The cervical sympathetic chain runs in the posterior carotid space, medial to the carotid sheath, on the prevertebral fascia. It consists of the superior cervical ganglion (C1-C4, largest, below skull base), the middle cervical ganglion (at C6, inconstant), and the inferior cervical ganglion (usually fused with T1 to form the stellate ganglion). Postganglionic sympathetic fibres ascend with the carotid arteries to supply the head, face, and orbit.
The cervical sympathetic chain produces Horner syndrome when disrupted: ptosis (superior tarsal muscle), miosis (dilator pupillae), anhidrosis (facial sweat glands), and enophthalmos. Central Horner syndrome affects the hypothalamospinal tract; preganglionic Horner syndrome involves the chain from T1 to the superior cervical ganglion; postganglionic Horner involves the pericarotid plexus. Pharmacological testing (cocaine, apraclonidine, hydroxyamphetamine) localises the lesion level. The cervical chain is damaged by carotid dissection, neck dissection, lung apex tumours, and cervical spine surgery.
Radical neck dissection stripping the prevertebral fascia may injure the cervical sympathetic chain running on its deep surface, producing Horner syndrome with ptosis, miosis, and ipsilateral facial anhidrosis; modified neck dissection with preservation of the prevertebral fascia reduces this risk but cannot eliminate it when nodes are adherent to the chain.
This website uses cookies to enhance your experience. Some are essential for site functionality, while others help us analyze and improve your usage experience. Please review your options and make your choice.
If you are under 16 years old, please ensure that you have received consent from your parent or guardian for any non-essential cookies.
Your privacy is important to us. You can adjust your cookie settings at any time. For more information about how we use data, please read our privacy policy. You may change your preferences at any time by clicking on the settings button below.
Note that if you choose to disable some types of cookies, it may impact your experience of the site and the services we are able to offer.
Some required resources have been blocked, which can affect third-party services and may cause the site to not function properly.
This website uses cookies to enhance your browsing experience and ensure the site functions properly. By continuing to use this site, you acknowledge and accept our use of cookies.
