Posterior Cervical Region Research Articles

The lower trapezius musculocutaneous flap revisited: versatile coverage for complicated wounds to the posterior cervical and occipital regions based on the deep branch of the transverse cervical artery.

The clinical role of the lower trapezius musculocutaneous flap varies within the literature. Many describe its use in the reconstruction of the lateral neck and facial regions, but very few refer to its use in the posterior cervical and occipital regions. Different vascular pedicles have also been described and effectively used. A retrospective analysis was conducted, reviewing the authors' experience with 13 patients who suffered complex open wounds to the posterior cervical and occipital regions that were treated with a lower trapezius muscle or musculocutaneous flap. All flaps were based on the deep branch of the transverse cervical artery. This pedicle was used to support a relatively large skin segment over the distal portion of the lower trapezius muscle, a margin that, in the authors' experience, extends at least 1 cm beyond the muscular margin. Postoperatively, patients were evaluated based on complications, residual shoulder function, and aesthetic outcome. In addition to the clinical study, cadaveric dissection of the trapezius muscle was conducted on 22 specimens, and the vascular anatomy was confirmed by direct visualization. The authors' experience indicates that the lower trapezius musculocutaneous flap, when based on the deep branch of the transverse cervical artery, provides a reliable alternative for the reconstruction of complicated wounds in the posterior cervical and occipital regions, with the added capability of providing richly vascularized tissue to compromised wounds as far cephalad as the vertex of the skull.

Efeito da vagotomia troncular em ratos injetados na fase neonatal com glutamato monossódico: estudo biométrico

Obesidade hipotalâmica pode ocorrer em humanos e pode ser reproduzida, experimentalmente, por lesão do VMH em ratos. Esta obesidade pode ser revertida por vagotomia troncular (VT), devido à redução da ingestão alimentar e da insulinemia mediada pelo nervo vago. Experimentalmente, a injeção de MSG causa lesão em nível de ARC. O objetivo deste trabalho é avaliar os efeitos do MSG em ratos e se VT os altera. Estudou-se 52 ratos Wistar machos, divididos em dois grupos de 26 animais, um submetido à injeção de MSG na fase neonatal e outro à de solução salina. Aos 30 dias de vida, após nova divisão, obteve-se: grupo MSG, submetido à VT (VTMSG), e outro à laparotomia (LAPMSG); grupo SALINA, submetido à VT (VTSAL), e outro à laparotomia (LAPSAL). Obteve-se peso, CNA e índice de Lee. O consumo alimentar foi obtido dos 30 aos 90 dias de vida. Aos 90 dias, após eutanásia, mensurou-se peso, CNA, índice de Lee e gordura perigonadal. Análise estatística foi realizada pelo "t de Student". Constatou-se que o MSG provoca redução do CNA e aumento do índice de Lee aos 30 dias de vida, e provoca redução do peso e do CNA, aumento do índice de Lee e da gordura perigonadal aos 90 dias e aumento do consumo alimentar dos 30 aos 90 dias de vida. A VT provoca redução do peso, do índice de Lee e da gordura perigonadal, e tendência à redução do CNA no rato injetado com MSG. A VT provoca redução de consumo alimentar nos primeiros 30 dias de pós-operatório, mas com tendência a maior consumo nos 30 dias subseqüentes. Conclui-se que o MSG injetado na fase neonatal provoca aumento do consumo alimentar e da adiposidade e causa redução da estatura e do peso do animal dos 30 aos 90 dias de vida. E que a VT, realizada aos 30 dias de vida, provoca redução do consumo alimentar nos primeiros 30 dias de pós-operatório, da adiposidade e do peso.

難治例に対する僧帽筋皮弁による再建の３例

A trapezius musculocutaneous (MC) flap was used for the defect after excision in an advanced squamous cell carcinoma on the left occipital region in a 75-year-old female, and in a multiple recurrent liposarcoma on the left shoulder in a 90-year-old female, respectively, and a trapezius cutaneous perforator flap was also used in a multiple recurrent soft tissue sarcoma (unclassified type) on the posterior cervical region in an 85-year-old male. A trapezius MC flap may be indicated for reliable coverage for head and neck, and shoulder defects, especially in an advanced and/or difficult malignant tumor with bleeding, odor, or obstinate pain. [Skin Cancer (Japan) 2001; 16: 228-232]

Glochinema bathyperuvensis sp. n. (Nematoda, Epsilonematidae): A new species from Peruvian bathyal sediments, SE Pacific Ocean

Glochinema bathyperuvensis sp. n., the first record of Epsilonematidae from bathyal muddy sediments of the oxygen minimum zone (OMZ) off Callao, Peru (eastern Pacific Ocean) is described. The new species belongs to the subfamily Glochinematinae and is characterized by the possession of more than 8 pairs of subdorsal thorns asymmetrically arranged and a single dorsal one in the pharyngeal region, as well as by the presence of ten to thirteen blade-like cuticular protrusions forming a latero-dorsal palisade around the posterior head region and anterior cervical region. In addition, G. bathyperuvensis is characterized by its large size, more than 240 cuticular annules, provided with an extremely dense „hairy“ body ornamentation and, four rows of ambulatory setae: two inner subventral ones with 8 to 9 setae in males, and 5 to 6 setae in females, and two outer subventral rows composed each of 9-12 ambulatory setae followed by a large number of modified somatic setae. The dense hairy body spines, the large number of modified somatic setae, its dominant occurrence exclusive in oxygen-depleted, organic-rich soupy surface sediments indicate an adaptation to the stressed OMZ habitat conditions.

Management strategy of mycobacterial cervical lymphadenitis.

The objectives of this study were to investigate the typical clinical presentation, diagnosis and treatment of mycobacterial cervical lymphadenitis (MCL). Medical records of 87 patients who were treated for MCL were retrospectively reviewed. Definitive diagnosis of MCL was made when a neck mass persisted for several weeks or months and one or more of the following was obtained: (1) positive mycobacterial cultures from biopsy material; (2) Positive mycobacterial staining of biopsy material; (3) Granulomatous inflammation and caseating necrosis on histopathological examination of biopsy material. Clinical findings were reviewed prior to treatment. The treatment included standard antituberculous medications followed by surgery in which either total excision or selective nodal dissection of the cervical lump was made. Follow-up results are presented. The chief complaint was a cervical mass that was localized mostly to the posterior cervical or submandibular regions. A fistula formation was encountered in 11.5 per cent. All patients recovered from MCL by combined antituberculous drug and surgical treatments. Clinical presentation of the disease and histopathological assessment are important in the diagnosis of MCL as well as in the differential diagnosis of tuberculous and nontuberculous MCL. Utilizing the combined medical and surgical treatment options, both tuberculous and non-tuberculous cervical adenitis can be treated successfully.

Airway Management and Rigid Spine Syndrome

Airway Management and Rigid Spine Syndrome

Posterior cervical rhytidectomy: a valuable adjunct in facial rejuvenation surgery.

To describe the aesthetic indications and operative technique of posterior cervical rhytidectomy as a staged procedure after extended cervical-facial rhytidectomy. The senior author's series of patients requiring posterior cervical rhytidectomy is reviewed, including preoperative and postoperative aesthetic results. A private practice plastic surgery clinic. Eleven patients who underwent staged posterior cervical rhytidectomy after extensive cervical-facial rhytidectomy are presented, with follow-up ranging from 3 months to 8 years. During this same duration, 941 primary and 256 secondary cervical-facial rhytidectomies were performed. The preoperative and postoperative results are presented along with a description of the pertinent anatomy and the senior author's operative technique. Potential complications are reviewed. A discussion is included on ways to minimize these untoward sequelae. The aesthetic postoperative results are reviewed, and representative clinical photographs are presented. Staged posterior cervical rhytidectomy is a safe and effective means of improving certain stigmata of previous cervical-facial rhytidectomy in patients requiring extensive facial rejuvenation. Posterior cervical rhytidectomy is a valuable surgical adjunct in selective patients who demonstrate redundant skin and soft tissue in the posterior cervical region.

Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami

The purpose of this study was to determine the distribution of referred pain from the cervical zygapophyseal joints (C0/1 to C7/Th1) and the cervical dorsal rami (C3 to C7). The subjects were 61 patients who had occipital, neck, and shoulder pain of suspected zygapophyseal origin in whom pain was reproduced by injection of contrast medium into the joints or by electrical stimulation of the dorsal rami. Under fluoroscopic control, the zygapophyseal joints from C0/1 to C7/Th1 were stimulated by the injection of contrast medium and while electrical stimulation of the cervical zygapophyseal dorsal rami at segments C3 to C7 was performed during facet denervation. If injection or electrical stimulation reproduced the patient's usual pain, the distribution of referred pain was determined and the sites of referred pain were divided into 10 areas. A total of 181 joints and 62 segments were studied. Each joint and dorsal ramus produced referred pain with a characteristic distribution. The main distribution of referred pain was as follows. Pain in the occipital region was referred from C2/3 and C3, while pain in the upper posterolateral cervical region was referred from C0/1, C1/2, and C2/3. Pain in the upper posterior cervical region was referred from C2/3, C3/4, and C3, that in the middle posterior cervical region from C3/4, C4/5, and C4, and that in the lower posterior cervical region from C4/5, C5/6, C4, and C5. In addition, pain in the suprascapular region was referred from C4/5, C5/6, and C4, that in the superior angle of the scapula from C6/7, C6, and C7, and that in the mid-scapular region from C7/Th1 and C7.

Transsigmoid and extreme lateral approaches for removal of jugular foramen tumors

Neoplasms arising in the jugular foramen may involve the posterior fossa, skull base, and cervical region. The infratemporal approach allows single-stage removal of tumor involving the posterior fossa, jugular foramen, and cervical region. The transient facial palsy and permanent conductive hearing loss associated with this approach led Mann et al to develop the transsigmoid approach. This technique, which combines the suboccipital and retrolabyrinthine approaches, provides access similar to the infratemporal fossa approach without rerouting the facial nerve or obliterating the middle ear. The extreme lateral approach is an inferior extension of the transsigmoid approach and may be used for jugular foramen lesions that extend inferiorly to the foramen magnum. The surgical technique and use of these approaches are discussed. Neoplasms arising in the jugular foramen may involve the posterior fossa, skull base, and cervical region. The infratemporal approach allows single-stage removal of tumor involving the posterior fossa, jugular foramen, and cervical region. The transient facial palsy and permanent conductive hearing loss associated with this approach led Mann et al to develop the transsigmoid approach. This technique, which combines the suboccipital and retrolabyrinthine approaches, provides access similar to the infratemporal fossa approach without rerouting the facial nerve or obliterating the middle ear. The extreme lateral approach is an inferior extension of the transsigmoid approach and may be used for jugular foramen lesions that extend inferiorly to the foramen magnum. The surgical technique and use of these approaches are discussed.

A patient with rhabdomyosarcoma and clear cell sarcoma of the skin

We describe a patient with rhabdomyosarcoma of the posterior cervical region and clear cell sarcoma on the occipital scalp. These two tumors later metastasized to distant skin. We differentiated these tumors by histopathologic, histochemical, immunohistochemical, and ultrastructural findings. Cells of the posterior cervical tumor showed differentiation toward striated muscle, whereas those of the occipital tumor showed findings compatible with melanocytic differentiation.

頚部リンパ節腫脹を主訴とした興昧ある２例 猫ひっかき病とＣａｓｔｌｅｍａｎリンパ腫

We examined and treated two patients with neck lymphadenopathy due to two different relatively uncommon diseases: cat scratch disease and Castleman's lymphoma. The swollen lymphnodes of the former were under the left auricle and those of the latter were in the left posterior cervical region. Detailed anamnesis and pathological examination of open biopsy specimens were useful for making the diagnosis. The clinical courses of both patients were uneventful.

Lymphadenopathy Two Years Later

Letters and Corrections1 July 1990Lymphadenopathy Two Years LaterPaul E. Ogden, MDPaul E. Ogden, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-113-1-84_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: In 1988, we reported what we believed to be an unusual reaction to fish oil supplementation (1). We described the case of a patient with tender cervical adenopathy in anterior and posterior cervical regions, fever, chills, myalgias, and an elevated sedimentation rate that resolved after lymph node biopsies and with discontinuation of fish oil supplementation. The patient reported resumption of symptoms when fish oil was resumed. The initial lymph node biopsies were reported as showing reactive hyperplasia with prominent histiocytosis. Cell surface markers were all negative.Subsequent events place our earlier diagnosis of reactive lymphadenopathy in question....Reference1. OgdenPiziakCainCarpentierHavemann PVPWD. Reactive lymphoid hyperplasia after omega-3 fatty acid supplementation [Letter]. Ann Intern Med. 1988;109:843-4. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Scott and White Memorial Hospital Temple, Texas 76508 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 July 1990Volume 113, Issue 1Page: 84-84KeywordsBiopsyFeversLymph nodesMyalgiaOils Issue Published: 1 July 1990 PDF downloadLoading ...

Cystic hygroma-lymphangioma: a rare and still unclear entity.

Hygroma cysticum coli or cystic hygroma remains a complex entity in terms of its development and management. Most recently, cystic hygroma has been categorized as part of a larger spectrum that includes lymphangiomas. The majority of lymphangiomas occur in the head and neck as cystic hygromas with the posterior cervical region as the most common site. Since its original description, there have been many attempts at treatment modalities: surgical excision remains the treatment of choice. The literature is reviewed and 40 cases from the author's institution are presented. The purposes of this review are, first, to bring some order to the theories and development of this lesion and its various pathological presentations. Second, to approach the treatment of these difficult lesions in an objective manner and to set up guidelines for management.

Observations and analysis of results in 131 cases of spasmodic torticollis after selective denervation.

In 131 patients treated exclusively by selective denervation during the past 10 years, all or almost all the abnormal movements of spasmodic torticollis were suppressed in 115 (88%) while preserving posture and mobility. This approach was also used in certain forms of adult-onset dystonia. An appreciable amount of abnormal movements remained in the other patients, either due to residual innervation or because of limitation of denervation necessary to preserve normal movements (laterocollis) or neck stability (retrocollis). A medio-lateral approach to the posterior cervical region in the sitting position using stimulation under light anaesthesia is recommended.

Malignant Pilomatricoma

An 86-year-old man had a tumor in the right posterior cervical region. The lesion showed histopathologic features of pilomatricoma but differed from that lesion by the presence of cytologically atypical cells and focal squamoid differentiation. The term "malignant pilomatricoma" is suggested for this tumor.

Adjuvant-induced arthritis in the temporomandibular joint of rats.

When Lewis rats were immunized by intradermal injection into the parietal scalp rather than into the footpad with mycobacterial delipidated cells in squalene, arthritis could be produced in the temporomandibular joint (TMJ) with a maximum incidence of 60%, accompanied by systemic polyarthritis. Other methods of immunization including intradermal injection into the tail, posterior cervical region, or intra-inguinal lymph nodes did not induce arthritis in the TMJ. A combination of this inoculation and hemiocclusal loss markedly increased the incidence of arthritis in the TMJ. This arthritis in the TMJ was, however, milder than that in other joints and was apparent only histologically. The group given intradermal injection of adjuvants into the parietal scalp showed definite suppression of body weight gain. Since the method of intradermal injection into the parietal scalp can induce a high incidence of arthritis in the TMJ, our study presents a unique experimental model for study of arthritis in the TMJ.

Radiation therapy for subclinical carcinoma in cervical lymph nodes.

Radiotherapy alone was used to treat 187 patients with a head and neck cancer and clinically uninvolved lymph nodes. Delayed lymph node metastases developed in 35 (19%) patients, and concomitant tumor at the primary site was present in 90% of them. In two (1%) of the 187 patients, delayed metastases developed in the irradiated nodes with the primary tumor controlled; both of these patients received a radiation dose of less than 5,000 rad. Metastases in supraclavicular and posterior cervical regions occurred in 4% of the patients; and these sites were not included in the original radiation fields. The following conclusions were reached: (1) a radiation dose of 5,000 rad or more can eradicate 99% of the subclinical carcinomas in lymph nodes; (2) whole-neck irradiation is not indicated in patients with N0 stage tumor; and (3) surgical resection of primary tumors alone, without added neck dissection, may be adequate if postoperative radiation therapy is planned.

Blood Supply to the Nape-of-the-Neck Flap: Implications from a Fetal Anatomical Study

The blood supply to the nape-of-the-neck flap was studied in 11 18-week-old fetuses by infusion of methyl methacrolate into the vascular system. Dissection of the posterior cervical region showed that the major blood supply to this area was through perforating vessels from the superficial portion of the ramus decendens of the occipital artery and the posterior auricular artery. Since a "named artery" was not found in the longitudinal axis of the flap, as is reported in the literature, it should be considered a cutaneous rather than an arterial flap. The findings of this study are consisted with classical anatomical descriptions about blood supply to this region. Collateral vascular pathways from the occipital artery and the corticervical trunk are discussed.

About Pain in Yohaku Point (XI-14) and the Posterior Cervical Region

About Pain in Yohaku Point (XI-14) and the Posterior Cervical Region

Rôle du mésoderme somitique dans le développement du plumage dorsal chez l’embryon de Poulet:II Régionalisation du mésoderme plumigène

ABSTRACT The role of somitic mesoderm in the development of dorsal plumage in chick embryos. II. Regionalisation Transplantation and inversion experiments were performed on the somitic mesoderm of 2-to 2·5-day chick embryos in order to study the role of regional and axial determinations in the development of the dorsal plumage. The transposition of a piece of somitic mesoderm from the posterior cervical region (where the spinal pteryla is narrow) to the thoraco-lumbar region (where it is wide) leads to a local and unilateral narrowing of the spinal pteryla at the operation site. Conversely, the transposition of somitic mesoderm from the thoraco-lumbar region to the posterior cervical region results in a local and unilateral widening of the spinal pteryla. Consequently at the time of operation the segmented or not yet segmented somitic mesoderm is already determined to give rise to a definite transverse level of the spinal pteryla. The inversion of the cephalo-caudal polarity of a piece of somitic mesoderm without the ectodermal covering, or of a portion of the axial organs deprived of the overlying ectoderm has no effect on the orientation of feather filaments and feather rows. In contrast, the inversion of the cephalo-caudal polarity of a portion of the axial organs together with the overlying ectoderm results in the development of feathers growing in a cephalad direction and feather chevrons opening towards the head of the embryo. The inversion of the dorso-ventral polarity of a piece of somitic mesoderm does not prevent the normal differentiation of feathers in the operated region. The inversion of the medio-lateral polarity of a piece of unsegmented somitic mesoderm has little effect on the development of the spinal pteryla. On the contrary, the medio-lateral inversion of a chain of somites precludes the formation of the feathers at the level of operation. The somitic mesoderm, even when segmented, is endowed with extensive regulative capacity of its axes, except for the medio-lateral polarity, which is fixed irreversibly at the time of segmentation. The regional determination of the feather-forming somitic mesoderm is acquired at an early stage, at any rate before segmentation. However, at a given transverse level of the cephalo-caudal axis, the somitic cells remain totipotent as concerns their histogenetic destiny (dermatome, myotome, or sclerotome) until after the onset of segmentation.