Weak flexors from front of vertebral column skull ¨ superior mediastinum
Covered by strong prevertebral fascia
Front of foramen magnum ¨ lateral mass of atlas.
Edge to edge with anterior; jugular process of occipital bone ¨ transverse process of atlas
Forwards lateral to atlanto-occipital jt ¨ supplies above 2 then ¨ into longus capitis overlying.
- branch goes with XII ¨ meningeal branch, superior root of ansa cervicalis, branches to thyrohyoid and geniohyoid.
From basiocciput (in front of rectus capitis anterior) ¨ four tendons to C3-6 transverse processes
- lies behind nasopharynx, bulging its wall slightly forward
Innervation: anterior rami C1-4; Action: Flexes head
Anterior tubercle of atlas ¨ superior mediastinum
- triangular shape due to upper lower and central fibres converging together
- picks up fibres from front of C2-7 and T1-3 and ant tubercles trans processes C3-6
Innervation: segmentally by anterior rami spinal nerves; Action: flexes head.
Ascends from thorax across neck of 1st rib (medial to highest intercostal vein) ¨ medial to vert a.
- lies in front of prevertebral fascia, behind carotid sheath, medial to vagus
Ends at superior cervical ganglion: 3cm long in front of C2,3 vertebrae.
Middle cervical ganglion: small, inconsistent, medial to carotid tubercle of C6
- in front of inferior thyroid artery
Inferior cervical ganglion: behind commencement of vertebral artery;
- often fused with T1 ganglion ¨ stellate (cervicothoracic) ganglion in front of neck of 1st rib
- connection to middle partly via ansa subclavia; passes in front of subclavian artery.
No white rami from cervical nerves
Grey rami ¨ all 8 cervical nerves; superior ¨ C1-4, middle ¨ C5,6, inferior ¨ C7,8 (ie brach plexus)
Each ganglion also ¨ cardiac branch:
- all pass to deep cardiac plexus apart from upper left ganglion ¨ superficial
- all 6 pass behind CCA and subclavian to superior mediastinum.
Vascular branches follow arteries:
- internal carotid nerve with ICA ¨ internal carotid plexus ¨ all branches + pterygopalatine ganglion + eyeball (latter including motor supply of dilator pupillae of iris).
- Plexus on ECA ¨ all branches + pharyngeal plexus + submandibular + otic ganglia.
- Middle cervical ganglion ¨ inferior thyroid artery
- Inferior cervical ganglion ¨ branches to subclavian and to vertebral artery (vertebral plexus)
Interruption of cervical sympathetics ¨ HornerŐs syndrome.