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Cervicothoracic (stellate) ganglion
P 1303 Gray's:
Cervicothoracic (stellate) ganglion
This is irregular in shape and much larger that the middle cervical ganglion. It is probably formed by a fusion of the lower two cervical and first thoracic segmental ganglia, sometimes including the second and even third and fourth thoracic ganglia. The first thoracic ganglion may be separate, leaving an inferior cervical ganglion above it. The sympathetic trunk turns backwards at the junctions of the neck and thorax and so the long axis of the cervicothoracic ganglion becomes almost anteroposterior. The ganglion lies on or just lateral to the lateral border of the longus colli between the base of the seventh cervical transverse process and the neck of the first rib (which are posterior to it), the vertebral vessels being anterior. Below it is separated from the posterior aspect of the cervical pleura by the suprapleural membrane; the costocervical trunk branches near its lower pole. Lateral is the superior intercostal artery.
A small vertebral ganglion may be present on the sympathetic trunk anterior or anteromedial to the origin of the vertebral artery and directly above the subclavian. When present, it may provide the ansa subclavia and is joined to the cervicothoracic ganglion by fibres enclosing the vertebral artery. It is usually regarded as a detached part of the middle cervical or cervicothoracic ganglion. Like the middle cervical ganglion it may supply grey rami communicantes to the fourth and fifth cervical spinal nerves. The cervicothoracic ganglion sends grey rami communicantes to the seventh and eighth cervical and first thoracic spinal nerves and gives off a cardiac branch, branches to nearby vessels and sometimes a branch to the vagus nerve.
The grey rami communicantes to the seventh cervical spinal nerve vary from one to five; two, the usual number, are shown in 8.398, 399. A third often ascends medial to the vertebral artery in front of the seventh cervical transverse process, connects with the seventh cervical nerve and sends a filament upwards through the sixth cervical transverse foramen in company with the vertebral vessels to join the sixth cervical spinal nerve as it emerges from the intervertebral foramen. An inconstant ramus may traverse the seventh cervical transverse foramen. Grey rami to the the eighth cervical spinal nerve vary from three to six in number.
The cardiac branch descends behind the subclavian artery and along the front of the trachea to the deep cardiac plexus. Behind the artery it connects with the recurrent laryngeal nerve and the cardiac branch of the middle cervical ganglion, the latter often being replaced by fine branches of the cervicothoracic ganglion and ansa subclavia.
Branches to blood vessels form plexuses on the subclavian artery and its branches. The subclavian supply is derived from the cervicothoracic ganglion and ansa subclavia, extending to the first part of the axillary artery; a few fibres may extend further. According to Pearson and Sauter an extension of the subclavian plexus to the internal thoracic artery is joined by a branch of the phrenic nerve (p. 1265). The vertebral plexus is derived mainly from a large branch of the cervicothoracic ganglion which ascends behind the vertebral artery to the sixth transverse foramen, reinforced by branches of the vertebral ganglion or the cervical sympathetic trunk which pass cranially on the ventral aspect of the artery; from this plexus deep rami communicantes join the ventral rami of the upper five or six cervical spinal nerves. The plexus contains some neuronal cell bodies and continues into the skull along the vertebral and basilar arteries and their branches as far as the posterior cerebral artery, where it meets a plexus from the internal carotid. Some consider the vertebral plexus to be the main intracranial extension of the sympathetic system (Lazorthes 1949; Mitchell 1952). The plexus on the inferior thyroid artery reaches the thyroid gland, connecting with recurrent and external laryngeal nerves, the cardiac branch of the superior cervical ganglion, and the common carotid plexus.
The preganglionic fibres for the head and neck emerge from the spinal cord in the upper five thoracic spinal nerves (mainly the upper three), ascending in the sympathetic trunk to synapse in the cervical ganglia. The preganglionic fibres supplying the upper limb stem from upper thoracic segments, probably T2-6 (or 7), ascending via the sympathetic trunk to synapse mainly in its cervicothoracic ganglion, whence postganglionic fibres pass to the brachial plexus (mainly its lower trunk). Most of the vasoconstrictor fibres for the upper limb emerge in the second and third thoracic ventral roots; the arteries can thus be denervated by cutting the sympathetic trunk below the third thoracic ganglion, severing the rami communicantes connected with the second and third thoracic ganglia or by cutting the ventral roots of the second and third thoracic spinal nerves (intradurally). The white ramus to the cervicothoracic ganglion is not cut, partly because it does not convey many vasomotor or sudomotor fibres to the upper limb but mainly because it contains most of the preganglionic fibres for the head and neck; these ascend the trunk to the superior cervical ganglion, from which postganglionic branches supply vasoconstrictor and sudomotor nerves to the face and neck, secretory fibres to the salivary glands, dilator pupillae (and probably cilaris oculi), non-striated muscle in the eyelids and the orbitalis. Destruction of this nerve would thus lead to meiosis, ptosis, enopthalmos and loss of sweating on the face and neck (Horner's syndrome) and possibly some disturbance of accomodation. For a review consult Haxton (1954) and Bannister and Mathias (1992).
Blood vessels of the upper limb beyond the first part of the axillary artery receive their sympathetic supply via branches of the brachial plexus adjacent to them, e.g. the median nerve supplies branches to the brachial artery and palmar arches, the ulnar nerve supplies the ulnar arery and palmar arches and the radial nerve supplies the radial artery.
The first and second (and occasionally the third) intercostal nerves may be interconnected anterior to the necks of the ribs by filaments containing postganglionic fibres from their grey rami; these fibres provide another path by which postganglionic nerves can pass from the upper thoracic ganglia to the brachial plexus.
Why anyone would want to manipulate all this I have no idea. Wait a minute, I do... by pretending that none of it exists in that moment in time, in the neck within one's hands? Sorry, it doesn't all go away just because you close your mind to its existence. You can't wish it away. It's going to be there whatever you do to someone's neck, so start learning less violent ways of treating it.
Next, the thoracic part of the sympathetic system.
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Last edited by Diane; 18-06-2006 at 03:05 AM.