Side Of Neck Research Articles

The anatomical relationship between recurrent laryngeal nerve and inferior thyroid artery in thyroidectomy patients.

Objective: To identify the anatomical relationship of recurrent laryngeal nerve with inferior thyroid artery. Study Design: Prospective Clinical study. Setting: Department of Surgery, Kishwar Fazal Teaching Hospital. Period: July 2019 to February 2023. Methods: Total 64 patients underwent subtotal thyroidectomies for proven benign goiters were enrolled. Results: Out of these 64 patients, 8 were male and 56 were female, male to female ratio 1:7 with median age 34 years. In 64 patients, 128 dissections were performed and in all patients (RLN) and its relation with Inferior Thyroid Artery (ITA) was identified. On right side of neck in 63 (98.43%) patients out of 64 (100%) patients RLN found deeper to ITA and in one (1.56%) patient it was found superficial to ITA. On left side of neck in 61 (95.31%) patients out of 64(100%) patients it was deeper to ITA and in 3 (4.68%) patients the nerve was superficial to ITA. Identification of RLN was difficult in 16 (12.5%) dissections and the reason was adhesions and huge multinodular goiter. Conclusion: During thyroid surgery, the connection between RLN and ITA is significant to surgeons. When it comes to RLN security, visible anatomical identification is still the gold standard.

Poorly differentiated carcinoma thyroid: an oddball of thyroid malignancy

Poorly differentiated thyroid carcinoma (PDTC) is an aggressive form of follicular cell derived thyroid carcinoma with a poor prognosis with an incidence of 0.3% to 6.7%. It ranks between DTC and ATC regarding the degree of differentiation. PDTC was recognized as a distinct pathologic entity in the classification of thyroid tumour by World Health Organization (WHO) classification of endocrine tumours. This case report was done in Government Villupuram Medical College and Hospital in a 56-year-old male patient who presented with two swellings in the neck one in the midline in the region of thyroid and the other on right lateral side of neck for 5 months. The patient was diagnosed to have poorly differentiated thyroid carcinoma postoperatively and the following course of events are discussed here.

Submandibular gland pleomorphic adenoma masquerading as a multinodular goitre: a case report

Tumors of the salivary gland comprise of a small percentage of all head and neck tumors, of which nearly 80% are benign. The submandibular gland tumors constitute only 5-10% of this group, of which pleomorphic adenoma is the commonest type. They can weigh several kilograms and grow to ludicrous sizes. If left untreated, they may result in facial deformity and airway compromise. We describe a case of a big pleomorphic adenoma arising from submandibular salivary gland that developed in a 65 years old female presenting as a swelling in right side of neck since 15 years. The dimensions of the lesion were roughly around 8×12×11 cm. During surgical examination, a solid mass that originated from the right submandibular gland was discovered to be linked to both the skin and the soft tissue beneath it. Pleomorphic adenoma was confirmed by histopathological examination. Review and discussion of the relevant literature was conducted. This article's emphasis is on the fact that, although the pleomorphic adenoma is a well-reported entity, they can attain very large sizes involving the neck region and can misrepresent itself leading to diagnostic dilemma due to many possible differential diagnoses of neck swellings.

Shell biomechanics suggests an aquatic palaeoecology at the dawn of turtle evolution

The turtle shell is a remarkable structure that has intrigued not only evolutionary biologists but also engineering and material scientists because of its multi-scale complexity and various functions. Although protection is its most apparent role, the carapace and plastron are also related to many physiological functions and their shape influences hydrodynamics and self-righting ability. As such, analysing the functional morphology of the shell could help understanding the ecology of Triassic stem-turtles, which will contribute to the century-long debate on the evolutionary origins of turtles. Here, we used 3D imaging techniques to digitize the shells of two of the earliest stem-turtle taxa, Proganochelys and Proterochersis, and submitted their models to biomechanical and shape analyses. We analysed the strength performance under five predation scenarios and tested the function of two morphological traits found in stem-turtles, the epiplastral processes and an attached pelvic girdle. The latter, also present in the crown-lineage of side-necked turtles, has been suggested to increase load-bearing capacity of the shell or to improve swimming in pleurodires. Our results do not confirm the shell-strengthening hypothesis and, together with the results of our shape analyses, suggest that at least one of the first stem-turtles (Proterochersis) was an aquatic animal.

Clinical outcomes of bilobed platysma myocutaneous flap technique with neck dissection in lower lip squamous cell carcinoma

BackgroundSquamous cell carcinoma (SCC) in the lower lip is among the most frequently encountered types of cancer. As the size of this cancer increases, the need for reconstruction becomes evident, posing a significant challenge. Depending on the staging results in these patients, neck dissection may be recommended. ObjectiveThis study aims to demonstrate the successful application or feasibility of our Bilobed Platysma Myocutaneous Flap technique in patients with lower lip SCC. MethodsThe Bilobed Platysma Myocutaneous Flap was applied to all patients. Following TNM staging, supraomohyoid and/or radical neck dissection were performed. Surveys were conducted with the patients, and scoring was implemented based on the results for evaluation. ResultsBetween 2014 and 2018, 23 patients underwent treatment with this flap, and all flaps survived. Among these patients, bilateral supraomohyoid neck dissection was performed on 14, while modified radical neck dissection on one side and supraomohyoid neck dissection on the other side were conducted on the remaining 9 patients. Throughout the 5-year follow-up period, no recurrence was observed in the patients. ConclusionThe combination of the Bilobed Platysma Myocutaneous Flap technique and neck dissection can be successfully employed in the reconstruction and treatment of lower lip cancers.

The Alchemy Limerence of Love and Lust - Get Your Life Back from Incredibly Painful Vagus Nerve Simulation

Love biologist Dawn Maslar states that hormones such as dopamine and vasopressin are important for a man to begin falling in love. Oxytocin, a hormone released when you hug a loved one, is very important in building and strengthening love in men in later stages. The left vagal nerve runs down the left side of your neck, and the right vagal nerve runs down your right side. This nerve extends all the way from your brain to the large intestines: down your neck, through your chest, around your heart, around your lungs, and through your abdomen and intestines. Cause of Pheromones continue to be an exciting area of research. Currently, the 16-androstenes, and in particular androstadienone is fairly well characterized as a pheromone for women. They are present in male axillary sweat and possibly in other bodily secretions. While this is going on, cholecystokinin suppresses gastric emptying so your stomach won't deliver any more food until the first batch is done. It also suppresses your appetite while you're digesting, by making your stomach feel physically full and by activating vagal nerves in your stomach wall.

FDG PET-CT for the Detection of Occult Nodal Metastases in Head and Neck Cancer: A Systematic Review and Meta-Analysis.

Because of an estimated 20-30% prevalence of occult lymph node (LN) metastases in patients with head and neck squamous cell carcinoma (HNSCC), neck dissection is often proposed, despite its potential morbidity. In this systematic review and meta-analysis, the diagnostic performance of FDG PET-CT in detecting occult LN metastases was evaluated in patients with clinically negative necks (cN0) and in whom histopathology of a neck dissection specimen served as gold standard. Overall, 16 studies out of 2062 screened on PubMed and EMBASE fulfilled the inclusion criteria (n = 1148 patients). Seven of these sixteen studies were split into two or three studies because they contained data that could be processed distinctly in our meta-analysis. For this reason, a total of 25 studies were identified and included in the analysis (n total = 1918 patients). The overall prevalence of metastatic nodes per patient was 22.67%. The pooled sensitivity, specificity, diagnostic odds ratios, and negative predictive value (NPV) were 0.71 (95%CI: 0.66-0.75), 0.90 (95%CI: 0.84-0.93), 20.03 (95%CI: 13.51-29.70), and 0.92 (95%CI: 0.89-0.95), respectively. The main causes of inter-study heterogeneity included different reference standards (evaluation per patient, per neck side, or per neck level). The current meta-analysis showed that FDG PET-CT has a high specificity and NPV for ruling out nodal involvement in cN0 necks, but a limited sensitivity.

Between-Session Reliability of Field-Based Assessments of Isometric Neck Strength.

The reliability of the fixed-frame dynamometer for measuring isometric neck strength is established, but with limited field-based applications. This study aimed to establish the inter- and intra-session reliability of the peak force for neck flexors, extensors, and side flexors using the VALD ForceFrame and DynaMo and the force-time characteristics in the quadruped position (ForceFrame). Twenty-seven recreationally active males performed three repetitions of isometric neck flexion, extension, and side flexion over two sessions in random order using the VALD ForceFrame and DynaMo. Both devices demonstrated acceptable reliability, with the Forceframe ICC > 0.8 and CV% < 13.8% and the DynaMo ICC > 0.76 and CV% < 13.8%. No systematic or proportional differences were found using the Passing-Bablock procedure, and Bland-Altman analysis confirmed agreement across measures. Reliability was shown for right-side (ICC > 0.76) and left-side (ICC > 0.79) flexion and flexion (ICC > 0.75) across 50, 100, 150, and 200 ms. Statistical parametric mapping indicated no differences in ForceFrame-generated isometric force-time curves between sessions, though the CV was highest in the force development phase. The findings suggest that both tools can reliably assess neck strength, supporting their use in sports and clinical settings. However, assessment methods are not interchangeable, emphasising the need for standardised neck strength assessment approaches.

The Importance of the Time Interval Between Preoperative 18F-FDG PET/CT Imaging and Neck Dissection for the Detection of Nodal Metastases in Patients with Head and Neck Squamous Cell Carcinoma.

Detection of nodal metastasis is critical for the treatment and prognosis of head and neck cancer (HNC). Positron emission tomography/computed tomography (PET/CT) is increasingly being used to detect cervical lymph node involvement. The purposes of this study were to (1) investigate the diagnostic accuracy of PET/CT for the detection of neck metastasis in patients with HNC and (2) determine the effect of the time interval between surgery and PET/CT. Fifty patients with head and neck squamous cell carcinoma who underwent PET/CT before surgery were included in this study. Preoperative PET/CT images that determined lymph node metastasis were compared with the histopathological analysis of neck dissection samples. Neck dissections were divided into three groups according to the time interval between surgery and PET/CT (0-2 weeks, >2-4 weeks, and >4 weeks). The concordance between PET/CT and histopathology was measured using the neck sides at different time intervals. The specificity, sensitivity, accuracy, negative predictive value (NPV), and positive predictive value (PPV) of PET/CT in detecting metastatic lymph nodes in the neck were calculated. A total of 79 neck dissections were included in the study as 29 (58%) of the patients underwent bilateral neck dissection. The overall accuracy of PET/CT in detecting nodal metastasis was highest for the 0-2 weeks interval (95.6%). During this time interval, the sensitivity, specificity, NPV, and PPV of PET/CT were 100%, 90.9%, 100%, and 92.3%, respectively. Although PET/CT is an important and reliable diagnostic method for detecting nodal metastases in patients with HNC, its reliability decreases as the time between surgeries increases. The optimal interval was 2 weeks; however, up to 4 weeks was acceptable.

Turbocharging of Deep to Superficial Venous System for Vessel Depleted Neck in Radial Forearm Free Flap: A Case Report of One Neck Vein for Drainage of Both Venous Systems

Dual venous anastomosis in radial forearm free flap surgery increases chances of flap survival as compared to anastomosing only the superficial system. A 48-year-old male patient who had received three previous microsurgical reconstructions and radiotherapy presented with recurrent oral cavity carcinoma. Two of these reconstructions were anastomosed to the left side neck vessels. The recurrence was in the left half of the soft palate. The left neck and underlying vessels were severely scarred and fibrotic, and only 2 cm of the left internal jugular vein (IJV) could be circumferentially mobilized for anastomosis, allowing for only one venous anastomosis. The radial forearm free flap was harvested and a tributary of the cephalic vein was preserved in the proximal part to act as a conduit for drainage of one of the venae comitantes. The cephalic vein was anastomosed end-to-side to the IJV and one venae comitantes to the preserved tributary in end-to-end fashion. The flap survived and the patient was discharged in a week. This novel method helps to drain both venous systems through one available neck vein.

The relation of recurrent laryngeal nerve to inferior thyroid artery and extralaryngeal nerve branching may increase the risk of vocal cord paralysis in thyroidectomy

PurposeThe anatomical variations of the recurrent laryngeal nerve (RLN) are common during thyroidectomy. We aimed to evaluate the risk of RLN paralysis in case of its anatomical variations, retrospectively.MethodsThe patients with primary thyroidectomy between January 2016 and December 2019 were enrolled. The effect of age, gender, surgical intervention, neuromonitorisation type, central neck dissection, postoperative diagnosis, neck side, extralaryngeal branching, non-RLN, relation of RLN to inferior thyroid artery (ITA), grade of Zuckerkandl tubercle on vocal cord paralysis (VCP) were investigated.ResultsThis study enrolled 1070 neck sides. The extralaryngeal branching rate was 35.5%. 45.9% of RLNs were anterior and 44.5% were posterior to the ITA, and 9.6% were crossing between the branches of the ITA. The rate of total VCP was 4.8% (transient:4.5%, permanent: 0.3%). The rates of total and transient VCP were significantly higher in extralaryngeal branching nerves compared to nonbranching nerves (6.8% vs. 3.6%, p = 0.018; 6.8% vs. 3.2%, p = 0.006, respectively). Total VCP rates were 7.2%, 2.5%, and 2.9% in case of the RLN crossing anterior, posterior and between the branches of ITA, respectively (p = 0.003). The difference was also significant regarding the transient VCP rates (p = 0.004). Anterior crossing pattern increased the total and transient VCP rates 2.8 and 2.9 times, respectively.ConclusionRLN crossing ITA anteriorly and RLN branching are frequent anatomical variations increasing the risk of VCP in thyroidectomy that cannot be predicted preoperatively. This study is the first one reporting that the relationship between RLN and ITA increased the risk of VCP.

Efficacy of superficial cervical plexus block in the management of neck pain due to surgical positioning in patients undergoing burr-hole craniotomy for unilateral chronic subdural hematoma under scalp block: A prospective randomized control trial

: Alternatives to general anesthesia technique, pain management of surgical sites have been discussed at length in various studies for burr-hole evacuation in geriatric patients. This is the first study addressing the management of pain that occurs due to extreme contra-lateral side neck rotation to access the surgical site. : This trial was conducted (from January 2021 to January 2022) on 60 patients of age ≥ 18 years with ASA grade I/I/III undergoing unilateral burr hole craniotomy for evacuation of chronic subdural hematoma (CSDH) under scalp block. Group D (n=30) received 5 ml of 0.5% bupivacaine by ultrasound-guided superficial cervical plexus block (SCPB), and group P (n=30) received SCPB with placebo (normal saline). The primary outcome was the numerical rating pain score (NRS) pain score during neck movement in the postoperative period. Secondary objectives were muscle spasm assessed by the modified Ashworth scale (MAS), consumption dosage of rescue analgesia, modified Ramsay sedation score (MRSS), and hemodynamic parameters.: NRS scores were significantly lower at 8 hours in the SCPB with drug (D) group compared to the SCPB with placebo group (p-value = 0.019). MAS were higher in group P compared to group D until 12 (&amp;#60;0.001). Consumption of rescue analgesia was higher in group P than group D (&amp;#60;0.001). MRSS was significantly higher in group D compared to group P throughout the intra-operative period (&amp;#60;0.001).: Preoperative superficial cervical plexus block decreases postoperative neck pain and facilitates neck rotation.

Open surgery with a lateral neck approach in cases of foreign body impaction that penetrating the neck through the esophagus: a single-center experience

BackgroundBecause the cases are quite scarce, we aimed to review cases of foreign body impaction penetrating the neck through the esophagus to analyze the characteristics of these cases. The open surgery skills of the surgeon, the treatment procedure and the surgeons’ experience in the rare diseases were analyzed.MethodsWe collected and analyzed all cases from 2015–2020 in our hospital. Surgical skills and procedures for fasting and anti-infection treatment were reviewed retrospectively. Follow-up was telephone communication.ResultsOur series included 15 cases. Tenderness in the pre-cervical site was a physical sign for screening. Thirteen cases underwent a lateral neck open surgery with the incision including the left side of neck and only two cases were incised from the right side of the neck. Pus was found 3 days after the impaction in one case, the shortest time observed in our series. The esophageal laceration was only sutured primarily in 5 cases (33.33%) among all fifteen cases. After sufficient drainage (average more than 9 days), antibiotic treatment and fasting (normally 2–3 weeks), patients gradually began to switch to solid foods from fluids after complete blood counts and confirmations from esophageal radiography result. No severe complications occurred, and all the patients have no swallowing dis-function and recovered well.ConclusionSurgery should be performed as soon as possible after impaction. Lateral neck approach surgery and the therapeutic procedure described in this article are safe and effective treatments.

A head-to-head comparison of [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT in patients with nasopharyngeal carcinoma: a single-center, prospective study.

We aimed to compare the staging efficiency of [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT in nasopharyngeal carcinoma (NPC) patients. Thirty-nine patients with pathologically confirmed NPC were enrolled in this prospective study. Each patient underwent paired [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT on 2 successive days. The accuracy of two PET/CT for assessing T, N, and M stages was compared by using head-and-neck MRI, histopathologic diagnosis and follow-up results as reference standards. The radiotracer uptake derived from two PETs was also compared. For treatment-naïve patients, [68Ga]Ga-DOTATATE PET/CT showed identical sensitivity for the primary tumours but clearer tumor delineation induced by higher tumour-to-background (TBR) ratio (19.1 ± 8.7 vs. 12.4 ± 7.7, P = 0.003), compared with [68Ga]Ga-FAPI PET/CT. Regarding cervical lymph node (CLN) metastases, [68Ga]Ga-DOTATATE PET had significantly better sensitivity and accuracy based on neck sides (98% vs. 82%, P < 0.001; 99% vs. 88% P = 0.008), neck levels (98% vs. 78%, 99% vs. 97%; both P < 0.001) and individual nodes (89% vs. 56%, 91% vs. 76%; both P < 0.001), and higher TBR (8.1 ± 4.1 vs. 6.3 ± 3.7, P < 0.001). Additionally, [68Ga]Ga-DOTATATE PET/CT revealed higher sensitivity and accuracy for distant metastases (96% vs. 53%, 95% vs. 52%; both P < 0.001), particularly in bone metastases (99% vs. 49%, 97% vs. 49%; both P < 0.001). For post-treatment patients, [68Ga]Ga-DOTATATE PET/CT identified one more true-negative case than [68Ga]Ga-FAPI PET/CT. [68Ga]Ga-DOTATATE PET/CT performed better than [68Ga]Ga-FAPI PET/CT in visualizing the primary tumours, detecting the metastatic lesions and identifying the local recurrence, suggesting [68Ga]Ga-DOTATATE PET/CT may be superior to [68Ga]Ga-FAPI PET/CT for NPC staging.

Infantile Fibrosarcoma Presenting as Neck Mass: A Case Report

Abstract A one year old boy presented with a mass in the posterior triangle of left side of neck for ten months with rapid increase in size since one month. Radio-imaging was done. He underwent surgery, the mass was excised and the histopathological examination was done. Clinically, it was thought to be as schwannoma. Tumor measured 10 x 8 x 6 cm approximately, fixed with underlying tissue, venous prominence seen on bosselated surface and was non-tender. Microscopically, showed a cellular neoplasm composed of spindle cells arranged in herringbone pattern, also as fascicles and bundles, with focal area showing slit like thin-walled vessels simulating hemangiopericytoma like vasculature. Focally, shows infiltration of muscle and fat. Immunohistochemistry study was performed. Correlating histology with clinical, radiology and immunohistochemistry findings, the patient was diagnosed as a case of Infantile Fibrosarcoma of neck region, a relatively rare malignant fibroblastic tumor, occurring mostly in infancy, often misdiagnosed with benign tumor. Keywords: Cellular, herringbone pattern, hemangiopericytoma, immunohistochemistry, fibroblastic.

An anatomic consideration of the femoral nerve during direct anterior hip approach: A cadaveric study.

This study aimed to investigate the distance and correlation between the anatomy of the anterior side of the hip joint and the femoral nerve. Using ten fresh-frozen cadavers with twenty hip joints. We dissected and marked the femoral nerve in the inguinal area. Employing the direct anterior approach, we identified and marked study points, including the superior and inferior points of the anterior rim of the acetabulum, ¼ point, half point, and ¾ point along an imagined line connecting the formers, the inferomedial and mid aspect of the femoral neck, and the soft spot. Coronal plane measurements gauged the distance between these points and the femoral nerve. The collected data were analyzed to assess the distance and correlation. In the coronal plane, the median distance between the inferior point of the anterior rim of the acetabulum and the femoral nerve was 0 millimeters (interquartile range [IQR] 0-0). Likewise, the median distance between the mid aspect of the medial side of the femoral neck and the femoral nerve was 0 millimeters (IQR 0-0). Additionally, the mean distance between the soft spot and the femoral nerve was 1.18cm (SD 0.63). Surgeons approaching the hip joint via the direct anterior approach should be cautious at the inferior point of the anterior rim of the acetabulum and the mid aspect of the femoral neck. The soft spot at the anterior rim of the acetabulum remains safe from direct injury when surgeons use the correct technique during anterior retractor insertion.

Living with a tumor: A case of osteosarcoma involving the medullary region in Phrynops cf. P. geoffroanus (Testudines: Chelidae).

The individual Geoffroy's side-necked turtle, Phrynops cf. P. geoffroanus, was diagnosed postmortem with osteosarcoma associated with the forelimb through morphological and histological analysis. Osteosarcoma stands as the most prevalent primary malignant bone tumor in tetrapods. The tumor presents itself as a large mass in the distal epiphysis, characterized by spicular outgrowths and a rugose external texture. Histologically, the afflicted humerus displayed a high degree of vascularity and exhibited an extensive bone resorption process involving the medullary and endosteal regions. Notably, a clear transition between the bone marrow and cortical bone was absent, indicative of a remodeling process featuring Haversian bone system apposition. Additionally, the diaphyseal region displayed the progression of neoplastic bone tissue along the bone. For comparative purposes, we describe a humeral thin section from a healthy specimen revealing compact primary bone interrupted by cyclical growth marks which differs from the continuous growth observed in the neoplastic humerus. To assess the neoplastic bone growth rate at the mid-diaphysis level, phylogenetic eigenvector maps (PEM) were employed, utilizing osteocyte density and vascular density as explanatory variables. The findings indicated that the osteosarcoma exhibited a slow-growing nature, suggesting that the turtle had to live with this condition for years. As the neoplasia continued to expand, it likely led to disadvantages for the pathological Phrynops individual due to humeral deformity. Furthermore, malignancy was associated with angiogenesis and the invasion of the medullary region by neoplastic bone tissue, raising the likelihood of metastasis as an additional factor contributing to the individual's sickness. The presence of numerous vascular canals in the diaphyseal thin section suggested a low-grade central osteosarcoma. It is worth noting that osseous neoplasms are rarely documented in Testudines, making this case of osteosarcoma in a South American freshwater chelid specimen a unique and rare occurrence.

Occult Thyroid Carcinoma with Cervical Lymph Node Metastasis: A Rare Case Report.

Cervical lymph node metastasis is one of the most common clinical presentations of papillary thyroid carcinoma (PTC). Occult thyroid carcinoma is described as absence of primary tumour or with presence of microcarcinoma in thyroid with cervical lymph node metastasis. Frequency of occult thyroid cancer has decreased due to developments in imaging and improved accuracy of histological examinations. 38year old male presented to us with complaints of swelling over the left side of neck for the past 2months. Ultrasonography was suggestive of multiple suspicious enlarged nodes in left level II, III, IV and V and fine needle aspiration cytology showed features of metastatic PTC. He was planned for total thyroidectomy with central compartment clearance and bilateral functional neck dissection. Final histopathology staging was pT0N1b. Radioactive iodine (RAI) screening showed residual functioning thyroid and later therapeutic RAI was administered. He has been on regular follow up and disease free for 1year post treatment. Occult thyroid carcinoma is a rare diagnosis with multiple treatment plans. Few hypothesis for this entity includes tumor regression, ectopic thyroid carcinoma or missed pathological findings.

Impacted Foreign body of Porcupine spine in Neck- a case report

Abstract: Introduction: Trauma and foreign body impaction in the neck can be dangerous because of high chances of injury to vital structures like the major blood vessels, airway, digestive tract and nerves located in the neck. Hence, early diagnosis and treatment is important to prevent severe morbidity and mortality. Case presentation: A 24 years old male from Rolpa had presented with complaint of painful swelling over right side of neck for a week.He had past history of encounter with porcupine a month back. Ultrasonography of the neck revealed impaction of foreign body in the right lateral neck(sternocleidomastoid muscle) with pus and granulation tissue around it. He was then admitted and exploration under general anesthesia was done and porcupine spine was removed. Conclusion: Any neck trauma should be evaluated for residual foreign body as it can be dangerous in the neck. Early detection and removal of foreign body should be done on time to prevent life threatening complications.

Changes in bone mineral density and clinical parameters after stroke in elderly patients with osteopenia.

We aimed to determine the association between changes in bone mineral density (BMD) of the lumbar spine, bilateral femoral necks and clinical parameters in ambulatory older adult patients with stroke who were diagnosed with osteopenia. This retrospective study included ambulatory patients older than 65 years diagnosed with stroke between January 2019 and June 2021. Osteopenia was diagnosed within 1 month after stroke diagnosis. Subsequently, follow-up BMD was performed within 12 to 14 months. The manual muscle test and modified Barthel index were measured as clinical parameters, and bone turnover markers were measured as biochemical markers. The Wilcoxon signed-rank test was used to compare whether a significant difference in the change in BMD was noted at each site measured at 1-year intervals. The BMD of the paretic and non-paretic femoral necks decreased significantly over time, but no significant change was observed in the BMD of the lumbar spine. Bone turnover markers were significantly changed at follow-up. Patients with modified Barthel index of less than 82 had significant bone loss only on the paretic side of the femoral neck. The BMD of the paretic side of the femoral neck was significantly decreased regardless of the strength of the hip and knee extensors. Although older adult patients with stroke and osteopenia can walk independently, more active osteoporosis treatment is needed to prevent bone loss and fractures, including improvement in daily living function and bilateral lower extremity strength training.