Cervical Sympathetic Trunk and Distribution Flashcards
Where does the cervical sympathetic trunk lie?
The cervical sympathetic trunk lies on the prevertebral fascia behind the carotid sheath
What does the cervical sympathetic trunk contain?
The cervical sympathetic trunk contains three interconnected ganglia, the superior, middle and inferior (stellate or
cervicothoracic)
Where do the spinal preganglionic fibres of the cervical sympathetic trunk emerge and descend?
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.
What do the grey rami communicantes do in their course?
In their course, the grey rami communicantes may pierce longus capitis or
scalenus anterior
The superior cervical ganglion is the…
Largest of the three ganglia
Where does the superior cervical ganglion?
The superior cervical ganglion lies on the transverse processes of C2 and C3
What is the superior cervical ganglion formed from?
The superior cervical ganglion is formed from 4 fused ganglia judging by its grey rami to C1–4.
What unites the lower end of the ganglion and the middle cervical ganglion?
The Lower end of the ganglion is united by a connecting trunk to the middle
cervical ganglion.
Where are the postganglionic branches distributed?
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
What does the superior cervical ganglion supply?
The superior cervical ganglion supplies the dilator pupillae and smooth muscle in the eyelids and orbitalis.
Where are the postganglionic branches also distributed?
Postganglionic branches are also distributed along the external carotid artery
What does the plexus on the external carotid artery do?
The plexus on the external carotid artery accompany all its branches.
What does the superior cervical ganglion supply?
In addition, the superior cervical ganglion supplies the sympathetic fibres to the pharyngeal plexus,
submandibular and otic ganglia.
What nerves does the superior cervical ganglion supply to the face and neck?
The superior cervical ganglion supplies the vasoconstrictor and sudomotor nerves to the face and neck
The middle cervical ganglion is the…
the smallest of the three, and is occasionally absent
Where is the middle cervical ganglion usually found?
The middle cervical ganglion is usually found at the level of the sixth cervical vertebra, anterior or just
superior to the inferior thyroid artery
What does the middle cervical ganglion represent?
The middle cervical ganglion represents a coalescence of the ganglia of the fifth and sixth cervical
segments
What does the middle cervical ganglion give off?
The middle cervical ganglion gives off thyroid branches that accompany the inferior thyroid artery to the
thyroid gland
What does the middle cervical ganglion communicate with?
The middle cervical ganglion communicates with the superior cardiac, external laryngeal and recurrent
laryngeal nerves, and send branches to the parathyroid glands.
Describe the fibres to both glands[thyroid & parathyroid]
Fibres to both glands are largely vasomotor but some reach the secretory cells.
Where do the fine branches from the middle cervical ganglion pass?
Fine branches from the middle cervical ganglion also pass to the trachea and oesophagus.
Describe the inferior[or cervicothoracic/stellate] ganglion.
The inferior[or cervicothoracic/stellate] are irregular in shape and much larger than the middle cervical ganglion
What is the inferior[or cervicothoracic/stellate] ganglion formed by?
The inferior[or cervicothoracic/stellate] ganglion is formed by a fusion of the lower two cervical and first thoracic segmental ganglia
Describe the state of the first thoracic ganglion?
The first thoracic ganglion may be separate, leaving an inferior cervical ganglion above it
Where does the ganglion lie?
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
What does the inferior[or cervicothoracic/stellate] ganglion send?
The inferior[or cervicothoracic/stellate] ganglion sends grey rami communicantes to the seventh and eighth cervical and first thoracic spinal nerves
What do the inferior[or cervicothoracic/stellate] ganglion give off?
The inferior[or cervicothoracic/stellate] ganglion gives off a cardiac branch, branches to nearby vessels and sometimes a branch to the vagus nerve.
What do the branches to blood vessels form?
The branches to blood vessels form plexuses on the subclavian artery and its branches
What does each ganglion give?
Each ganglion gives a cardiac branch
Where do the branches from the upper left ganglion run down?
The branches from the upper left ganglion runs down to the superficial cardiac plexus
Where do the other branches pass?
The others all pass to the deep plexus
What is Horner’s syndrome?
Horner’s syndrome is any condition or injury that destroys the sympathetic trunk ascending from the thorax
through the neck into the face
What is Horner’s syndrome characterized by and what simulates its occurrence?
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
What does Horner’s syndrome occur as?
Horner’s syndrome occurs as a complication of cervical sympathectomy or a radical neck dissection.
How may the avulsion of the first thoracic nerve from the spinal cord be diagnosed?
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.
