Congenital torticollis is usually not apparent at birth but within the first week a swelling is noted over the sternoclei-domastoid muscle (stenomastoid tumor). This is thought to occur as a result of spasm, hemorrhage or fibrosis. It results in shortening of the sternocleidomastoid muscle and tilting of the head. It is important to recognize since it may cause astigmatism. Figure 4.52. Congenital torticollis is usually not apparent at birth but within the first week a swelling is noted over the sternoclei-domastoid muscle (stenomastoid tumor). This is thought to occur as a result of spasm, hemorrhage or fibrosis. It results in shortening of the sternocleidomastoid muscle and tilting of the head. It is important to recognize since it may cause astigmatism.
Speaking, or changes in head position. Typically, the first muscles involved are in the periorbital region, preceded by facial weakness, and within months spreading to ipsilateral facial muscles. These twitches continue in sleep. Blink reflexes are expressed normally. Hemifacial spasms occur when the facial nerve is compressed at the root entry zone, usually by the anterior or posterior inferior cerebellar or vertebral artery. Treatment of choice is botulinum toxin injections, but clonazepam is also prescribed (Sathornsumetee and Stacy in press). Video Segment 29
Compressions will seriously decrease the number of cycles given per minute. This can be a very real problem for the solo rescuer and there is no easy solution. In the infant and small child, the free hand can maintain the head position. The correct position for compressions should not be re-measured after each ventilation.
The sternum has to be pulled continuously, and the endothoracic membrane is to be separated from the sternum. A longitudinal incision along the anterior border of the left sternocleidomastoid muscle is made to expose the cervical esophagus. Blunt preparation with the hand through the substernal tunnel usually leads to rupture of the mediastinal pleura (A-1,A-2,A-3).
Thorough surgical extirpation is the only curative treatment for MTC. In patients without a palpable neck mass who are found to be carriers of a RET mutation by genetic testing, total thyroidectomy and central node dissection are recommended. At our institution, total parathyroidectomy with autotransplantation is often done at the same time as total thy-roidectomy for MTC. This is because the parathyroid glands are closely associated with perithyroidal lymph nodes and preservation of these glands is difficult if the central nodes are removed. The vascular supply to a parathyroid gland may be interrupted by dissection and excision of perithyroidal and central nodes. Parathyroid glands are therefore removed and preserved in cold saline at the time of thyroidectomy for MTC. The glands are sliced into 20 1 x 3 mm fragments and autotransplanted into the muscle of the nondominant forearm (in patients with MEN type IIA) or sternocleidomastoid muscle (in patients with FMTC or MEN type IIB)....
The indication or the role of GPi DBS for cervical dystonias (CD) has not yet been established 4 . However, based on our experience of 132 CD patients treated with selective peripheral denervation, we strongly believe that GPi DBS is definitely indicated in the complex type of CD. Complex type of CD is characterized by irregular involuntary head and neck movements and diffuse bilateral involvement of the neck muscles. Neurosurgical treatment of CD has a long history. In the beginning, the sternocleidomastoid muscle (SCM) and the accessory nerve were the target of surgical intervention. Then the importance of the posterior neck muscles, mainly the splenius muscle (SPL), was recognized. In order to denervate the accessory and cervical spinal nerves innervating to SCM and SPL, intradural rhizotomy was started, with some benefit. But inadequate denervation of SPL and complications due to denervation of normal muscles, turned out to be a problem. Some performed spinal cord stimulation to...
Symptoms are primarily those of increasing muscle weakness and neuromuscular fatigue, which improve after resting. Muscles of the eye and face are affected early in the disease, producing ptosis and diplopia. Bulbar palsy may result in swallowing and speech difficulties, and neck muscles may be affected. Sometimes respiratory muscle involvement occurs early. Variable progression or remission may occur.The involvement of particular muscle groups is inconstant, but proximal muscles of the upper limbs are affected more frequently than the lower limbs.
After treatment with l-DOPA, rats with a unilateral 6-OHDA lesion show torsional movements and twisted postures of the trunk and the neck toward the side contralateral to the lesion. When the dystonic posture of the upper trunk is very severe it may cause the animal to lose balance and fall down to the floor, making one or more rotational movements before regaining a bipedal sitting position (note that the asymmetric body posture precedes and accompanies the rotational movement).
Work-related musculoskeletal injuries are a major cause of decreased productivity and increased litigation costs in the United States.23 In the OR, occupational injuries can be caused by excessive lifting, improper posture, collision with devices, electrical or thermal injury, puncture by sharp instruments, or exposure to bodily tissues and fluids. Temporary musculoskeletal injuries resulting from poor posture (particularly static posture) or excessive straining are less commonly acknowledged by members of the surgical team but occur relatively frequently during some operations.
The muscles of the abdominal cavity are infrequently involved in either the disease process or the operative procedure in gynecologic oncology. However, they do serve as borders for lymph node dissections. For instance, the middle of the psoas muscle marks the lateral extent of the pelvic lymphadenectomy and the internal obturator muscle does the same for the obturator space lymphadenectomy. The muscles of the proximal lower extremity are similarly used as landmarks in the inguinofemoral dissection (see Figures 3-5, Chapter 15). During a scalene node biopsy, the dissection is carried to the surface of the scalenus anterior muscle between the sternocleidomastoid and the trapezius muscles (Figures 9, 10). Bony and cutaneous landmarks are sometimes overlooked by junior operating surgeons in their eagerness to enter the abdomen (see Figure 9). However, more experienced surgical oncologists will recognize their value in planning successful gynecologic oncology procedures. For instance,...
Termination Palate, pharynx, sternocleidomastoid and trapezius muscles Effects of damage Impaired movement of head, neck, and shoulders difficulty in shrugging shoulders on damaged side paralysis of sternocleidomastoid, causing head to turn toward injured side Clinical test Test ability to rotate head and shrug shoulders against resistance
The internal jugular23 (JUG-you-lur) vein courses down the neck, alongside the internal carotid artery, deep to the sternocleidomastoid muscle. It receives most of the blood from the brain, picks up blood from the facial vein and superficial temporal vein along the way, passes deep to the clavicle, and joins the subclavian vein. (Note that the facial vein empties into both the cavernous sinus and the internal jugular vein.) 2. The external jugular vein drains tributaries from the parotid gland, facial muscles, scalp, and other superficial structures. Some of this blood also follows venous anastomoses to the internal jugular vein. The external jugular vein courses down the side of the neck superficial to the sternocleidomastoid muscle and empties into the subclavian vein.
Central nervous system disorders are among the three major causes of mortality in neonates. All of the conditions that affect the infant's brain do so in part because this system is developing at a rapid rate. The neurologic examination of the newborn must thus be interpreted in the context of the child's brain maturation (gestational age) and level of alertness. The examination should be brief so as to avoid hypoxemia and fluctuations in arterial blood pressure. Head circumference is a useful measure of intracranial volume, and longitudinal measurements in particular provide important information. Observation of movement and symmetry can contribute significantly to the evaluation while minimizing the effects of handling, especially in the sick neonate. These observations should include any available assessment of the fetus in the intrauterine environment. Examination of the following cranial nerves is possible 1 (olfaction) 2 (optic fundi) 3 (pupils) 3, 4, 6 (extraarticular...
Abnormal development of the branchial clefts and arches may result in remnants, fistulae or cysts. Defects are usually unilateral and the external opening lies at the anterior edge of the sternocleidomastoid muscle, usually at the lower third. Secondary bacterial infection and cyst formation may occur. In this infant there is a branchial cleft remnant.
The principal flexors of the neck are the sternocleidomastoid34 and three scalenes on each side (fig. 10.10). The prime mover is the sternocleidomas-toid, a thick cordlike muscle that extends from the sternum and clavicle to the mastoid process behind the ear. It is most easily seen and palpated when the head is turned to one side and slightly extended. As it passes obliquely across the neck, the sternocleidomastoid divides it into anterior and posterior triangles. Other muscles and landmarks subdivide each of these into smaller triangles of surgical importance (fig. 10.11). When both sternocleidomastoids contract, the neck flexes forward for example, when you look down at something between your feet. When only the left one contracts, the head tilts down and to the right, and when the right one acts alone, it draws the head down and to the left. To visualize this action, hold the index finger of Sternocleidomastoid (STIR-no-CLY-doe-MASS-toyd) your left hand...
In neurosurgical procedures, air enters most frequently via veins held open by the neck muscles, or those in the dura, venous sinuses, or bone. In sterotactic procedures under local anaesthesia the event often occurred immediately after opening the dura (Stone et al 1997).
A major use of biofeedback is to teach relaxation skills. A second use of biofeedback is to alter pathophysiological processes such as blood flow or SNS arousal for migraine headache patients, to decrease the flow of gastric juices for ulcer patients, to decrease muscle tension and increase proper posture for the chronic back-pain patient. Biofeedback should be considered as a therapeutic tool that can help introduce the client to therapy in a concrete and nonthreaten-ing manner. It can be especially useful for the patient who focuses on physical problems or insists his problems are not physiological. Biofeedback can also be used to increase feelings of self-efficacy and self-control. The client learns quickly the connection between emotions, thoughts, and physiological responses.
Be very aware of your posture as you sit and walk, and keep your head up and your spine straight. Keeping your shoulders back and your abdominal muscles pulled in will also increase your back muscle strength to support your spine. You can do some gentle arm and shoulder exercises when you are sitting but use pain as your guide. If just lifting a teacup causes pain, then activities using the arms and shoulders may need to be avoided for a while. Some experts suggest partial squat exercises, which help to increase the strength of your thigh muscles, without causing additional stress on the spine.
Quality Branchial motor innervation of the sternocleidomastoid and trapezius muscles. Outside the jugular foramen, the nerve passes posteriorly and medially to the styloid process, then descends obliquely to enter the upper portion of the sternocleidomastoid muscle. The nerve crosses the posterior triangle of the neck, closely associated to lymph nodes. Above the clavicle it passes the deep anterior border of the trapezius to supply this muscle.
Most patients with Lemierre's syndrome are older than 10 years (62). The patients look toxic and manifest fever, sore throat, cough neck, pain, dyspnea, and arthralgia. Palpable jugular arch can be detected in about 20 of patients. Swelling and tenderness at the angle of the jaw and along the sternocleidomastoid muscle with signs of severe sepsis along with evidence of pleuropulmonary emboli, is very suggestive of thrombophlebitis of the internal jugular vein (61).
Patients with suspected sporadic, nonfamilial hyperparathyroidism should undergo a preoperative localization study when a focal approach is considered. Sestamibi scanning is currently the most accurate and cost effective. If a solitary hot spot is identified, a 2 cm incision can be made over the corresponding portion of the neck. Use of a gamma probe has been suggested for guiding this approach,39 but we and others have not found it to be more helpful than the preoperative sestamibi scan in localizing the suspected parathyroid tumor. The gland is approached lateral to the strap muscles and medial to the sternocleidomastoid muscle. Once the parathyroid adenoma is identified, it is removed (Figures 5-9 and 5-10). Pre-excision and 10-minute
Epiphora in a child with a history of tearing since birth has been caused mostly by an obstructive membrane within the naso-lacrimal duct (Valve of Hasner). Intermittent acquired epiphora in an adult usually results from partial stenosis of the membranous duct and or dacryolithiasis, and may also be seen in patients with allergic rhinitis. The relationship of symptoms to the previous medical therapy (topical idoxuridine, phospholine iodide, systemic 5-fluoro-uracil), orbital trauma, and environmental factors, however, as to the head position, stress, etc., are also factors. Previous sinus surgery should indicate the possibility of duct injury as well. The presence of recurrent sinus disease can cause rhinitis or intranasal polyps.
At this stage, the cardiologist locates the catheter head position before and after the pull-back in both angiogram views, and two, three-dimensional points are reconstructed. Note that these points represent the location in space of the center of the first and last IVUS images. Figure 10.38 shows two views of the catheter after finishing the pull-back. Once located, the position of the catheter head in one x-ray projection, the epipolar line, suggests the position of the catheter head in the other view. A local histogram-based image enhancement can be applied to the angiograms (see Figure 10.38) to emphasize the appearance of catheter position.
The abducens nerve is posterior to the trigeminal and is located exiting the brain between the pons and the medulla oblongata. It is a motor nerve to the lateral rectus muscle of the eye. On the anterior portion of the medulla oblongata is the facial nerve, which is both a sensory and motor nerve to the face and the tongue. The vestibulocochlear nerve is a sensory nerve that receives impulses from the ear. It picks up auditory stimuli as well as information about equilibrium. The glossopharyngeal nerve is a nerve that carries both sensory and motor impulses. It innervates the tongue and throat. A large nerve on the side of the medulla oblongata is the vagus nerve. It is also a mixed nerve carrying both sensory and motor impulses. The vagus nerve innervates organs in the thoracic and abdominal regions. The accessory nerve is inferior to the vagus nerve and is a motor nerve to the neck muscles. The hypoglossal nerve is a motor nerve to the tongue. Label the cranial nerves and color...
To assess the AP skeletal pattern the patient has to be postured carefully with the head in a neutral horizontal position (Frankfort Plane horizontal to the floor). Different head postures can mask the true relationship. If the head is tipped back the chin tends to come further forward and makes the patient appear to be more Class III. Conversely, if the head is tipped down the chin moves back and the patient appears to be more Class II. Sit the patient upright in the dental chair and ask them to occlude gently on their posterior teeth. Ask them to gaze at a distant point this will usually bring them into a fairly neutral horizontal head position. Look at the patient in profile and identify the most concave points on the soft tissue profile of the upper and lower lips (Fig. 1).
Symptoms include myalgias, with subacute development of muscle weakness and dysphagia. Patients may also develop a rash (Fig. 3) with arthralgias, joint contractures and systemic symptoms related to cardiac or pulmonary involvement. DERM is associated with proximal muscle weakness, including weakness of the neck flexors, dysphagia and ventilatory failure. This is associated with erythema and telangiectasis over
This illustration also shows some fibers from the optic tract that project to the superior colliculus by-passing the lateral geniculate via the brachium of the superior colli-culus (labeled in the lower illustration). This nucleus serves as an important center for visual reflex behavior, particularly involving eye movements. Fibers project to nuclei of the extra-ocular muscles (see Figure 8A and Figure 51A) and neck muscles via a small pathway, the tecto-spinal tract, which is found incorporated with the MLF, the medial longitudinal fasciculus (see Figure 51B).
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