The middle cervical ganglion is the smallest of the three cervical sympathetic ganglia and is sometimes absent. It lies on the sympathetic trunk at about the level of the C6 vertebra, near the arch of the inferior thyroid artery. It sends grey rami to the C5 and C6 spinal nerves, branches to the thyroid, and the middle cervical cardiac nerve to the cardiac plexus.
| Origin | Preganglionic sympathetic fibres from the upper thoracic spinal cord ascending in the sympathetic trunk |
|---|---|
| Course | Lies on the sympathetic trunk at the C6 level, in front of or just above the inferior thyroid artery, connected below to the cervicothoracic ganglion by the sympathetic trunk and the ansa subclavia |
| Motor |
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| Sensory |
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The middle cervical ganglion is linked to the cervicothoracic (stellate) ganglion by the ansa subclavia, a loop around the subclavian artery, and lies close to the target used for stellate ganglion block at the C6 anterior tubercle. Injury during thyroidectomy, ligation of the inferior thyroid artery or neck dissection can interrupt sympathetic fibres to the head, producing Horner syndrome. Its cardiac branch carries pain fibres from the heart.
Damage to the cervical sympathetic trunk at the middle ganglion during thyroid or anterior spine surgery causes ptosis, a small pupil and reduced facial sweating on the same side.
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