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The superior cervical ganglion (SCG) is the upper-most and largest [1] of the cervical sympathetic ganglia of the sympathetic trunk. [1] [2] It probably formed by the union of four sympathetic ganglia of the cervical spinal nerves C1–C4. [1] It is the only ganglion of the sympathetic nervous system that innervates the head and neck.
In rare cases, Horner's syndrome may be the result of repeated, minor head trauma, such as being hit with a soccer ball. Although most causes are relatively benign, Horner's syndrome may reflect serious disease in the neck or chest (such as a Pancoast tumor (tumor in the apex of the lung) or thyrocervical venous dilatation). [citation needed]
Near the stellate ganglion, the sympathetic fibers go around the subclavian artery (shown along with the carotid vessels). This is a site of lesion especially due to its proximity to the apex of the lung (eg. Pancoast's tumor). The superior division of oculomotor nerve is shown supplying the Superior rectus and levator palpebrae superioris.
Postganglionic sympathetic fibres ascend from the superior cervical ganglion, along the walls of the internal carotid artery, to enter the internal carotid plexus.These fibres are then distributed to deep structures, including the superior tarsal muscle and pupillary dilator muscle. [2]
The cervical ganglion has three paravertebral ganglia: superior cervical ganglion (largest) – adjacent to C2 & C3; postganglionic axon projects to target: (heart, head, neck) via "hitchhiking" on the carotid arteries; middle cervical ganglion (smallest) – adjacent to C6; target: heart, neck; inferior cervical ganglion.
The superior end of it is continued upward through the carotid canal into the skull, and forms a plexus on the internal carotid artery; the inferior part travels in front of the coccyx, where it converges with the other trunk at a structure known as the ganglion impar.
The stellate ganglion (or cervicothoracic ganglion [1]) is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic (superior thoracic sympathetic) ganglion, [2] which is present in 80% of individuals. Sometimes, the second and the third thoracic ganglia are included in this fusion.
When the triad of an ipsilateral Horner's syndrome, shoulder/arm pain and weakness of the intrinsic hand muscles occurs, the presentation is called the Pancoast syndrome. This syndrome is due to involvement of brachial plexus roots and that of sympathetic fibers as they exit the cord at T1 and ascend to the superior cervical ganglion. [11] [10]