The Cervical Portion of the Sympathetic System - Revision history

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	The '''[[cervical]] portion''' of the sympathetic trunk consists of three ganglia, distinguished, according to their positions, as the '''[[superior]], middle''' and '''[[inferior]] ganglia''' connected by intervening cords.		The '''[[cervical]] portion''' of the sympathetic trunk consists of three ganglia, distinguished, according to their positions, as the '''[[superior]], middle''' and '''[[inferior]] ganglia''' connected by intervening cords.
			[[File:Gray844.png\|thumb\|FIG. 844– Diagram of the cervical sympathetic. (Testut.) (''Picture From the Classic Gray's Anatomy'')]]
	This portion receives no white rami communicantes from the cervical [[spinal nerves]]; its spinal fibers are derived from the white [[rami]] of the upper [[thoracic nerves]], and enter the corresponding thoracic [[ganglia]] of the [[sympathetic trunk]], through which they ascend into the neck.		This portion receives no white rami communicantes from the cervical [[spinal nerves]]; its spinal fibers are derived from the white [[rami]] of the upper [[thoracic nerves]], and enter the corresponding thoracic [[ganglia]] of the [[sympathetic trunk]], through which they ascend into the neck.

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	The '''[[Inferior]] Branch''' communicates with the middle cervical ganglion.		The '''[[Inferior]] Branch''' communicates with the middle cervical ganglion.

			[[File:Gray845.png\|thumb\|FIG. 845– Plan of right sympathetic cord and splanchnic nerves. (Testut.) (''Picture From the Classic Gray's Anatomy'')]]
	The '''[[Lateral]] Branches''' (''external branches'') consist of gray rami communicantes to the upper four [[cervical nerves]] and to certain of the [[cranial nerves]]. Sometimes the branch to the fourth cervical nerve may come from the trunk connecting the upper and middle cervical ganglia. The branches to the cranial nerves consist of delicate filaments, which run to the ganglion nodosum of the vagus, and to the hypoglossal nerve.		The '''[[Lateral]] Branches''' (''external branches'') consist of gray rami communicantes to the upper four [[cervical nerves]] and to certain of the [[cranial nerves]]. Sometimes the branch to the fourth cervical nerve may come from the trunk connecting the upper and middle cervical ganglia. The branches to the cranial nerves consist of delicate filaments, which run to the ganglion nodosum of the vagus, and to the hypoglossal nerve.
	A filament, the '''[[jugular nerve]]''' passes upward to the base of the skull, and divides to join the [[petrous ganglion]] of the [[glossopharyngeal]], and the jugular ganglion of the [[vagus]].		A filament, the '''[[jugular nerve]]''' passes upward to the base of the skull, and divides to join the [[petrous ganglion]] of the [[glossopharyngeal]], and the jugular ganglion of the [[vagus]].
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	The '''[[laryngopharyngeal]] branches''' (''rami laryngopharyngei'') pass to the side of the [[pharynx]], where they join with branches from the glossopharyngeal, vagus, and external laryngeal nerves to form the '''[[pharyngeal plexus]]'''		The '''[[laryngopharyngeal]] branches''' (''rami laryngopharyngei'') pass to the side of the [[pharynx]], where they join with branches from the glossopharyngeal, vagus, and external laryngeal nerves to form the '''[[pharyngeal plexus]]'''

	==== The '''Middle Cardiac Nerve''' ====		==== The '''Middle Cardiac Nerve''' ====
	The '''Middle Cardiac Nerve''' (''n. cardiacus superior'') ''arises'' by two or more branches from the superior cervical ganglion, and occasionally receives a filament from the trunk between the first and second cervical ganglia. It runs down the neck behind the common [[carotid artery]], and in front of the [[Longus colli]] muscle; and crosses in front of the inferior [[thyroid artery]], and recurrent nerve. The course of the nerves on the two sides then differ.		The '''Middle Cardiac Nerve''' (''n. cardiacus superior'') ''arises'' by two or more branches from the superior cervical ganglion, and occasionally receives a filament from the trunk between the first and second cervical ganglia. It runs down the neck behind the common [[carotid artery]], and in front of the [[Longus colli]] muscle; and crosses in front of the inferior [[thyroid artery]], and recurrent nerve. The course of the nerves on the two sides then differ.
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	The '''left nerve''' in the [[thorax]], runs in front of the left common [[carotid artery]] and across the left side of the arch of the aorta, to the superficial part of the [[cardiac plexus]].		The '''left nerve''' in the [[thorax]], runs in front of the left common [[carotid artery]] and across the left side of the arch of the aorta, to the superficial part of the [[cardiac plexus]].

	~~<center>http://www.wikimd.org/images/gray/large/image844.gif </center>~~

	~~FIG. 844– Diagram of the cervical sympathetic. (Testut.) (''Picture From the Classic Gray's Anatomy'')~~
	The '''[[Anterior]] Branches''' (''nn. carotici externi'') [[ramify]] upon the common carotid artery and upon the external carotid artery and its branches, forming around each a delicate [[plexus]], on the nerves composing which small ganglia are occasionally found.		The '''[[Anterior]] Branches''' (''nn. carotici externi'') [[ramify]] upon the common carotid artery and upon the external carotid artery and its branches, forming around each a delicate [[plexus]], on the nerves composing which small ganglia are occasionally found.

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	In the neck, it communicates with the superior cardiac and [[recurrent nerves]]. On the left side, the middle cardiac nerve enters the chest between the left [[carotid]] and [[subclavian]] arteries, and joins the left half of the deep part of the cardiac plexus.		In the neck, it communicates with the superior cardiac and [[recurrent nerves]]. On the left side, the middle cardiac nerve enters the chest between the left [[carotid]] and [[subclavian]] arteries, and joins the left half of the deep part of the cardiac plexus.

	~~<center>http://www.wikimd.org/images/gray/large/image845.gif </center>~~

	~~FIG. 845– Plan of right sympathetic cord and splanchnic nerves. (Testut.) (''Picture From the Classic Gray's Anatomy'')~~

	=== The '''inferior cervical ganglion''' ===		=== The '''inferior cervical ganglion''' ===

Prab at 09:25, 1 September 2023

2023-09-01T09:25:44Z

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[[Anatomy]] > [[Gray's Anatomy| Gray's Anatomy of the Human Body]] > IX. Neurology > 7b. The Cervical Portion of the Sympathetic System

[[Henry Gray]] (1821–1865). Anatomy of the Human Body. 1918.

== '''The Cervical Portion of the Sympathetic System''' ==
'''(Pars Cervicalis S. Sympathici)'''

The '''[[cervical]] portion''' of the sympathetic trunk consists of three ganglia, distinguished, according to their positions, as the '''[[superior]], middle''' and '''[[inferior]] ganglia''' connected by intervening cords.

This portion receives no white rami communicantes from the cervical [[spinal nerves]]; its spinal fibers are derived from the white [[rami]] of the upper [[thoracic nerves]], and enter the corresponding thoracic [[ganglia]] of the [[sympathetic trunk]], through which they ascend into the neck.

=== The '''superior cervical ganglion''' ===
The '''superior cervical ganglion''' (''ganglion cervicale superius''), the largest of the three, is placed opposite the second and third cervical [[vertebrae]]. It is of a reddishgray color, and usually [[fusiform]] in shape; sometimes broad and flattened, and occasionally constricted at intervals; it is believed to be formed by the coalescence of four ganglia, corresponding to the upper four cervical nerves. It is in relation, in ''front'' with the sheath of the internal [[carotid artery]] and internal [[jugular vein]]; ''behind'' with the Longus capitis muscle.
==== Branches ====
Its '''branches''' may be divided into '''inferior, lateral, medial''' and '''anterior'''
The '''[[Inferior]] Branch''' communicates with the middle cervical ganglion.

The '''[[Lateral]] Branches''' (''external branches'') consist of gray rami communicantes to the upper four [[cervical nerves]] and to certain of the [[cranial nerves]]. Sometimes the branch to the fourth cervical nerve may come from the trunk connecting the upper and middle cervical ganglia. The branches to the cranial nerves consist of delicate filaments, which run to the ganglion nodosum of the vagus, and to the hypoglossal nerve.
A filament, the '''[[jugular nerve]]''' passes upward to the base of the skull, and divides to join the [[petrous ganglion]] of the [[glossopharyngeal]], and the jugular ganglion of the [[vagus]].

The '''[[Medial]] Branches''' (''internal branches'') are peripheral, and are the '''larnygopharyngeal branches''' and the '''superior [[cardiac nerve]]'''

The '''[[laryngopharyngeal]] branches''' (''rami laryngopharyngei'') pass to the side of the [[pharynx]], where they join with branches from the glossopharyngeal, vagus, and external laryngeal nerves to form the '''[[pharyngeal plexus]]'''
==== The '''Middle Cardiac Nerve''' ====
The '''Middle Cardiac Nerve''' (''n. cardiacus superior'') ''arises'' by two or more branches from the superior cervical ganglion, and occasionally receives a filament from the trunk between the first and second cervical ganglia. It runs down the neck behind the common [[carotid artery]], and in front of the [[Longus colli]] muscle; and crosses in front of the inferior [[thyroid artery]], and recurrent nerve. The course of the nerves on the two sides then differ.

The '''right nerve''' at the root of the neck, passes either in front of or behind the [[subclavian]] artery, and along the [[innominate]] artery to the back of the arch of the [[aorta]], where it joins the deep part of the [[cardiac plexus]]. It is connected with other branches of the sympathetic; about the middle of the neck it receives filaments from the external [[laryngeal nerve]]; lower down, one or two twigs from the [[vagus]]; and as it enters the [[thorax]] it is joined by a filament from the recurrent nerve. Filaments from the nerve communicate with the thyroid branches from the middle cervical ganglion.

The '''left nerve''' in the [[thorax]], runs in front of the left common [[carotid artery]] and across the left side of the arch of the aorta, to the superficial part of the [[cardiac plexus]].

<center>http://www.wikimd.org/images/gray/large/image844.gif </center>

FIG. 844– Diagram of the cervical sympathetic. (Testut.) (''Picture From the Classic Gray's Anatomy'')
The '''[[Anterior]] Branches''' (''nn. carotici externi'') [[ramify]] upon the common carotid artery and upon the external carotid artery and its branches, forming around each a delicate [[plexus]], on the nerves composing which small ganglia are occasionally found.

The plexuses accompanying some of these arteries have important communications with other nerves. That surrounding the external maxillary artery communicates with the [[submaxillary]] ganglion by a filament; and that accompanying the middle [[meningeal artery]] sends an offset to the [[otic]] ganglion, and a second, the '''external [[petrosal nerve]]''' to the genicular ganglion of the facial nerve.

=== The '''middle cervical ganglion''' ===
The '''middle cervical ganglion''' (''ganglion cervicale medium'') is the smallest of the three cervical ganglia, and is occasionally wanting. It is placed opposite the sixth cervical vertebra, usually in front of, or close to, the inferior [[thyroid artery]]. It is probably formed by the coalescence of two ganglia corresponding to the fifth and sixth [[cervical nerves]].
It sends gray [[rami]] communicantes to the fifth and sixth cervical nerves, and gives off the middle cardiac nerve.
==== The '''Middle Cardiac Nerve''' ====
The '''Middle Cardiac Nerve''' (''n. cardiacus medius; great cardiac nerve''), the largest of the three cardiac nerves, ''arises'' from the middle cervical ganglion, or from the trunk between the middle and inferior ganglia.

On the right side it descends behind the common carotid artery, and at the root of the neck runs either in front of or behind the [[subclavian artery]]; it then descends on the [[trachea]], receives a few filaments from the recurrent nerve, and joins the right half of the deep part of the [[cardiac plexus]].

In the neck, it communicates with the superior cardiac and [[recurrent nerves]]. On the left side, the middle cardiac nerve enters the chest between the left [[carotid]] and [[subclavian]] arteries, and joins the left half of the deep part of the cardiac plexus.

<center>http://www.wikimd.org/images/gray/large/image845.gif </center>

FIG. 845– Plan of right sympathetic cord and splanchnic nerves. (Testut.) (''Picture From the Classic Gray's Anatomy'')

=== The '''inferior cervical ganglion''' ===
The '''inferior cervical ganglion''' (''ganglion cervicale inferius'') is situated between the base of the [[transverse process]] of the last [[cervical vertebra]] and the neck of the first rib, on the medial side of the [[costocervical artery]].

Its form is irregular; it is larger in size than the preceding, and is frequently fused with the first [[thoracic ganglion]]. It is probably formed by the coalescence of two ganglia which correspond to the seventh and eighth cervical nerves. It is connected to the middle cervical ganglion by two or more [[cords]], one of which forms a loop around the subclavian artery and supplies offsets to it. This loop is named the '''ansa subclavia''' (''Vieussenii'').
The ganglion sends gray [[rami]] communicantes to the seventh and eighth cervical nerves.
It gives off the inferior cardiac nerve, and offsets to bloodvessels.

==== The '''inferior cardiac nerve''' ====
The '''inferior cardiac nerve''' (''n. cardiacus inferior'') ''arises'' from either the inferior cervical or the first [[thoracic ganglion]]. It descends behind the [[subclavian artery]] and along the front of the [[trachea]], to join the deep part of the cardiac plexus. It communicates freely behind the subclavian artery with the recurrent nerve and the middle cardiac nerve.

The '''offsets to bloodvessels''' form plexuses on the subclavian artery and its branches. The [[plexus]] on the [[vertebral artery]] is continued on to the basilar, posterior cerebral, and cerebellar arteries. The plexus on the inferior thyroid artery accompanies the artery to the [[thyroid gland]], and communicates with the recurrent and external [[laryngeal nerves]], with the superior [[cardiac nerve]], and with the plexus on the common [[carotid artery]].
==Additional images==
<gallery>
File:Slide1EBAB.JPG|Muscles, arteries and nerves of neck. Newborn dissection.
</gallery>
==External links==
* {{SUNYAnatomyLabs|31|07|02|00}} - "The Sympathetic Trunk and Cervical Ganglia"
* [http://www.instantanatomy.net/headneck/nerves/autonomic/cervicalgangliaconnections.html Cervical ganglia connections (Instantanatomy)]
* [http://www.instantanatomy.net/headneck/nerves/autonomic/cervicalganglianeck.html Instant anatomy]
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