Anatomical variants of the cervical sympathetic chain to be considered during neck dissection

Horner's syndrome, as a complication of radical neck dissection, is given little attention in textbooks of head and neck surgery. To investigate which topographical anatomic factors, if any, might influence damage to the sympathetic chain during neck dissection, we undertook a series of 12 cadaveric neck dissections. The axial position of the cervical sympathetic chain varied. The chain could be clearly delineated from the carotid sheath except in two cadavers, in which it was found within the sheath. The presence of cervical ganglia also varied. We suggest that if the chain is within the sheath, it may be more likely to be injured during operation.