General topography
The cervical part of the sympathetic trunk (truncus sympathicus) lies in the deep layers of the neck. It runs strictly medial to the anterior tubercles of the transverse processes of the cervical vertebrae. The trunk is securely covered by the fifth fascia of the neck (prevertebral fascia), which anchors it to the deep muscles and separates it from the more superficial structures of the neurovascular bundle.
Superior cervical sympathetic ganglion
The largest ganglion of the cervical region is the superior cervical sympathetic ganglion (ganglion cervicale superius).
- Skeletotopy: The ganglion lies relatively high, corresponding to the level of the second and third cervical vertebrae.
- Syntopy: Anteriorly, it is covered by major blood vessels — the internal carotid artery and the internal jugular vein.
Relationships with the vagus nerve
The topographic relations between the sympathetic trunk and the vagus nerve (n. vagus) vary along the course of the neck:
- At the level of the superior ganglion: The trunk is crossed anteriorly by the inferior ganglion of the vagus nerve, which descends slightly lateral to the sympathetic structures.
- At the level of the third cervical vertebra: Here, the two neural structures approach each other as closely as possible. This specific anatomical feature makes it possible to perform A.V. Vishnevsky's vagosympathetic block. When a novocaine solution is injected at this level, the anesthetic bathes both the sympathetic trunk and the vagus nerve simultaneously.
- Below the C3 level: The vagus nerve moves away from the sympathetic trunk as it becomes enclosed within its own dense fascial sheath along with the common carotid artery and the internal jugular vein (forming the main neurovascular bundle of the neck).
Branches and connections of the sympathetic trunk
Important communicating and effector branches arise from the superior cervical ganglion:
- Superior cervical cardiac nerve (n. cardiacus cervicalis superior) — runs downward, passing directly along the fascial sheath of the common carotid artery.
- Internal carotid nerve (n. caroticus internus) — ascends into the cranial cavity, accompanying the artery of the same name.
In addition, the superior ganglion gives off numerous communicating branches to the vagus and glossopharyngeal nerves, and has connections with the cervical plexus of spinal nerves.
Topography of the accessory nerve
Accessory nerve (n. accessorius, cranial nerve XI) is also an important element of neck topography. Within the carotid triangle, it can be found by strongly retracting the sternocleidomastoid muscle laterally.
The main function of this nerve is motor. It innervates two large muscles: the sternocleidomastoid (m. sternocleidomastoideus) and the trapezius (m. trapezius).
Briefly: answers to topical questions
Which branches arise from the superior cervical sympathetic ganglion?
The superior cervical sympathetic ganglion gives off branches to the heart, blood vessels, and cranial cavity.
- Superior cervical cardiac nerve (n. cardiacus cervicalis superior) — descends along the sheath of the common carotid artery.
- Internal carotid nerve (n. caroticus internus) — ascends into the cranial cavity.
- Deep petrosal nerve (n. petrosus prof.) — joins the greater petrosal nerve.
- Branches to the external carotid plexus — spread out over the external carotid artery and its branches.
How many ganglia are distinguished in the cervical part of the sympathetic trunk?
Three main ganglia are distinguished in the cervical part of the sympathetic trunk.
- Superior cervical ganglion (ganglion cervicale superius).
- Middle cervical ganglion.
- Inferior cervical ganglion (ganglion cervicale inferius).
The inferior cervical ganglion often fuses with the first thoracic ganglion (ganglion thoracicum I) to form a single cervicothoracic (stellate) ganglion (ganglion cervicothoracicum / stellatum).
Where is the cervicothoracic (stellate) ganglion located?
The cervicothoracic (stellate) ganglion is located deep in the neck, within the scalenovertebral triangle (trigonum scalenovertebrale). It lies between the muscles deep to the prevertebral (fifth) fascia of the neck. Topographically, the ganglion is situated posterior to the inner semicircle of the subclavian artery, medial to the origin of the vertebral artery. It is also adjacent posteriorly to the cervical dome of the pleura along with the head and neck of the first rib and the longus colli muscles.
What branches arise from the middle cervical sympathetic ganglion?
The exact names of the branches of the middle cervical sympathetic ganglion are not specified in the sources. Sympathetic fibers from the middle cervical ganglion join the cardiac nerves and participate in the innervation of the heart. Sympathetic fibers from the cervical ganglia reach the thyroid gland via periarterial plexuses along the superior and inferior thyroid arteries.
Class and exam questions
At what level of the neck is the superior sympathetic ganglion located?
The superior cervical sympathetic ganglion projects at the level of the II and III cervical vertebrae.
Under which fascia does the sympathetic trunk run?
It lies deep to the fifth fascia of the neck, which is also known as the prevertebral fascia.
Why is a vagosympathetic block performed specifically at the level of the third cervical vertebra?
At the C3 level, the sympathetic trunk and the vagus nerve lie in extremely close proximity to each other. Below this level, the vagus nerve is isolated within the dense fascial sheath of the neurovascular bundle.
Which muscles are innervated by the accessory nerve (CN XI)?
It innervates the sternocleidomastoid and trapezius muscles.
What else to study on this topic
- Formation and further course of the superior cervical cardiac nerve
- Sympathetic plexuses of the cranial cavity (continuation of the n. caroticus internus)
- Anatomical connections of the sympathetic trunk with the glossopharyngeal nerve
- Topography of the neurovascular bundle in the carotid triangle
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