Rationale:Head and neck osteosarcoma is a rare malignancy, accounting for 6%–10% of all osteosarcomas, and typically affects younger individuals. Its occurrence as a metachronous tumor in elderly patients, particularly after radiotherapy, is exceedingly uncommon.Patient concerns:A 91-year-old man with a history of right lateral tongue verrucous carcinoma treated by surgery and adjuvant radiotherapy (50 Gy) in 2006 presented in 2024 with progressive hoarseness and dysphagia for 6 months.Diagnoses:Clinical examination revealed a firm neck mass. Laryngeal biopsy showed benign keratosis, while core needle biopsy demonstrated a malignant mesenchymal tumor with osteoid production. Immunohistochemistry showed negative cytokeratin and p63, and Ki-67 positivity in 20% of cells, confirming osteosarcoma. Imaging revealed a calcified lesion involving the hyoid, thyroid cartilage, and tongue base, consistent with metachronous head and neck osteosarcoma.Interventions:Due to advanced age and comorbidities (hypertension and diabetes), palliative radiotherapy (30 Gy in 15 fractions) was administered. Surgery and chemotherapy were avoided because of frailty and limited benefit.Outcomes:The patient tolerated treatment well, achieving partial symptom relief without major toxicity. Long-term follow-up continues with a focus on quality of life.Lessons:This case highlights the diagnostic challenges of secondary head and neck osteosarcoma following radiotherapy and the importance of long-term surveillance in elderly patients. Individualized management balancing treatment efficacy and tolerability is essential in geriatric oncology.

Controlling bacterial presence and inflammation in the larynx remains a significant challenge, especially in contexts where infection and immune responses can affect tissue health, prompting growing interest in developing bioactive materials that can be delivered locally and noninvasively to modulate microbial load and inflammatory responses. In this study, we developed and characterized aerosolizable formulations derived from decellularized extracellular matrix (dECMx) of porcine vocal fold lamina propria (VFLPx) and thyroid cartilage (Cx). These formulations were evaluated for their antibacterial and immunomodulatory effects. The dECMx formulations exhibited heterogeneous microstructures and aggregate sizes smaller than 5 μm, which is consistent with requirements for aerosol delivery. Antibacterial activity against Staphylococcus aureus was assessed through colony-forming unit (CFU) quantification and bacterial growth kinetics, comparing the liquid and aerosol forms. In liquid form, VFLPx reduced CFU counts by ∼66% and Cx by ∼16%, both showing statistically significant reductions compared to controls. In aerosolized form, both formulations demonstrated comparable antibacterial efficacy, with approximately ∼47% reductions in CFU for VFLPx and Cx. Immunomodulatory potential was evaluated using a THP-1 ascGFP reporter cell line, which was stimulated with LPS to activate NF-κB signaling. Exposure to both dECMx formulations significantly attenuated the LPS-induced GFP fluorescence, indicating a suppression of NF-κB-mediated activation. These in vitro results demonstrate that liquid dECM-derived formulations maintain significant antibacterial activity after processing and aerosolization while also inhibiting inflammatory pathways in human macrophages. This highlights their potential as localized treatments to effectively control bacterial infections without causing inflammation.

Despite recent advancements, ensuring the successful placement and safe ventilation of second-generation supraglottic airway devices (SAD) remains challenging, particularly in pediatric patients. This study aims to compare three LMA ProSeal insertion techniques to assess their impact on placement effectiveness in children, as measured by oropharyngeal leak pressure (OLP). This study hypothesized that different insertion techniques would have a statistically significant effect on OLP in pediatric patients. This was a prospective, randomized, controlled trial conducted at a single-center university hospital from October 2023 to April 2024. A total of 150 children aged 1-10 years undergoing short surgical procedures (≤90 minutes) were enrolled. After inserting the LMA ProSeal via standard technique (SD group), direct laryngoscopy (DL group), or videolaryngoscopy (VL group), OLP was measured by detecting air leaks at the thyroid cartilage while closing the valve up to 30 cmH<inf>2</inf>O. A fiberoptic bronchoscope was used to evaluate the glottic view. Of the 159 screened patients, 150 were analyzed per protocol. OLP was significantly higher in the VL group (median [Q1-Q3], 26 [24.2-27] cmH<inf>2</inf>O) compared to the DL group (23 [21.2-24] cmH<inf>2</inf>O) and SD group (21 [20-22] cmH<inf>2</inf>O) (P<0.001). The DL group showed significantly higher OLP than the SD group (P=0.001). Fiberoptic imaging scores were higher in the VL group than in the other groups (P<0.001). The first-attempt success rate of SAD insertion was comparable between the VL and DL groups (94% each), but lower in the SD group (86%) (p=0.290). The SAD insertion time was significantly longer in the VL and DL groups compared to the SD group (median [Q1-Q3], 21 [19.2-22] s; 21 [19-22] s; 14 [13-16] s respectively, P<0.001), although there was no significant difference between VL and DL. The number of additional maneuvers during SAD placement was similar between the VL and DL groups but lower in the SD group (P=0.008). Videolaryngoscopy resulted in the highest OLP and the best fiberoptic views, ensuring superior SAD placement. Direct laryngoscopy improved placement over the standard technique but was less effective than videolaryngoscopy.

Variations (topographical) in the course of the carotid arterial system are well-documented. Still, their clinical significance lies in their potential to alter cervical anatomy and increase the risk of iatrogenic injury. Retropharyngeal displacement most often involves the internal carotid artery (ICA), while involvement of the external carotid artery (ECA) or common carotid artery (CCA) is rarely reported. Simultaneous displacement of multiple carotid arteries (CAs) is extremely rare. We describe a 40-year-old female patient in whom computed tomography angiography (CTA) revealed an unusual constellation of vascular variants. Both ICAs and the ipsilateral ECA traveled through the retropharyngeal space. Bilateral carotid bifurcations were twisted. The right ICA showed a coiled shape at the level of the styloid process, and both CCAs were found in unusually close proximity to the superior cornu of the thyroid cartilage. No signs of atherosclerosis were seen, indicating a developmental rather than acquired variant. This case expands the range of known cervical vascular topographies by showing, for the first time, a tri-arterial retropharyngeal configuration with concurrent ICA coiling. While isolated or bilateral retropharyngeal displacements of the ICA, CCA, or superior thyroid artery have been documented, the presence of three major arteries in this compartment simultaneously seems unprecedented. Recognizing such extreme variants is essential for preventing severe hemorrhage and for guiding surgical and anesthetic planning in the anatomically restricted retropharyngeal region.

Aims: We aimed to report a rare case of a cervicothoracic mass revealing Non-Hodgkin's Lymphoma (NHL), highlighting its unusual localization. Non-Hodgkin's Lymphoma (NHL) is a rare condition, primarily affecting lymph nodes but can involve any organ. Extra-nodal NHL occurs in 25% of cases, with 60% located in the head and neck region. NHL in this area presents diverse clinical, morphological, and biological features, reflecting the complexity of histopathological classifications. Diagnosis relies on histology, which guides therapeutic management. This case report describes a cervicothoracic mass revealing laryngeal NHL. A 70-year-old man with a history of diabetes and hypertension, was admitted to the ENT department with a 10-month history of a painless left laterocervical swelling, dysphonia, and deteriorating general condition, without signs of tuberculosis, dyspnea, or initial dysphagia. ENT examination revealed a large, adherent, painless left laterocervical mass extending intrathoracically, associated with left upper limb lymphedema. Nasofibroscopy showed left laryngeal paralysis and deviation of the left hemi-laryngeal structures. Blood tests indicated bicytopenia. A CT scan identified a lesion in the left hemi-larynx with thyroid cartilage lysis and a cervical tumor extending into the cervico-thoracic area, displacing the trachea and esophagus. No lung nodules or mediastinal lymphadenopathy were observed. MRI confirmed a cervico-thoracic tumor with diffusion hypersignal, low ADC, and homogeneous enhancement, closely associated with the left thyroid lobe. Direct laryngoscopy and biopsy revealed diffuse large B-cell lymphoma (non-germinal type). Immunohistochemistry showed tumor cells positive for CD20, Bc16, and Mum1, negative for CD3, CD5, CD20, AE1/AE3, and Cyclin D1, with a high Ki67 proliferation index of 90%.

The aim is to reveal the basic morphology of the infrahyoid muscles by proposing a new classification system. Data were analyzed from 67 sides from 34 Japanese cadavers. We propose a new classification system for the infrahyoid muscles, dividing them into 12 areas: superficial (S) and deep (D), cranial (1, 3, 5) and caudal (2, 4, 6), lateral (1, 2), intermediate (3, 4) and medial (5, 6). This system integrates morphology and innervation pattern of these muscles more accurately. In the superficial layer, top of the intermediate tendon of the omohyoid muscle serves as the boundary between the cranial and caudal parts. In the deep layer, the thyroid cartilage represents the boundary. Additionally, innervation by the cranial and caudal branches of the ansa cervicalis is a required criterion for classification. The incidences for six areas - S1, S2, S5, S6, D3, and D4 - exceeded 99%, with this pattern observed in 71.6% of cases, suggesting that these may represent standard anatomical patterns. In contrast, areas such as S3, S4, D1, D2, D5, and D6 showed lower incidences. Notably, three novel anatomical variations were observed and described in detail. The proposed classification system allows for a more comprehensive understanding of the basic morphology of the infrahyoid muscle variation. Clinically, this is relevant for surgical procedures involving the infrahyoid area, such as flap reconstruction, where unexpected variations may occur surgical risks. Therefore, the proposed classification system offers anatomical and surgical framework of the infrahyoid muscles.

Background: Kosali cattle are a native breed from Chhattisgarh, India, primarily raised in rural areas on agricultural residues. However, there is limited information about the prenatal development of their thymus. Therefore, current study was conducted to understand the prenatal morphohistogenesis of thymus in Kosali breed of cattle. Methods: The present investigation involves 24 Kosali foetuses for the prenatal gross morphometric development of the thymus and categorized on the basis of crown-rump length (CRL) into four groups: Group I (CRL less than 20 cm), Group II (20-40 cm), Group III (40-60 cm) and Group IV ( greater than 60 cm). A midventral cervical incision from the larynx to the thoracic inlet was made to expose the thymus for in situ examination of its topography and morphology. Thymus samples were collected and processed for Hematoxylin and Eosin, Van Gieson’s, Verhoeff’s and Gomori’s staining for histological changes. Result: In Group I, the thymus had paired cervical parts and one unpaired thoracic part, with the right limb extending to the middle thyroid cartilage and the left to the cricoid cartilage. By Groups II to IV, the left limb shifted laterally. The thymus color changed from cream to pink and while lobes became more distinct, their number decreased and size increased. The capsule thickened and became more vascular. The stroma contained interlobar and interlobular septa that thinned over groups and the number of lobules per field decreased significantly, indicating involution of the thymus and functional adaptations with age. These observations suggest that the thymus undergoes progressive involution with age. The structural and vascular changes seem to reflect the functional adaptations that occur during development.

This study aimed to develop machine learning-based algorithms to assist physicians in ultrasound-guided localization of the cricoid cartilage (CC), thyroid cartilage (TC), and cricothyroid membrane (CTM) for cricothyroidotomy.Adult female participants presenting to the emergency department with dyspnea or to the obstetrics and gynecology department for a scheduled cesarean section between August 2022 and July 2024 were prospectively recruited. Ultrasonographic images were collected using a wireless handheld ultrasound device connected to an edge computing tablet. Three You Only Look Once (YOLO) model variants-v5n6, v8n, and v10n-were selected for development and evaluation.A total of 608 participants (median age: 58.0 years, interquartile range [IQR]: 40.0-73.0; median body mass index: 23.2kg/m², IQR: 20.2-26.5) contributed 117,094 ultrasonographic frames. All three YOLO-based models demonstrated high accuracy in detecting CC, TC, and CTM, with area under the receiver operating characteristic curve values exceeding 0.88. In correctly identified frames, the models effectively localized CC (IOU values: YOLOv5n6, 0.713 [95% confidence interval (CI): 0.698-0.726]; YOLOv8n, 0.718 [95% CI: 0.702-0.733]; YOLOv10n, 0.718 [95% CI: 0.701-0.734]; p value: 0.03) and TC (YOLOv5n6, 0.700 [95% CI: 0.683-0.717]; YOLOv8n, 0.706 [95% CI: 0.687-0.725]; YOLOv10n, 0.703 [95% CI: 0.783-0.721] ; p value: 0.037), though localization accuracy was lower for CTM (YOLOv5n6, 0.364 [95% CI: 0.333-0.394]; YOLOv8n, 0.363 [95% CI: 0.331-0.394]; YOLOv10n, 0.354 [95% CI: 0.325-0.381] ; p value: 0.053). The mean frames per second for YOLOv5n6, YOLOv8n, and YOLOv10n were 3.67, 13.83, and 14.13, respectively, when deployed on the handheld ultrasound platform.YOLO-based models demonstrated high accuracy in detecting and localizing CC, TC, and CTM. YOLOv8n and YOLOv10n achieved clinically acceptable real-time imaging performance when deployed on a wireless handheld ultrasound device with an edge computing tablet. Further studies are needed to assess whether this favorable performance translates into actual clinical benefits.

Direct submentoplasty remains a valuable alternative to rhytidectomy in male patients, addressing cervical laxity and fullness while avoiding feminization, periauricular scars, and prolonged recovery associated with traditional rhytidectomy.Since the early 20th century, submental skin excision has undergone refinement, progressing from horizontal ellipses to advanced configurations such as the Grecian urn pattern. These modifications aim to optimize scar camouflage while correcting horizontal and vertical redundancy.Key anatomic contributors to cervical aging include skin and platysmal laxity, supra- and subplatysmal fat, anterior belly of the digastric hypertrophy, ptotic submandibular glands, and a low-lying hyoid. Comprehensive preoperative analysis is required to address these factors.For patients presenting with submental fullness accompanied by good skin elasticity and minimal skin laxity, an isolated deep structural neck lift without skin excision may be sufficient. Optimal candidates for direct cervicoplasty (skin excision) demonstrate submental laxity limited to above the thyroid cartilage, minimal jowling, and acceptance of an anterior cervical scar.The isolated deep structural neck lift addresses the platysma and its underlying structures without the need for skin excision. A direct cervicoplasty with skin excision affords wide exposure for addressing the skin, platysma, and the subplatysmal anatomy. Skin excision patterns are varied and tailored to the patient's needs.Scar modulation strategies, drain management, lymphatic assistance with positioning/massage, and salivary flow management are key to a hastened recovery.Direct submentoplasty remains an essential tool in the aging male patient, offering reproducible results in appropriately selected patients who are willing to accept its limitations.

The goal of this study was to compare the cranial anatomical characteristics of different animals to provide a scientific basis for the selection of obstructive sleep apnoea (OSA) animal models. We analysed the computed tomography (CT) scan images of humans, Macaca, rabbits, mice, rats, and tree shrews; employed 3D reconstruction and measurement techniques to assess the morphological characteristics of the mandible, hyoid bone, and thyroid cartilage; normalized volumes of the tongue and soft palate, fat distribution, and volume and morphology of the airway in each species; and compared their similarity to the corresponding human structures. Macaca has the greatest similarity to humans in terms of skeletal structure, airway morphology, and fat distribution. With respect to skeletal structure and soft palate research, the anatomical features of tree shrews make them highly competitive candidates. Rabbits have a weak anterior neck area and a long soft palate and tongue base, thus forming a narrow supraglottic and glottic region; when the research target involves these areas, the use of a rabbit model may be more appropriate. These findings provide a solid scientific foundation for the selection and optimization of OSA animal models, which not only helps to deepen our understanding of the pathophysiological mechanisms of OSA but also promotes the development of new treatment methods.

Objective.The ProVision scanner is a dedicated prostate positron emission tomography (PET) system with limited angular coverage; it employs a new detector technology that provides high spatial resolution as well as information about depth-of-interaction (DOI) and time-of-flight (TOF). The goal of this work is to develop a flexible image reconstruction framework and study the image performance of the current ProVision scanner.Approach.Experimental datasets, including point-like sources, an image quality phantom, and a pelvic phantom, were acquired using the ProVision scanner to investigate the impact of oblique lines of response introduced via a multi-offset scanning protocol. This approach aims to mitigate data truncation artefacts and further characterise the current imaging performance of the system. For image reconstruction, we applied the list-mode Maximum Likelihood Expectation Maximisation algorithm incorporating TOF information. The system matrix and sensitivity models account for both detector attenuation and position uncertainty.Main results.The scanner provides good spatial resolution on the coronal plane; however, elongations caused by the limited angular coverage distort the reconstructed images. The availability of TOF and DOI information, as well as the addition of a multi-offset scanning protocol, could not fully compensate for these distortions.Significance.The ProVision scanner concept, with innovative detector technology, shows promising outcomes for fast and inexpensive PET without CT. Despite current limitations due to limited angular coverage, which leads to image distortions, ongoing advancements, such as improved timing resolution, regularisation techniques, and artificial intelligence, are expected to significantly reduce these artefacts and enhance image quality.

Background: Anthropometric tests and scales used to predict difficult intubation in people with obesity have limited sensitivity and specificity. A thyromental height test (TMHT) is based on the height between the anterior border of the thyroid cartilage and the anterior border of the mentum. Objectives: The aim of this study was to assess the usefulness of TMH in the prediction of difficult intubation in patients with obesity scheduled for elective surgical procedures. Methods: A prospective, observational cohort study in adult patients with BMI ≥ 30 kg⋅m−2 scheduled for elective surgical procedures under general anesthesia, direct laryngoscopy, and intubation was conducted in a university hospital between June 2020 and June 2021. The primary outcome measure was thyromental height, and the secondary outcome measures were thyromental distance (TMD), sternomental distance (SMD), score in the modified Mallampati test (MMT), Cormack–Lehane grade (CL), neck circumference (NC), and mouth opening (MO) distance. As a secondary outcome, a composite score was developed and analyzed for its predictive performance. Results: In 77 patients (56 females, 72.7%) aged 43.21 ± 9.39 years with a mean BMI of 37.18 (34.6–42.8) kg⋅m−2, difficult intubation was found in 18 patients (23.38%). Sleep apnea was present in 14 (23.75) patients with easy intubation vs. 9 (50%) patients with difficult intubation (p = 0.033). There were no statistically significant differences in thyromental height test, thyromental distance, neck circumference, and mouth opening scores. Male sex, TMD ≤ 175 mm, and MO ≤ 60.5 mm were predictors of difficult laryngoscopy. The OPERA Score (range 0–5) demonstrated superior predictive value (AUC = 0.8 p < 0.01), outperforming its individual components. Conclusions: Male sex, TMD ≤ 175 mm, and MO ≤ 60.5 mm are predictors for difficult laryngoscopy in patients with obesity. The results of our study indicate that TMH may not be a good predictor of difficult intubation in patients with obesity. However, when integrated into a composite score, it contributes meaningfully to a multifactorial risk assessment.

Thyroid Foramen: Prevalence and CT Morphology.

ObjectiveTo describe the computed tomographic (CT) features of neoplastic and inflammatory laryngeal masses. The authors hypothesized that specific CT features may help differentiate between these two origins and that regional lymph nodes would be larger in cases of laryngeal neoplasia.MethodsMedical records from two veterinary referral hospitals were screened for dogs diagnosed with either an inflammatory or neoplastic laryngeal mass who underwent CT scans of the neck. Information retrieved from medical records included signalment, physical examination findings, CT scan findings, and definitive diagnosis of the laryngeal mass based on cytological or histopathological results.ResultsFour dogs had laboratory reports compatible with a malignant neoplasia and three with an inflammatory process. The shape of the mass was defined as “ovoid” in all neoplastic masses and as “thickening” in cases of inflammatory processes. Masses were of various sizes (median length: 42 mm, range: 26–82 mm) and either unilateral (1/4 and 2/3 of neoplastic and inflammatory masses respectively) or bilateral. They were described as mineralized (1/4 and 1/3) and as having either an internal (1/4), external (2/4) growth pattern or both (1/4, 3/3). All masses had ill-defined margins and showed heterogeneous contrast enhancement. Two neoplastic and two inflammatory masses had a cavitary aspect. All but one case were associated with regional lymphadenopathy. Thyroid cartilage destruction was observed with two neoplastic and two inflammatory masses.Clinical relevanceThis case series describes CT features of laryngeal masses. The shape of the laryngeal mass may assist in determining its nature, inflammatory process was defined as “thickening” of the larynx and neoplasia as “ovoid”-shaped, whereas other studied features were inconsistently observed in both neoplastic and inflammatory conditions.

IntroductionTracheotomy and cricothyrotomy are life-saving airway interventions that carry a risk due to the presence of midline vascular structures in the anterior neck. Injury to these structures during blind landmark-based procedures can lead to serious complications. Ultrasound (US) is a non-invasive, real-time imaging modality that enables direct visualization of cervical anatomy and vascular variants. Despite its advantages, its routine use is not yet standardized in clinical protocols. This study aims to evaluate the prevalence of midline vasculature using US in healthy individuals and to review current guidelines regarding US use in airway access. The aim of the study is to assess the prevalence of midline cervical vasculature using US in healthy adults and to review national and international guidelines on US use in tracheotomy and cricothyrotomy procedures.MethodsThis cross-sectional observational study included 80 healthy volunteers in the age range of 18 to 49 years. High-resolution US scans were performed at three anatomical levels: the inferior border of the thyroid cartilage, the superior border of the cricoid cartilage, and the inferior edge of the thyroid isthmus. The presence of midline vascular structures was recorded. A concurrent review of airway management guidelines (American Society of Anesthesiologists, Difficult Airway Society, Royal College of Anaesthetists, and others) was also undertaken.Results Midline vascular structures were identified in 23 participants (28.7%). At specific anatomical levels, 18 participants (22.5%) had vessels at the thyroid isthmus, three participants (3.8%) had at the cricoid cartilage, and two participants (2.5%) had at the thyroid cartilage. No significant association was found between vascular presence and demographic factors such as sex, BMI, or ethnicity, with a p-value of 0.6 (Gender) and 0.9 (Ethnicity). Guideline review revealed no consistent recommendations for routine US use in tracheotomy or cricothyrotomy.ConclusionThe US detected significant vascular structures in the midline neck, particularly at the thyroid isthmus level, in a substantial portion of healthy individuals. These findings support integrating the US into standard airway management protocols to enhance safety and accuracy.

Laryngeal ultrasound-guided adhesive transcutaneous electrodes versus conventional endotracheal electrodes for intraoperative neuromonitoring during thyroid and neck surgery.

Radiotherapy is an effective treatment modality for head and neck cancer; however, it is associated with various side effects. One of the most devastating complications in the laryngopharyngeal region is radionecrosis, which presents with various signs and symptoms and can significantly impair patients' quality of life. This study aimed to identify factors related to the occurrence of radionecrosis and to evaluate treatment outcomes based on clinical experience. This retrospective study included patients diagnosed with laryngeal and hypopharyngeal cancer who received radiotherapy-based treatments as the initial modality at our tertiary referral center from January 2013 to December 2020. A total of 219 patients were included, of whom 20 (9.1%) developed radionecrosis requiring admission for treatment (Chandler's grade 3 or 4). Univariate analysis revealed significant associations between radionecrosis and clinically advanced T stage, thyroid cartilage involvement, paraglottic invasion, primary treatment modality (radiotherapy alone vs. chemoradiotherapy), and mid-radiation neutrophil-to-lymphocyte ratio (optimal cutoff; 2.4). Among the 20 patients treated for radionecrosis, including those who received hyperbaric oxygen (HBO) therapy, nine recovered without surgery, four recovered only after surgery, and seven did not improve. Patients with better outcomes tended to receive HBO therapy earlier and exhibited lower mid-radiation NLR values. Patients with an advanced tumor status and elevated mid-radiation NLR should be closely monitored for radionecrosis. This suggests that early intervention with HBO therapy may enhance the rate of organ preservation.

The superficial cervical plexus block can be used to provide perioperative analgesia in pediatric patients undergoing thyroid surgeries, brachial cleft cyst excision, tympano-mastoid surgery, as well as cochlear implantation. The cervical plexus is formed by the first four cervical spinal nerves, and the superficial cutaneous branches emerge from the posterior border of the sternocleidomastoid muscle, often referred to as the "nerve point of the neck." The aims of this study were to evaluate the location of this nerve point and formulate a standardized method of blocking the superficial cervical plexus in pediatric patients. The nerve point of the neck and the superficial branches of the cervical plexus were dissected and exposed on 22 neonatal cadavers from the Department of Anatomy, University of Pretoria, after ethical clearance was obtained. The distances between the nerve point and predetermined landmarks were calculated. The nerve point was located 17.51 mm from the sternocleidomastoid muscle attachment at the rudimentary mastoid process and 19.80 mm from the clavicular attachment of the muscle. The nerve point is approximately 20.99 mm from the midline of the neck, and the superior border of the thyroid cartilage corresponds to the level of the nerve point in 83.3% of neonatal dissections. The superficial cervical plexus can be blocked along the midpoint of the posterior border of the sternocleidomastoid muscle, at the level of the superior border of the thyroid cartilage. This research will assist in the successful performance of sensory nerve blocks in pediatric patients.

Background: We have already introduced the visualization of the posterior belly of the digastric muscle, which is a major component of the styloid diaphragm (SD). This helped the carotid endarterectomy (CEA) simulation considering the carotid bifurcation or carotid plaque height and their accessibility. In CEA cases, we examined the relationship between the SD and carotid bifurcation to determine whether the high bifurcation cases have the specific clinical profiles.Methods: Eighty-seven consecutive CEA-treated Japanese patients were evaluated, and the location of the carotid bifurcation, thyroid cartilage (TC), hyoid bone (HB), and gonion was measured on the computed tomography angiography, referred to the heights of cervical vertebra bodies.Results: Mean vertebral levels of the carotid bifurcation, TC, HB, and gonion were 3.9 ± 0.6, 5.5 ± 0.6, 4.2 ± 0.5, 3.9 ± 0.6, and 2.9 ± 0.6, respectively. Seven carotid bifurcations located higher than the SD. There were no statistical differences in the distribution of sex, age, and coexisting diseases except for coronary artery disease (P = 0.02) between normal (4.0 ± 0.6) and high bifurcation (3.4 ± 0.4) cases. The multivariate analyses revealed that the coronary artery disease (P = 0.04), twisted internal carotid artery (ICA) (P = 0.031), and TC levels (P = 0.007) were correlated with the high bifurcation.Conclusion: The high bifurcation correlates with the twisted ICA, high TC, and alternatively low gonion levels. The visualized SD could be the landmark for the CEA indication and preparation and enables meticulous surgical manipulation of the distal end of the carotid plaque.

Diagnosis of thyroid cartilage invasion by laryngeal and hypopharyngeal cancers based on CT with deep learning.