Neck

I have three concerns about the description of central venous catheterization in the video by Graham et al.(May 24 issue). 1 First, it is misleading to describe the risk of hemothorax as “not applicable” when the internal jugular approach is used, since hemothorax is a known ...

The inertial loading thresholds for infant head injury are of profound medico-legal and safety-engineering significance. Injurious experimentation with infants is impossible, and physical and computational biomechanical modelling has been frustrated by a paucity of paediatric biomechanical data. This study describes the development of a computational infant model (MD Adams®) by combining radiological, kinematic, mechanical modelling and literature-based data. Previous studies have suggested the neck as critical in determining inertial head loading. The biomechanical effects of varying neck stiffness parameters during simulated shakes were investigated, measuring peak translational and rotational accelerations and rotational velocities at the vertex. A neck quasi-static stiffness of 0.6 Nm/deg and lowest rate-dependent stiffness predisposed the model infant head to the highest accelerations. Plotted against scaled infant injury tolerance curves, simulations produced head acceleration...

We describe a case in which in-utero diagnosis of an esophageal atresia with a tracheo-esophageal fistula in the third trimester followed the finding of an increased nuchal translucency in the first trimester and suggest a mechanism by which these two findings might be associated.

Lymph nodes from sheep foetuses and postnatal lambs were examined to determine the participation of different leucocyte populations in primary follicle formation, with special emphasis on the emergence and subsequent development of follicular dendritic cells during late gestation and early postnatal life. A series of immune and enzyme histochemical markers was used. The first 5'-nucleotidase-positive primary follicles were found at 80 days gestational age (gestation in sheep is 150 days) in superficial cervical lymph nodes. In the last month of gestation the primary follicles possessed follicular dendritic cells, macrophages, dendritic cells, and CD5-positive lymphocytes, in addition to IgM-positive cells. Follicular dendritic cells in primary follicles were found to be ultrastructurally immature. These follicular dendritic cells were characterised by a few, coarse surface projections and many ribosomes attached to the endoplasmic reticulum. A final differentiation to mature follicular dendritic cells was coincident with the postnatal germinal centre reaction. Computer-assisted morphometric analysis demonstrated that the size of 5'-nucleotidase-positive primary follicles in the distal jejunal lymph node, but not in the superficial cervical lymph node, increased significantly during late gestation. It was concluded that stroreal cells in primary follicles of foetal sheep lymph nodes were a continuously developing population but that ultrastructural maturity was only achieved in the germinal centres of postnatal lambs.

CONTEXT AND OBJECTIVE: Pedicled flaps play an important role in cancer treatment centers, particularly in developing and emerging countries. The aim of this study was to identify factors that may cause complications and influence the final result from reconstructions using pectoralis major myocutaneous flaps (PMMFs) for head and neck defect repair following cancer resection. DESIGN AND SETTING: Cross-sectional study at the Hospital de Ensino Padre Anchieta of Faculdade de Medicina do ABC (FMABC). METHODS: Data on 58 patients who underwent head and neck defect reconstruction using PMMFs were reviewed. The final result from the reconstruction (success or failure) and the complications observed were evaluated in relation to the patients' ages, area reconstructed, disease stage, previous oncological treatment and need for blood transfusion. RESULTS: There were no total flap losses. The reconstruction success rate was 93.1%. Flap-related complications occurred in 43.1% of the cases, ...

Some of the authors of this publication are also working on these related projects: Development of MALDI-TOF methods for detection and classification of Brucella spp., Mycobacterium spp., Salmonella e Escherichia coli in bovines View project Flábio Araújo Brazilian Agricultural Research Corporation (… 129 PUBLICATIONS 1,023 CITATIONS

Ultrasonography has been used in the evaluation of enlarged lymph nodes in patients with malignant lymphoma, which comprises a variety of histopathological subtypes. We assessed ultrasonic findings of infiltration in cervical lymph nodes of 47 patients with previously untreated malignant lymphoma and correlated them with histopathological subtypes. Common findings among various histopathological subtypes were hypoechoic masses, spot and/or line echoes, involvement of multiple nodes, and posterior enhancement. In addition, each histopathological subtype showed characteristic findings: Hodgkin's disease had a contour with a lobular pattern (9/10 cases), septum-like echo (9/10 cases), and tubular structure (9/10 cases) in the internal echo, reflecting histopathologically fibrous connective tissue surrounding lymph nodes and small vessels. In B-cell lymphoma, there was characteristically a tendency for lymph node fusion (19/28 cases) and spot and/or line echoes (17/28 cases), reflecting histopathological replacement and destruction of the structure of lymph node and capsule by proliferation of lymphocytes. These findings were strengthened in diffuse large B-cell lymphoma. T-cell lymphoma was distinguished from other types of lymphoma by the presence of a hilum-like echo (6/9 cases), reflecting histopathologically prominent vascularization in lymph nodes accompanied by a dilated hilum area. In summary, this preliminary study suggests that ultrasonic findings of infiltration of cervical lymph nodes in major subtypes of malignant lymphoma could reflect characteristic histopathological structures, therefore providing information helpful for differentiating them. Am. J. Hematol. 67:234-239, 2001.

To provide neck circumference (NC) percentiles and mean values for Turkish children and to investigate their significance in clinical and epidemiological use. Methods: Data were obtained from a cross-sectional screening study; DAMTCA II (Determination of Anthropometric Measurements in Turkish Children and Adolescents) in which 5481 subjects from 17 primary, secondary and high schools were included. NC percentiles were produced using the LMS method, and NC was compared with other parameters which define body fat distribution. Results: The smoothed NC curves of 3rd, 5th, 15th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentiles were constructed by age and gender. The descriptive characteristics of collected data were presented as mean (SD: standard deviation) and median (Min-Max: minimum-maximum) to provide detailed information other than smoothed values. The most prominent finding of this study was that the NC of boys was greater, but not significantly higher, than that of girls until the age of 12 but later a prominent increase in the NC of boys is observed compared with girls. We compared obese and non-obese children in the 6-10, 11-13, 14-18 age groups, NC was found to be an important parameter to define obesity. Conclusions: This study provides NC percentiles, means and medians values and analyses their significance in obesity evaluation in clinical practice.

Epidermal inclusion cysts of the head and neck are rare. We report the case of a non-traumatic epidermal inclusion cyst in the submandibular region, with both intraosseous and extraosseous components, which communicated with the socket of a third molar extracted 12 years previously.

Fibreoptic intubation remains a key technique for the management of difficult intubation. We randomly compared the second generation single-use Ambu Ò aScope TM 2 videoscope with a standard re-usable flexible intubating fibrescope in 50 tracheal intubations in patients with a difficult airway simulated by a semirigid collar. All patients' tracheas were intubated successfully with the aScope 2 or the re-usable fibrescope. The median (IQR [range]) time to intubate was significantly longer with the aScope 2 70 (55-97 [41-226]) s vs 50 (40-59 [27-175]) s, p = 0.0003) due to an increased time to see the carina. Quality of vision was significantly lower with the aScope 2 (excellent 24 (48%) vs 49 (98%), p = 0.0001; good 22 (44%) vs 1 (2%), p = 0.0001; poor 4 (8%) vs 0, p = 0.12) but with no difference in the subjective ease to intubate (easy score of 31 (62%) vs 38 (76%), p = 0.19; intermediate 12 (24%) vs 7 (14%), p = 0.31; difficult 7 (14%) vs 5 (5%), p = 0.76). The longer times to intubate and the poorer scores for quality of vision do not support the use of the single-use aScope 2 videoscope as an alternative to the re-usable fibrescope.

Superior cervical ganglionectomy (SCGx) is a valuable microsurgical model to study the role of the sympathetic nervous system in a vast array of physiological and pathological processes, including homeostatic regulation, circadian biology and the dynamics of neuronal dysfunction and recovery after injury. Despite having several experimental applications in the rat, a thorough description of a standardized procedure has never been published. Here, we provide a brief review of the principal features and experimental uses of the SCGx, the surgical anatomy of the neck and sympathetic cervical chain, and a step-by-step description of how to consistently remove the superior cervical ganglia through the omohyoid muscle or the carotid triangle. Furthermore, we suggest procedures and precautions to be taken during and after surgery to optimize results and describe tools to validate surgical success. We expect that the following standardized and optimized protocol will allow researchers to organize knowledge into a cohesive framework in those areas where the SCGx is applied.

Different head-and-neck positions (HNPs) are discussed in relation to potential welfare issues. To evaluate the effect on welfare, seven Royal Dutch Sport horses were studied in five predetermined HNPs: (1) unrestrained (HNP1); (2) neck raised, bridge of nose around the vertical (HNP2); (3) neck lowered and considerably flexed, bridge of nose pointing towards the chest (HNP4); (4) neck raised and extended, bridge of nose in front of the vertical (HNP5), and (5) neck lowered and flexed, bridge of nose pointing towards the carpus (HNP7). A standardised exercise test (SET) of 34 min consisted of trot, canter and walk. Behaviour was recorded with a pre-defined ethogram and R-R intervals measured using telemetry. Cortisol concentrations were taken at the start, 5 and 30 min after the SET. Behaviour around the SET was scored separately. Conflict behaviours increased significantly during HNP2 when compared with HNP1, HNP4 and HNP7 during the SET, and there was significant negative anticipa...

During the last decades of the previous century, school desks with a tilt top have disappeared. The chairs have been designed for sitting upright, with the hip, knees and ankles all at right angles. However, the erect posture cannot be maintained for more than one or two minutes, after which it will result in fatigue, discomfort or poor posture. The main aim of project is to identify the type of furniture that most effectively contribute to adequate neck and back postures of the school children, by carrying out a postural analysis of a sample of school pupils when using three different types of furniture. The postures adopted by school pupils were monitored by video during several activities, such as reading, writing and painting tasks, copying from a blackboard and listening the teacher. Additionally, the characteristics of the adopted postures were assessed by registering the head tilt, flexion of the neck, trunk and hips position. All these aspects were classified and the results were recorded for future analysis. The obtained results seem to point out that the use of a school desk with a tilted table surface resulted in a reduction in trunk and neck flexion, preserving the natural lordosis in the lumbar and cervical regions. Accordingly, it can be concluded that there are alternatives to consider in the furniture design in order to eliminate tensions and, consequently, to improve children's wellbeing.

Objective: To examine the possible association between increased fetal nuchal translucency thickness at 10–14 weeks and congenital diaphragmatic hernia.Methods: This was a multicenter ultrasound screening study for chromosomal defects in singleton pregnancies by a combination of maternal age and fetal nuchal translucency at 10–14 weeks’ gestation. The prevalence of diaphragmatic hernia diagnosed prenatally or postnatally was calculated in the chromosomally

This paper reports data from recent studies on integrative jaw–neck motor control in healthy subjects and disturbed jaw–neck behaviour in whiplash-associated disorders (WAD). The results show that neck function is an integral part of natural jaw behaviour, and that neck injury can impair jaw function and therefore disturb eating behaviour. We also show preliminary results from implementation of a new approach for rehabilitation of jaw–neck dysfunction and pain in WAD.

We conducted a two-part study that contributes to the discussion about cervical auscultation (CA) used as a scientifically justifiable and medically useful tool to identify patients with a high risk of aspiration/penetration. We sought to determine (i) acoustic features which mark a deglutition act as dysphagic; (ii) acoustic changes in healthy older deglutition profiles compared with those of younger adults; (iii) the correctness and concordance of rater judgments based on CA; (iv) if education in CA improves individual reliability. The first part of the study focuses on a comparison of the "swallow morphology" of dysphagic as opposed to healthy subjects' deglutition in terms of structure properties of the pharyngeal phase of deglutition. We obtained the following results. The duration of deglutition apnoea is significantly higher in the older group than in the younger one. Comparing the younger and the dysphagic group we found significant differences in the parameters duration of deglutition apnoea, onset time and number of gulp. Just one parameter, number of gulps distinguishes significantly between the older and the dysphagic groups. The second part of the study aimed at evaluating the reliability of CA in detecting dysphagia measured as the concordance and the correctness of CA experts in classifying swallowing sounds. The inter-rater reliability coefficient AC1 resulted in a value of 0.46 which is to be interpreted as fair agreement. Further, we found that comparison with radiologically defined aspiration/penetration for the group of experts (speech and language therapists; SLTs) yielded 70 % specificity and 94 % sensitivity. We conclude that the swallowing sounds contain audible cues that should in principle permit reliable classification and view CA as an early warning system for identifying patients with a high risk of aspiration/penetration however it is not appropriate as a stand alone tool.

Recent observations in man of concomitant mandibular and head movements during single maximal jaw-opening/-closing tasks suggest a close functional relationship between the mandibular and the head-neck motor systems. This study was aimed at further testing of the hypothesis of a functional integration between the human jaw and neck regions. Spatiotemporal characteristics of mandibular and associated head movements were evaluated for 3 different modes of rhythmic jaw activities: self-paced continuous maximal jawopening/-closing movements, paced continuous maximal jaw-opening/-closing movements at 50 cycles/minute, and unilateral chewing. Mandibular and head-neck movements were simultaneously recorded in 12 healthy young adults, by means of a wireless opto-electronic system for 3-D movement recordings, with retro-reflective markers attached to the lower (mandible) and upper (head) incisors. The results showed that rhythmic mandibular movements were paralleled by head movements. An initial change in head position (head extension) was seen at the start of the first jaw-movement cycle, and this adjusted head position was retained during the following cycles. In addition to this prevailing head extension, the maximal jaw-opening/-closing cycles were paralleled by head extension-flexion movements, and in general the start of these head movements preceded the start of the mandibular movements. The results support the idea of a functional relationship between the temporomandibular and the cranio-cervical neuromuscular systems. We therefore suggest a new concept for human jaw function, in which "functional jaw movements" are the result of activation of jaw as well as neck muscles, leading to simultaneous movements in the temporomandibular, atlantooccipital, and cervical spine joints.

Context: Proper conditioning of the neck muscles may play a role in reducing the risk of neck injury and, possibly, concussions in contact sports. However, the ability to reliably measure the force-time–based variables that might be relevant for this purpose has not been addressed. Objective: To assess the between-days reliability of discrete force-time–based variables of neck muscles during maximal voluntary isometric contractions in 5 directions. Design: Cohort study. Setting: University research center. Patients or Other Participants: Twenty-six highly physically active men (age  =  21.6 ± 2.1 years, height  =  1.85 ± 0.09 m, mass  =  81.6 ± 9.9 kg, head circumference  =  0.58 ± 0.01 m, neck circumference  =  0.39 ± 0.02 m). Intervention(s): We used a custom-built testing apparatus to measure maximal voluntary isometric contractions of the neck muscles in 5 directions (extension, flexion, protraction, left lateral bending, and right lateral bending) on 2 separate occasions separa...

Objective: The purpose of this study was to evaluate the validity of thermal measurements by infrared camera thermometry. Methods: Seventeen subjects underwent a 30-minute acclimatizing period in a controlled environment room. Thermal recordings were executed at the levels of C4 and L4. Fifteen recordings per segment were acquired in an alternating mode that always started at L4. Each subject was required to participate on 5 occasions. The exclusion criteria for the subjects included the following: no inflammatory disease or fever, no consumption of beverages containing caffeine, and no participation in physical activity 2 hours before the recording session; female subjects could not be menstruating on a day of recording. Results: A total of 2550 recordings for the cervical area and the lumbar area was recorded. Strong significant correlations were found for the left (r = .77) and right (r = .71) lumbar sections ( P b .0001) whereas weaker significant correlations were observed for the left (r = .56) and right (r = .63) cervical areas ( P b .0001). The limits of agreement (Bland-Altman) showed good relationships but poor interchangeability. Conclusions: In this study, the infrared cameras showed that they were valid tools in a controlled environment; however, the technique for the cervical measurements needs to be reassessed. (J Manipulative Physiol Ther 2006;29:150-155)

Purpose: The objective of this study was to theoretically model, based on the Hertz contact theory, the impact force and contact time, as well as the linear and angular head accelerations during heading in children using two neck stiffness conditions (infinite and negligible stiffness). Methods: The following mathematical model inputs were obtained: elastic modulus and mass of size three, four, and five balls at inflation pressures of 10, 12, and 14 psi, head modulus, head mass, head length, head and trunk moment of inertia, and the precontact ball velocity. The model outputs consisted of linear and angular head acceleration, impact force, contact time between the ball and head, and head impact criteria (HIC) all at the point of impact. Head mass and length were obtained as a percentage of body weight and height, respectively, based on age. Results: With an increase in head mass, there is a decrease in the linear and angular head acceleration. With an increase in ball size, for the same head mass, there is an increase in the contact time between the head and the ball. Changing ball inflation pressure has little effect on the impact characteristics. Infinite neck stiffness decreased linear and angular head acceleration and HIC. Conclusion: Head mass and ball size have an effect on linear and angular head acceleration and contact time, respectively, whereas ball inflation pressure has a minimal effect on the impact characteristics. These results indicate that children should be restricted to using the appropriate ball for their age. Smaller head size within an age group is an underemphasized though important identifier of a player's injury risk.

This study aimed to evaluate the association of neck circumference (NC) with obesity to determine the sex-specific and age-specific optimal cut-off points of this measure in association with obesity in a national sample of the Iranian paediatric population. This survey on weight disorders was conducted among a national sample of Iranian children and adolescents, aged 6-18 years. Using the area under the curve (AUC) of the receiver operator characteristic curves, we evaluated the association of NC with general and abdominal obesity. This national survey was conducted among 23 043 school students (50.8% boys) with a mean age (SD) of 12.55 (3.31) years. A significant association was documented between NC and other anthropometric measures in both sexes and in the whole population. In all age groups and genders, NC performed relatively well in classifying participants to overweight (AUC: 0.67 to 0.75, p<0.001), general obesity (AUC: 0.81 to 0.85, p<0.001) and abdominal obesity (AUC...

Purpose: The purpose of this study is to assess the anatomical spaces and causative micro-organisms responsible for deep fascial space head and neck infections and evaluate the resistance of antibiotics used in the treatment of these infections. Patients and Methods: A 6-year retrospective study evaluated hospital records of 103 patients. All patients in this study underwent surgical incision and drainage, received IV antibiotics, and had culture and sensitivity performed. Patient demographics reviewed were gender, age, involved fascial space(s), micro-organisms identified and antibiotic resistance from culture and sensitivity testing. Results: There were 56 male (54%) and 47 (46%) female patients. The submandibular space was the most frequent location for a single space abscess (30%), followed by the buccal space (27.5%) and the lateral pharyngeal space (12.5%). Sixty-three patients presented with multiple space involvement, totaling 142 spaces involved. A total of 269 bacterial strains were isolated from 103 patients. The bacteria were found to be 63.5% gram-positive. Gram-positive cocci were isolated 57.7% of specimens and gram-negative rods were isolated in 33% of cultures. There were 178 aerobes (65.7%) and 91 anaerobes (34.3%) isolated. The most common bacteria isolated were Viridans streptococci, Provetella, Staphylococci, and Peptostreptococcus. Culture and sensitivities were reviewed on 101 patients. Conclusion: Patients who underwent surgical incision and drainage in the operating room had a tendency for involvement of multiple space abscesses with the submandibular space, submental, and lateral pharyngeal spaces effected most frequently. Cultures and sensitivities commonly showed greater growth in aerobes (65.7%) than in anaerobes. Gram positive cocci and gram negative rods had the greatest growth percentage in cultures.

To date the influence that specific sitting posture has on the head/neck posture and cervico-thoracic muscle activity has been insufficiently investigated. Therefore the aim of this study was to investigate whether three different thoraco-lumbar sitting postures affect head/neck posture and cervico-thoracic muscle activity.

The condition of patients sustaining penetrating neck trauma often appears deceptively stable, even when mqjor structures have been injured. The clinician must identify patients who require treatment and limit invasive procedures in those without significant injuries. Angiography is often used to search for vascular damage following penetration of the neck and face.

In 42 cases of trisomy 13 at 10±14 weeks of gestation, compared with 947 controls, the median multiple of the median (MoM) of maternal serum free b-human chorionic gonadotrophin (b-hCG) and pregnancy associated plasma protein A (PAPP-A) was signi®cantly decreased (0.506 MoM and 0.248 MoM respectively), whilst fetal nuchal translucency was increased (2.872 MoM). In 38% and 71% of cases of trisomy 13 maternal serum free b-hCG and PAPP-A was below the 5th centile of the appropriate normal range for gestation and in 62% of cases the nuchal translucency was above the 95th centile. When combined together in a multivariate algorithm with maternal age, 90% of cases of trisomy 13 could be detected at a 0.5% false positive rate or 84% at a 0.1% false positive rate. We conclude that speci®c trisomy 13 risks should be part of developing risk algorithms combining maternal serum biochemistry and nuchal translucency for use in ®rst trimester screening alongside those for trisomy 21 and trisomy 18.

Background : Patients suffering head trauma are at high risk of having a concomitant cervical spine injury. A rigid cervical collar is usually applied to each patient until spinal stability is confirmed. Hard collars potentially cause venous outflow obstruction and are a nociceptive stimulus, which might elevate intracranial pressure (ICP). This study tested the hypothesis that application of a hard collar is associated with an increase in ICP. Methods : A prospective series of 10 head-injured patients with a postresuscitation Glasgow coma scale score of nine or less had ICP measurements before and after cervical hard collar application. Results : Nine out of 10 patients had a rise in ICP following application of the collar. The difference in pre-and postapplication ICP was statistically significant ( P < 0.05). Conclusions : Early assessment of the cervical spine in head-injured patients is recommended to minimize the risk of intracranial hypertension related to prolonged cervical spine immobilization with a hard collar.

The purpose of this study was to document head and neck loading in a group of ordinary people engaged in non-injurious everyday and more vigorous physical activities. Twenty (20) volunteers that were representative of the general population were subjected to seven test scenarios: a soccer ball impact to the forehead, a self-imposed hand strike to the forehead, vigorous head shaking, plopping down in a chair, jumping off a step, a seated drop onto the buttocks, and a vertical drop while seated supine in a chair. Some scenarios involved prescribed and well-controlled stimuli, while others allowed the volunteers to perform common activities at a self-selected level of intensity. Head accelerations up to 31 g and 2888 rad/s 2 and neck loads up to 268 N in posterior shear, 526 N in compression, and 36 Nm in extension were recorded. Most head and neck injury criteria predicted a low risk of injury in all activities. However, rotational head accelerations and Neck Injury Criterion (NIC) values were much higher than some proposed tolerance limits in a large number of tests, all of which were noninjurious. The data from this study help us to establish an envelope of head and neck loading that is commonly encountered and presents a minimal risk of injury.

This article reviews the role of imaging, imaging characteristics and significance of individual imaging modalities as well as the newer imaging modalities in the evaluation of head and neck cancer. In the pretreatment evaluation, imaging is performed primarily to determine the stage of tumor and to look for an occult primary. It helps in obtaining tissue samples to establish the diagnosis, and treatment planning if radiotherapy is considered. Postsurgery and radiotherapy changes can be differentiated from residual or recurrent pathology on imaging. Imaging also plays an important role in assessing the response to treatment.

This review constitutes the ®rst of four reviews that systematically address contemporary knowledge about the mechanical behavior of the cervical vertebrae and the soft-tissues of the cervical spine, under normal conditions and under conditions that result in minor or major injuries. This ®rst review considers the normal kinematics of the cervical spine, which predicates the appreciation of the biomechanics of cervical spine injury. It summarizes the cardinal anatomical features of the cervical spine that determine how the cervical vertebrae and their joints behave. The results are collated of multiple studies that have measured the range of motion of individual joints of the cervical spine. However, modern studies are highlighted that reveal that, even under normal conditions, range of motion is not consistent either in time or according to the direction of motion. As well, detailed studies are summarized that reveal the order of movement of individual vertebrae as the cervical spine¯exes or extends. The review concludes with an account of the location of instantaneous centres of rotation and their biological basis.