of the supraclavicular brachial plexus.