Cervical Spine Problems Research Articles

Temporomandibular joint and cervical spine disability assessment in people with hypermobility joint syndrome.

Temporomandibular disorders (TMDs) and cervical spine problems are a growing public health issue, as they increase the risk of disability in people with hypermobility joint syndrome (HJS). The present study aimed to assess the prevalence of TMD symptoms, and cervical spine and TMJ disability in HJS patients. A survey was conducted among physical therapy students (mean age: 21 years). The study comprised 2 stages. The 1st one was HJS assessment (the Beighton scale and the Brighton criteria). Based on the assessment, 56 HJS subjects were enrolled for the study. The control group (CG) consisted of 60 HJS-free subjects, according to the aforementioned criteria. The 2nd stage of the study involved conducting a self-administered questionnaire on the prevalence of TMD symptoms. Both the TMD disability questionnaire (TMD-Q) and the neck disability index (NDI) scores were recorded. Pain intensity was assessed using the numeric rating scale (NRS). The HJS group showed higher NRS scores (p < 0.001). Headache, neck and shoulder girdle pain, and temporomandibular joint (TMJ) pain were found to be more severe in almost each patient from the HJS group as compared to CG. Those individuals had a greater degree of disability on the TMD-Q and the NDI scales (p < 0.001). The HJS group showed significant positive correlations between the TMD-Q and NDI scores (p = 0.0035), and between the TMD-Q and TMJ symptom questionnaire scores (p = 0.0047). A significant positive correlation between the NDI and TMJ symptom questionnaire scores was found both in the HJS group (p < 0.001) and CG (p < 0.001). The HJS bearers tended to obtain higher TMJ and cervical spine disability scores, at the same time reporting increased headache, neck and shoulder girdle pain, and TMJ pain intensity. Therefore TMJs should be carefully examined for possible signs of dysfunction in HJS subjects prior to dental or prosthetic treatment. According to our data, TMJ and cervical spine disability assessment should be included as a routine practice in the case of HJS patients, who should remain under the long-term care of a multidisciplinary team of doctors and therapists.

Outcome of Physiotherapy Treatment for Chronic Neck Pain: A Case Study

Physiotherapists are autonomous health professionals and they have to deal with familiar and unfamiliar cases in clinical practice in musculoskeletal area. Based on the patients complains and evaluation of complaints, Physiotherapists select different treatment approaches. The aim of the study was to describe the clinical decision as well as treatment of a single case suffering from cervical spine problem. Mrs. X is a 47 years old housewife complained of occasional mild posterior and right lateral neck and right shoulder pain. The intensity of pain was moderately higher in right shoulder than neck. She has been suffering from this problem for last six months. The patient rated her neck pain 3/10 and right shoulder pain as a 6/10 on a numeric pain rating (NPR) scale. Patient also had history of hypertension and taking medication for it. Physician initially diagnosed her as right frozen shoulder and he referred to Physiotherapist for better management. Cervical muscle strengthening exercise, Mulligan and Maitland mobilization applied 3 sessions per week for 4 weeks. Each session consists of 30 minutes. The outcome of this case study would strengthen Physiotherapy practitioners, academicians and researchers knowledge on chronic neck pain management.

The Impact of Cervical Spine Ailments and Dysfunctions on the Quality of Life of Professionally Active Nurses

Introduction. In the era of contemporary changes and evolution of the nursing profession, changing work standards and ergonomics, the professional group of people suffering from cervical spine problems is growing. So far, little research has been conducted on the occurrence of spine problems and their impact on the quality of life of professionally active nurses.&#x0D; Aim. The aim of the study was to analyse and assess the impact of cervical spine complaints on the quality of life of professionally active nurses.&#x0D; Material and Methods. The research was conducted among nursing staff employed in the surgical and preventive departments of the Specialist Municipal Hospital of Nicolaus Copernicus in Toruń. The study group consisted of 100 people, women and men, of whom 80 were qualified for further stages of the study. The prospective studies used survey techniques as well as observation and measurement. In the assessment of dysfunctions related to spinal problems, the Polish version of the questionnaire, the indicator of disability caused by pain in the cervical spine — Neck Disability Index (NDI), was used.&#x0D; Results. The analysis of the conducted research shows that the majority of respondents significantly experience increased pain resulting from work-related stress. Statistical analysis showed that the demographic factors influencing the occurrence of pain are: age (p=0.001), work experience of the respondents (p=0.003) and work system (p=0.026). There was no relationship between gender (p=0.726), marital status (p=0.528) and education of the respondents (p=0.507) and the occurrence of pain.&#x0D; Conclusions. 1. Work-related stress significantly increases the incidence of cervical spine problems among nurses and worsens their quality of life. 2. The most common complaints among professionally active nurses are headaches and tingling and numbness in the limbs. 3. The occurrence of ailments is determined by demographic factors. 4. Professionally active nurses describe their quality of life as average. 5. The nursing team does not consult a doctor before implementing pharmacological treatment. (JNNN 2023;12(3):127–133)

Radiological study of foramen arcuale: implications for screw insertion via posterior arch for fixation of C1 vertebrae in atlantoaxial instability using plain radiograph

Abstract Introduction: Foramen arcuale is an osseous structure forming a bridge from the superior articular process of the atlas that completely or partially encircles the vertebral artery. We retrospectively reviewed plain cervical radiographs as suggested by neurosurgeons, neurologists and orthopaedic surgeons for evaluation of cervical spine problems. When foramen arcuale is present, it creates a false impression of a broad posterior arch and can pose a risk during neurosurgery. The aim of this study is to investigate the prevalence of foramen arcuale in the Jalgaon &amp; Baramati population. Materials and Methods: 1255 lateral cervical spine radiographs were obtained from the radiology department, GMC, Jalgaon &amp; GMC Baramati. The patient of which 655 (59.04%) were males and 600(31.42%) were females. Cases were classified as an incomplete and complete bony ridge. Results: Overall prevalence of Foramen arcuale was 8.36%, with complete lesions in 3.50% and incomplete lesions in 4.86%. We noted an increasing percentage of patients with Foramen arcuale from the younger to the adolescent age group, with significantly greater prevalence in patients aged 15-30 years compared with the younger groups. Lesions were more common in males (59.04%) compared with females (31.42%), but no statistically significant difference between genders was detected for complete as well as incomplete foramen arcuale (p=0.95). Conclusion: The foramen arcuale is a relatively common osseous structural variant therefore; surgeons should consider the risk of the presence of an FA prior to procedures on the atlas in each patient. So we suggest the identification of this variant by preoperative lateral radiograph as a starting point for C1 lateral mass for screw fixation via the posterior arch for atlantoaxial instability. If foramen arcuale is suspected or confirmed on a radiograph, 3D CT scanning should be considered for variations in size and shape of foramen arcuale and the possibility of injury to the vertebral artery.

Influence of smartphone game play on head flexion angle, muscle activity, and load at C7 among adolescents.

Smartphones cause physiological problems due to inappropriate postures and extensive usage. India, being the second leading country with the highest number of smartphone users (492 million in 2021), has witnessed a significant rise in smartphone-related musculoskeletal disorders (MSD). This study compared the effects of 60-min smartphone gameplay on head flexion angle, muscle activity, and loads at C7 on Indian adolescents. A subjective assessment was conducted on 1659 participants, of which, 40 young male adults aged between 20-28 years performed the experimental trial. Muscle (Sternocleidomastoid) activity, head flexion angle, and load acting at the neck (C7) were analyzed through postural assessment, pre-and post-subjective analysis. Participants maintained an average of 28.46°±4.04° head flexion angle for more than 43 min (71%) in an hour while performing the task. The muscle activity increased to 23% (p < 0.001) of MVC at the end of the task compared to the beginning. The results indicated a significant increase in muscle activity (1.61 times), spinal loads (4.6 times) and subjective discomfort (2.9 times) after prolonged smartphone usage. It is evident that various aspects (duration, posture, content) play a vital role in smartphone-related MSD and there is a potential risk of cervical spine problems. The increased loads reduce muscle stiffness and increase intervertebral disc pressure.

Development of a machine-learning based model for predicting multidimensional outcome after surgery for degenerative disorders of the spine.

It is clear that individual outcomes of spine surgery can be quite heterogeneous. When consenting a patient for surgery, it is important to be able to offer an individualized prediction regarding the likely outcome. This study used a comprehensive set of data collected over 12years in an in-house registry to develop a parsimonious model to predict the multidimensional outcome of patients undergoing surgery for degenerative pathologies of the thoracic, lumbar or cervical spine. Data from 8374 patients (mean age 63.9 (14.9-96.3) y, 53.4% female) were used to develop a model to predict the 12-month scores for the Core Outcome Measures Index (COMI) and its subdomain scores. The data were split 80:20 into a training and test set. The top predictors were selected by applying recursive feature elimination based on LASSO cross validation models. Based on the 111 top predictors (contained within 20 variables), Ridge cross validation models were trained, validated, and tested for each of 9 outcome domains, for patients with either "Back" (thoracic/lumbar spine) or "Neck" (cervical spine) problems (total 18 models). Among the strongest outcome predictors in most models were: preoperative scores for almost all COMI items (especially axial pain (back or neck) and peripheral pain (leg/buttock or arm/shoulder)), catastrophizing, fear avoidance beliefs, comorbidity, age, BMI, nationality, previous spine surgery, type and spinal level of intervention, number of affected levels, and surgeon seniority. The R2 of the models on the validation/test sets averaged 0.16/0.13. A preliminary online tool was programmed to present the predicted outcomes for individual patients, based on their presenting characteristics. https://linkup.kws.ch/prognostictool . The models provided estimates to enable a bespoke prediction of the outcome of surgery for individual patients with varying degenerative pathologies and baseline characteristics. The models form the basis of a simple, freely-available online prognostic tool developed to improve access to and usability of prognostic information in clinical practice. It is hoped that, following confirmation of its validity and practical utility, the tool will ultimately serve to facilitate decision-making and the management of patients' expectations.

Does Paramedian Approach Preferentially Secure Optimal Drug Delivery Onto Ventral Epidural Space and Subsequent Superior Clinical Efficacy Over a Dorsal Midline Approach During Cervical Interlaminar Epidural Injection?

There is paucity in the literature directly comparing the clinical results between the paramedian and the midline interlaminar cervical epidural injections. To compare the proportion of ventral epidural spread of injectate and consequent clinical outcome between the paramedian and midline approach during interlaminar epidural injection in patients with axial neck and/or interscapular pain triggered from the underlying cervical spine pathologic condition. Retrospective study. Primary pain clinic and spine hospital. Two hundred and twenty-three patients with axial neck and/or interscapular pain due to cervical problem underwent interlaminar epidural injection through either a paramedian approach (PM group, n = 93) or a midline approach (ML group, n = 130). We compared the portion of ventral epidural filling, Numeric Rating Scale (NRS), and McNab criteria between both groups. The NRS and McNab criteria were also separately compared between the ventrally spread (VS) group and non-ventral spread (non-VS) group inside each PM and ML group, respectively, at 2 weeks and 10 weeks post-injection. The PM group showed a significantly higher proportion of ventral spread, successful NRS reduction, and satisfactory McNab criteria than the ML group at 10 weeks. In the PM group, the VS group showed the same results as above compared to the non-VS group. A retrospective analysis based on the relatively short-term follow-up period clinical results. The paramedian approach showed the better direct injectate transfer over the ventral epidural space and subsequently superior clinical efficacy for the patients suffering from axial neck and/or interscapular pain secondary to cervical spine problems.

Return to Golf, Tennis, and Swimming After Elective Cervical Spine Surgery

BackgroundAfter surgery for degenerative cervical spine problems, most patients hope to return to non-competitive sports and other leisure activities. Limited data are available to counsel patients about return to play (RTP) in non-competitive sports after cervical surgery.MethodsParticipants had cervical surgery for degenerative diagnoses from April 1, 2007, to April 1, 2018. Demographic data were collected, and participants were asked to complete a survey regarding sports participation before and after cervical surgery. ResultsOf the 73 participants who responded to the study, the majority (81.1%) were able to return to one or multiple hobby sports after elective spine surgery. RTP rates at 12 months for golf, tennis, and swimming were 67.6%, 31.2%, and 81.6%, respectively. Younger age and lack of preoperative motor deficit were significant predictors of return to swimming after surgery. After surgery, 54.3% of golfers reported similar or improved levels of play. ConclusionsAfter elective cervical spine surgery, the majority of hobby athletes can expect to return to athletics. The majority of golfers returned to play with similar or improved frequency and quality of play compared to preoperative levels. Future prospective studies will further elucidate factors predicting RTP after different types of elective cervical surgeries.

Health Surveillance along with Application of Age-based Scheduled Training Program for Down syndrome

Rehabilitation of the family of DS child to provide long-standing follow-up and support as well as the early detection of different health problems. A prospective observational study was accomplished on 65 children with DS selected randomly from the outpatient clinic of pediatric genetics. Application of Health Supervision Guidelines for Individuals with DS for specialized management and monitoring based on different of age groups. Also, the parents of DS children underwent scheduled training plan for solving their children difficulties as hypotonia and associated problem as feeding problem, cervical spine problem and hip dislocation by doing prefeeding exercises and some home physiotherapy in weekly visits. Then these children were evaluated at the end of every four months to assess outcome and retraining of the caregivers as needed. The prevalence of the most associated health problem with DS was the speech difficulty followed by iron deficiency anemia, medically treated ear problems , physical disability , urinary and bowel incontinence ,feeding problems, hypothyroidism and bilateral SNHL (72%, 64.6% , 35%, 33%, 29.2%, 24.6%, 16.9%, 10.7% respectively). After application of our scheduled training program, 84% of trained parents carried out prefeeding exercises, 86% of children showed adequate positioning during feeding as well as improved child cooperation during feeding. Furthermore, 84% got balanced nutritious diet. 68% of children developed urinary control by daytime whereas 60% developed urinary control by day and night. 81% showed improvement in bowel control by decreased frequency of encopresis. An effective early intervention, positive home environment and continuous supportive training of mothers of children with DS are helpful in improving the overall functioning and productivity of these children.

Total Thyroidectomy From A Patient’s Perspective

Total Thyroidectomy From A Patient’s Perspective

Temporal Stability and Reliability of an Adaptation of the Linear Excursion Measurement Device

Background: The Linear Excursion Measurement Device (LEMD) is used to detect and objectively record changes in cervical posture over time and in quantifying the effectiveness of physiotherapy interventions for posturerelated problems.Objective: The study investigated the temporal stability and reliability of measurements obtained from the LEMD; and the influence of time of day on the measurements obtained.Methods: The study involved 46 volunteering apparently healthy undergraduates (mean age 22.3 ± 2.26years). Vertical and horizontal movements at the selected landmarks were obtained from the LEMD (morning and afternoon) for four consecutive days, and the excursion angles computed for each day. Data obtained was presented using descriptive statistics of mean and standard deviation, and analyzed using inferential statistics of Paired t-test and Pearson Product Moment Correlation Coefficient. Level of significance was set at 0.05 in each case). A significant correlation existed between day 1 and 2 (r=0.247, r=0.316), day 1 and 3 (r=0.425, r=0.478), and day 1 and 4 (r=0.274, r=0.592) at both landmarks respectively.Conclusions: LEMD is time efficient and reliable with temporal stability. It can be used by physiotherapists for assessing and quantifying improvement in patients with cervical spine problems.

Recurrent Carpal Tunnel Syndrome—Analysis of the Impact of Patient Personality in Altering Functional Outcome Following a Vascularised Hypothenar Fat Pad Flap Surgery

We retrospectively analysed 25 patients (27 hands) who had both clinical and electrophysiological confirmation of true recurrent carpal tunnel syndrome from January 2004 to December 2009. In all the patients, after releasing the nerve a vascularised fat pad flap was mobilised from the hypothenar region and sutured to the lateral cut end of flexor retinaculum. The patient characteristics, co-morbidities, duration of symptom, interval between first release and revision surgery and intra-operative findings were assessed against post-operative relief of pain, recovery of sensory and motor dysfunction. The average age of the patients was 58years (43-81) and the dominant hand was involved in 22 patients. Intra-operatively the nerve was compressed by scar tissue connecting the previously divided ends of the retinaculum in 18 and nine had scar tissue and fibrosis around the nerve. Following surgery 16 patients had complete recovery (asymptomatic at the first follow-up), eight had delayed recovery (partial recovery of symptoms at final follow-up) and three had a poorer outcome (persistence of preoperative symptoms at the final follow-up). The patients with delayed recovery/poorer outcome had a) Early recurrence; b) Diabetes mellitus; c) Obesity; d) Cervical spine problems; e) Involvement of non-dominant hand; and f) Intraoperative scar tissue and fibrosis. The hypothenar fat pad transposition flap provides a reliable source of vascularised local tissue that can be used in patients with recurrent carpal tunnel syndrome. The factors that were associated with poorer/delayed recovery were involvement of non-dominant hand, recurrence within a year from the previous surgery, intra-operatively scar tissue in the carpal tunnel and associated co-morbidities, like obesity diabetes mellitus and cervical spine problems.

Is it time for routine use of the retromolar fiberscope?

Purpose:This study aimed to determine the effectiveness, safety, and oral intubation time (IT) using a retromolar Bonfils fiberoptic scope compared with a conventional Macintosh laryngoscope.Materials and Methods:Sixty patients (16-60 years old, American Society of Anesthesiology I/II) scheduled for general anesthesia for elective ear-nose-throat and plastic surgery were randomly divided into a Bonfils group (Group B, n = 30) and a Macintosh group (Group M, n = 30). Exclusion criteria included Mallampati IV, thyromental distance ≤4 cm, mouth <4 cm, cervical spine problems, body mass index >35, sleep apnea, reflux esophagitis, coronary artery disease, intracranial vascular malformation, elevated intracranial pressure, bleeding disorders, allergies to planned drugs, and patient refusal. Mallampati scoring, mouth opening, and thyromental distance were used for airway assessment. The time needed for successful intubation (IT), number of attempts, number of failures, systolic (SBP), diastolic (DBP), mean blood pressure (MBP), heart rate (HR) and Oxygen saturation (O2) and damage to the lips, dentures, and pharyngeal or laryngeal structures were recorded. Continuous variables are presented as mean ± standard deviation and categorical variables are presented as frequency and percentage. Chi-square tests and Student's t-tests were used to compare the groups. P < 0.05 was considered statistically significant.Results:The groups were comparable regarding demographic data, preoperative airway parameters, IT, the number of attempts, O2, and the incidence of complications (P > 0.05). However, Bonfils intubation was associated with more stable HR, SBP, DBP and MBP (P < 0.05).Conclusion:The Bonfils fiberoptic scope is comparable to a Macintosh laryngoscope but assures better hemodynamic stability. In difficult cases, the Bonfils scope is a better choice because of its ability to navigate.

TMJ and Posture, Yes it’s All Connected: The Chain Theory of Body Linkage

The physiology involved in the integration between the rings of the chain explained by many biomechanical theories which based on that, the change in the tissue tension-compression in one ring of the muscles chain will lead to changes of the tissue tension-compression leading to bad posture. Some other theories based on the electro myographic activity of the muscles in one ring of the chain which associated with elongation of shorting of the other rings within the muscle chain. Patients with TMD reported to be associated with decrease of the posterior facial height with backward and clock wise rotation of the mandible. This features influence the Craniocervical pos- ture. Patients with TMD and cervical spine problem (upper ring) associated with head moved forward. Normally, the head sit di- rectly over the neck and shoulders, change in the posture with forward head posture lead to a sequence of events. Forward head movement cause strain on the muscle of the neck and shoulders and upper back muscle. This cause decrease of the blood supply of the muscle with muscle fatigue and pain. This movement led to shifting the center of the gravity. As a result, the upper body and back (middle ring) try to compensate by drafting backward. While the hip and lower body (lower ring) moving forward. So, the TMD and neck problem can result in middle and lower back problem, due to loss of balance between the rings of the body chain. High heels are very popular with many women and can be one of the reasons of increasing the incidence of the TMD within the women group of patients. The higher the heel, the more poten- tial damage you can cause to the ankle and foot, by shortening the Achilles tendon that runs behind the heel to the bottom of the foot. This lead to tighten and shortening of the tendon resulting in heel pain. Also, its change the angle of the heel to the toes there- by changing our center of gravity. The Calf muscles contract and adjust to the angle of the high heel and walking with high heel making excessive force within the knee (lower ring). The high heels push the center of the body forward taking the hip and spine put of the normal alignment (middle ring). All of the previously mentioned changes lead to posture alteration which affects the Craniocervical and TMJ muscles (upper ring). This changes the alignment of the hips and spine, (which in- clude our head and neck), predisposing us to back and leg pain or pain anywhere up the chain of linkage. Wearing of sport comfort- able shoes can relief the muscle strain in the lower body (lower ring) with subsequent improvement of the bad posture. The re- sult of improving the bad posture will be reelected on the TMD and the neck (upper ring).

Cervical Sagittal Alignment Parameters of Patients Admitted to Neurosurgery and Emergency Clinics in a State Hospital at Eastern Part of Turkey.

ObjectiveCervical spine encompasses a bridge role between the head and the lower parts of the spine and therefore has unique properties. Our aim in this study was to evaluate the cervical sagittal alignment parameters in pediatric and adult non-surgical patients and to find any differences in respect of age, sex and admission type.MethodsAll patients who were admitted to emergency and neurosurgery clinics of Diyarbakir Bismil State Hospital due to cervical spine problems (trauma, radiculopathy, paraspinal pain) in 2014 were enrolled retrospectively into the study. Cervical anterior-posterior and lateral X-rays were obtained. Our exclusion criteria were cervical coronal deformity, multitrauma, Glasgow Coma Scale <15, traumatic disruption of the cervical spine, history of malignancy, spinal infection, metabolic or rheumatologic diseases.ResultsThere were 44 female and 55 male patients (n=99) in the study. Thirty-five (35.35%) of the patients were younger than 18 years of age. Mean cervical spinal alignment parameters were as follows: -42.81±11.23° (OC2), -17.15±11.48° (C2-C7), -29.82±7.60° (T1 slope), -3.62±3.05° (C3), -3.14±3.05 (C4), -3.80±2.74° (C5), -3.12±2.36° (C6), -3.43±2.53° (C7). Positive correlations were observed between age-C2C7 angle, C2C7 angle-T1 slope, C3 angle-C4 angle, C4 angle-OC2 angle, C4 angle-T1 slope, C4 angle-C5 angle. The one only negative correlation was between OC2 angle-C2C7 angle.ConclusionIn this regional study, it has been observed that global cervical lordosis increases as age increases. C4 vertebra is in the middle of this evaluation as it has many correlations with other cervical segments, which should be kept in mind when making surgical plans for this delicate spine region.

Myofascial Pain in War Veterans with Post-Traumatic Stress Disorder

AbstractObjectives: This study is aimed to investigate occurrence of myofascial pain syndrome in a group of Croatian war veterans suffering from post-traumatic stress disorder [PTSD] and to compare them with a healthy normal control [HNC] group, and to describe the most frequent locations of trigger points in the head and neck region.Methods: A total of 202 male subjects participated in the examination. They were divided into a group of war veterans suffering from a PTSD and an HNC group. The first group consisted of 101 war veterans with PTSD [mean age = 47.22 years, range = 33–73 years]; the HNC group consisted of 101 subjects [mean age = 46.72 years, range = 34–61 years] who did not participate in the War of Independence.Results: The PTSD group revealed a higher prevalence of headaches [p < 0.001], cervical spine problems [p < 0.001], jaw clicking and popping [p = 0.032], teeth grinding or clenching during the day [p < 0.001], teeth grinding or clenching while sleeping [p < 0.001], jaw ache in the morn...

Cervical Biomechanics and Neck Pain of “Head-Spinning” Breakdancers

The cervical spine of breakdancers is at great risk due to reversed body loading during headspin manoeuvers. This study focused on the cervical biomechanics of breakdancers and a correlation with neck pain. A standardized interview and biomechanical testing of the cervical spine of 25 participants with "headspin" ability ages 16-34 years and an age-matched cohort of 25 participants without any cervical spine problems was conducted. Neck pain history, Neck Disability Index (NDI), cervical range of motion (CROM) and cervical torque were recorded. The "headspin" group reported significantly better subjective fitness, more cervical complaints, higher pain intensity, a longer history of neck pain and a worse NDI compared to the "normal" collective. The "headspin" group showed a 2-2.5 times higher rate of neck pain than the normal population, with increased cervical flexion (p<0.05) and increased cervical torque in all planes (p<0.001). The CROM showed a negative moderate to strong correlation with NDI, pain intensity and history of neck pain. Sports medicine practitioners should be aware of headspin maneuver accidents that pose the risk of fractures, dislocations and spinal cord injuries of breakdancers.

AB0841-HPR The effect of active cervical lateral flexion range on shoulder joint range of motion in adhesive capsulitis patients: a pilot study

BackgroundMuscles affecting scapulahumeral motion have their orijin on spine. Upper trapezius and levator scapula muscles’ orijin is cervical region. In patients with adhesive capsulitis arm elevation is achieved by increased...

Management of an incidental malignant peripheral nerve sheath tumour in the parapharyngeal space

Parapharyngeal space tumours are uncommon and represent 0.5-1 per cent of all head and neck neoplasms; 20-30 per cent of these are malignant. Malignant peripheral nerve sheath tumours are rare and mostly encountered in patients with neurofibromatosis type 1. Only four cases of parapharyngeal space tumours have been reported in the English language in patients without neurofibromatosis type 1. We report the case of a 64-year-old man with no stigmata of neurofibromatosis type 1, in whom a mass in the left pre-styloid region of the parapharyngeal space was an incidental finding following magnetic resonance imaging for investigation of cervical spine problems. The mass was consequently removed using a transcervical approach. A histological review revealed a low-grade malignant peripheral nerve sheath tumour. We consider the pathophysiology of this highly malignant tumour as well as the challenging anatomy of the parapharyngeal space and the surgical and other therapeutic modalities utilised to treat this condition.

Anaesthesia and airway management in mucopolysaccharidosis

This paper provides a detailed overview and discussion of anaesthesia in patients with mucopolysaccharidosis (MPS), the evaluation of risk factors in these patients and their anaesthetic management, including emergency airway issues. MPS represents a group of rare lysosomal storage disorders associated with an array of clinical manifestations. The high prevalence of airway obstruction and restrictive pulmonary disease in combination with cardiovascular manifestations poses a high anaesthetic risk to these patients. Typical anaesthetic problems include airway obstruction after induction or extubation, intubation difficulties or failure [can’t intubate, can’t ventilate (CICV)], possible emergency tracheostomy and cardiovascular and cervical spine issues. Because of the high anaesthetic risk, the benefits of a procedure in patients with MPS should always be balanced against the associated risks. Therefore, careful evaluation of anaesthetic risk factors should be made before the procedure, involving evaluation of airways and cardiorespiratory and cervical spine problems. In addition, information on the specific type of MPS, prior history of anaesthesia, presence of cervical instability and range of motion of the temporomandibular joint are important and may be pivotal to prevent complications during anaesthesia. Knowledge of these risk factors allows the anaesthetist to anticipate potential problems that may arise during or after the procedure. Anaesthesia in MPS patients should be preferably done by an experienced (paediatric) anaesthetist, supported by a multidisciplinary team (ear, nose, throat surgeon and intensive care team), with access to all necessary equipment and support.Electronic supplementary materialThe online version of this article (doi:10.1007/s10545-012-9563-1) contains supplementary material, which is available to authorized users.