Cervical Sympathetic Trunks

Cervical Part
of
Sympathetic Trunks
Presented by :- Dr. Sushma Tomar

Associate Professor
Department of Anatomy
Introduction
• There are two sympathetic trunks (right
& left) in human body.
Location-
• Each sympathetic trunk is paravertebral

in position.
• Each sympathetic trunk extends from

the base of skull to the first coccygeal
vertebra (base of coccyx).
Introduction contd…
• At the base of coccyx, both
sympathetic trunks join to
form Ganglion Impar.
Sympathetic Trunks In The Neck
Location-
• Cervical part of
sympathetic trunk lies in
front of transverse
processes of cervical
vertebrae and neck of 1st
rib.
• Each sympathetic trunk

presents 3 ganglia in the
cervical part:-
• Superior.
• Middle.
• Inferior.
Sympathetic Trunks In The Neck contd…
• Sometimes, inferior cervical and first thoracic sympathetic
ganglion are fused to form a cervico-thoracic or stellate
ganglion.
Sympathetic Trunks In The Neck contd…
 Initially the number of cervical
sympathetic ganglia
corresponds with the number of
spinal nerves.
• Later, upper 4 cervical ganglia

fuse to form superior cervical
ganglion.
• 5th & 6th cervical ganglia fuse to

form middle cervical ganglion.
• 7th & 8th cervical ganglia fuse to

form inferior cervical ganglion.
Cervical Part Of Sympathetic Trunk Contd…
• Cervical part of the trunk
does not receive pre-
ganglionic fibres through
white rami communicantes
from the cervical segments
of the spinal cord.
• Each cervical sympathetic

trunk gives post-
ganglionic fibres via grey
rami communicantes to
each of the 8th cervical
spinal nerves.
Cervical Part Of Sympathetic Trunk Contd…
• All pre-ganglionic fibres

for the cervical sympathetic
trunk are derived from
lateral horn cells of T1-T5
segments of spinal cord.
• These preganglionic fibres

ascend through the trunk
and finally relayed in 3
cervical sympathetic
ganglia.
Superior Cervical Ganglion
• Largest of the cervical sympathetic
ganglia.
• Formed by the fusion of upper 4

cervical sympathetic ganglia.
SHAPE- Fusiform (spindle).
LENGTH- ~2.5 cm.
LOCATION-
• In front of transverse processes of C2
& C3 vertebrae.
Superior Cervical Ganglion
• It receives pre-ganglionic
fibres mostly from upper 3
thoracic segments of
spinal cord.
Branches Of Superior Cervical Ganglion
 Divided into following

groups:-
• Lateral.
• Medial.
• Anterior.
• Ascending.
 All branches convey post-

ganglionic fibres and
some sensory fibres from
the target organs.
Lateral Branches Of Superior Cervical Ganglion
• These are grey rami

communicans to upper 4
cervical nerves.
Medial Branches Of Superior Cervical Ganglion
• Laryngo-pharyngeal
branches.
• Cardiac branch.
Laryngo-pharyngeal
branches-
• Supply Carotid body.
• Form pharyngeal plexus with
9th & 10th nerves.
Cardiac branch-
• Right cardiac branch joins
with the deep cardiac plexus.
• Left cardiac branch joins with
the superficial cardiac plexus.
Anterior Branches Of Superior Cervical
•
Ganglion
These ramify around common
carotid aretry, external carotid
artery and its branches.
• Sympathetic plexus around

facial artery gives a filament to
the submandibular ganglion.
• Sympathetic plexus around

middle meningeal artery gives a
filament to the otic ganglion
and another filament to the
genicular ganglion of facial
nerve as external petrosal nerve.
Ascending Branches Of Superior Cervical
Ganglion
• Internal Carotid Nerve.
Branches of Sympathetic
Plexus around Internal
Carotid Artery-
• Carotido-tympanic nerves.
• Deep petrosal nerve.
• Nervus conarii- supply pineal

gland.
• Communicating branches- to
trigeminal ganglion, 3rd , 4th ,
5th & 6th cranial nerves.
• Terminal branches- supply

the piamater and tarsal
muscles.
Middle Cervical Ganglion
• Formed by the fusion of 5th & 6th
cervical sympathetic ganglia.
LOCATION-
• In front of transverse process of 6th
cervical vertebra.
• Just above the loop of inferior
thyroid artery .
Middle Cervical Ganglion Contd…
COMMUNICATIONS-
• Connected with inferior

cervical ganglion by ansa
subclavia.
• Ansa subclavia loops in

front and below the first
part of subclavian artery.
Branches Of Middle Cervical Ganglion
• Lateral.
• Medial.
Lateral branches-
• These are grey rami
comminicans to 5th & 6th
spinal nerves.
Medial branches-
• Thyroid branches.
• Cardiac branches.
Inferior Cervical Ganglion
• Formed by the fusion of 7th & 8th
cervical ganglia.
LOCATION-
• Between transverse process of C7

vertebra and neck of 1st rib.
Inferior Cervical Ganglion Contd…
• Sometimes this ganglion
joins with the first thoracic
sympathetic ganglion to
form cervico-thoracic or
stellate ganglion.
Branches Of Inferior Cervical Ganglion
• Grey rami communicans.
• Cardiac branches.
• Vascular branches.
Grey Rami Communicans-
• To C7 & C8 cervical
spinal nerves.
Vascular Branches-
• Form plexuses around
subclavian artery, 1st part
of axillary artery and
vertebral artery.
Applied Anatomy
HORNER’S SYNDROME-
• A lesion affecting the pre-ganglionic fibres
from T1 & T2 segments of spinal cord.
Clinical Features-
• Constriction of pupil (miosis).
• Drooping of upper eyelid (ptosis).
• Enophthalmos.
• Absence of sweating on affected half of

face and head (anhydrosis).
• Loss of ciliospinal reflex.

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Cervical Part

Presented by :- Dr. Sushma Tomar

• Each sympathetic trunk is paravertebral

• Each sympathetic trunk extends from

• Each sympathetic trunk

• Later, upper 4 cervical ganglia

• 5th & 6th cervical ganglia fuse to

• 7th & 8th cervical ganglia fuse to

• Each cervical sympathetic

• All pre-ganglionic fibres

• These preganglionic fibres

• Formed by the fusion of upper 4

SHAPE- Fusiform (spindle).

LENGTH- ~2.5 cm.

 Divided into following

 All branches convey post-

• These are grey rami

• Sympathetic plexus around

• Sympathetic plexus around

• Deep petrosal nerve.

• Nervus conarii- supply pineal

• Terminal branches- supply

• Connected with inferior

• Ansa subclavia loops in

• Between transverse process of C7

Grey Rami Communicans-

• Constriction of pupil (miosis).

• Drooping of upper eyelid (ptosis).

• Absence of sweating on affected half of

• Loss of ciliospinal reflex.

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