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At least 217 records · Page 12Linked to original sources

Use of the levator scapulae muscle flap in head and neck reconstruction.

There are numerous techniques available for reconstruction of defects following composite resection of oral cavity and oropharyngeal tumors. No single technique is applicable in all situations. The levator scapulae muscle flap is well known for its application in carotid protection. Little attention is paid to its usefulness in other aspects of head and neck reconstruction. We have been using the levator scapulae muscle flap for a variety of reconstructive problems. The flap is useful for buttressing intraoral suture lines, closing intraoral defects, and providing soft tissue to fill in dead spaces and bulk out lateral and anterior oral defects. The levator flap was found to be easy to elevate, safe, and reliable with a minimum of wound complications. A review of 18 patients, representative case studies, and a discussion of surgical technique and relevant anatomy and blood supply is presented.

Aged↗

Innervation of the levator scapulae, the serratus anterior, the rhomboideus and the scapular muscles in the gray kangaroo (Macropus giganteus). Comparisons are drawn to the crab-eating macaque and man.

The origin, course and distribution of the nerves to the levator scapulae, rhomboideus, serratus anterior, supraspinatus, infraspinatus, subscapularis, teres minor, deltoid, teres major and latissimus dorsi muscles were examined in 7 kangaroo body-halves. The levator scapulae and the serratus anterior formed a continuous muscle sheet arising from the transverse processes of the lower 5 cervical vertebrae and the upper 6 ribs. The rhomboideus arose from the occipital bone in addition to the cervical dorsal median raphe. Six segmental nerves from C3 to C8 innervated these 3 muscles. Each segmental nerve originated from the dorsal surface of the corresponding root of the cervicobrachial plexus. All these nerves innervated the levator-serratus muscle sheet and 4 segmental nerves from C3 to C6 innervated the rhomboideus. Of the remaining scapular muscles, the supraspinatus was well developed, and the teres minor was a small muscle. The nerves supplying the scapular muscles originated from the area between the upper trunk and the posterior cord of the brachial plexus. Four segmental nerves from C5 to C8 usually innervated these 7 muscles. Judging from the relationships between nerves and muscles, all of these muscles are thought to have originally belonged to the same 2 groups of the dorsal musculature extending between the trunk, the shoulder girdle, and the limb. Muscle type and modes of nerve supply to the muscles in the grey kangaroo are similar to those found in the crab-eating macaque.

Animals↗

Elastofibroma dorsi as a cause of shoulder pain or snapping scapula.

Elastofibroma dorsi is a benign soft tissue tumor, not well-known because of its low incidence, located in the chest wall in the subscapular area. In 10 patients with elastofibroma dorsi, the clinical symptoms were snapping scapula or shoulder pain. In three of the patients, the previous diagnosis was shoulder impingement, and the patients were treated without success. The clinical diagnosis was confirmed by magnetic resonance imaging. Surgical treatment resolved the symptoms in all patients. This tumor should be considered in the differential diagnosis of snapping scapula or shoulder impingement.

Aged↗

The dermis-prelaminated scapula flap for reconstructions of the hard palate and the alveolar ridge: a clinical and histologic evaluation.

Ideal reconstructions of complex defects in the midface require the restitution not only of bone and soft tissue, but also of a thin and durable lining of the oral cavity. So far, split-thickness skin grafts, intestinal grafts, and in vitro cultured mucosal grafts have been used for the reconstruction of the oral lining. The use of skin as a substitute for oral mucosa is controversial because contraction, hair growth, maceration, and dysplastic changes can occur. This clinical and histologic study was performed to evaluate the suitability of dermis as a substitute for oral lining. Twelve complex defects of the midface were reconstructed with dermis-prelaminated scapula flaps. A bony flap from the lateral border of the scapula was prepared, and osseointegrated implants were placed. The bone flap was then prelaminated with dermis and covered with a Gore-Tex membrane to prevent adhesions. The composite flap was transferred to the midface 2 to 3 months later. The oral lining of the flap was evaluated clinically and histologically at 2, 4, and 6 weeks and at 3 to 41 months after the reconstruction. In all patients, the reconstructed bone was covered with a thin and lubricated surface without hair growth. None of the patients showed any signs of maceration. Histologically, these findings corresponded to a keratinized stratified squamous epithelium with highly developed connective-tissue papillae. These features closely resemble those of the normal mucosa of the hard palate and the gingiva. Thus, dermis prelamination is an effective method for reconstructing the mucosa of the alveolar ridge and the hard palate.

Adolescent↗

Clear cell sarcoma of the scapula. A case report and review of the literature.

BACKGROUND: Clear cell sarcoma of tendons and aponeuroses (CCSTA) appears usually in the extremities and rarely in the trunk. CASE PRESENTATION: We present an unusual case of CCSTA overlying the scapular region and with secondary osseous extension in the lower scapula. The patient underwent a wide local excision with removal of the tumor and the lower two thirds of the scapula. He had no local recurrences but he developed lung metastases after 5 months in spite of postoperative chemotherapy. He finally died ten months later. CONCLUSION: The patients with CCSTA have a variable unpredictable course. Despite treatment the overall prognosis is poor.

Journal Article↗

Transfer of the levator scapulae, rhomboid major, and rhomboid minor for paralysis of the trapezius.

Twenty-two patients who had paralysis of the trapezius muscle secondary to injury of the spinal accessory nerve had transfer of the levator scapulae and rhomboid major and minor muscles. In each patient, function of the trapezius had failed to improve with either physical therapy or an operative attempt at neurolysis or reconstruction of the spinal accessory nerve. The etiology of the injury was biopsy of a cervical node in thirteen patients, trauma in seven, and radical dissection in the neck in two. All patients had pain, visible deformity, and dysfunction of the shoulder girdle. Physical examination revealed asymmetry of the neckline, drooping of the shoulder girdle with lateral displacement of the scapula, and weakness of active elevation. Fourteen patients had had an incorrect clinical diagnosis, and twelve patients had had an inaccurate or incomplete electromyographic examination. A long thoracic nerve palsy developed in three patients. At an average of seven and a half years (range, two to fourteen years), the result of the operative procedure, as determined with the American Shoulder and Elbow Surgeons Shoulder Evaluation Form, was excellent for thirteen patients, satisfactory for six, and unsatisfactory for three. All but three patients had adequate relief of pain and demonstrable functional improvement.

Accessory Nerve Injuries↗

[A family of scapula-back type of x-linked recessive muscular dystrophy].

In this paper are described seven men with a scapula-back type of x-linked recessive muscular dystrophy in a family. Onset began in boyhood. The scapula-back muscles were affected, but the calf muscles were normal. All of the patients were able to walk. The oldest patient was thirty-seven years old. Muscular dystrophy was confirmed by electro-myography (EMG), pathologic and CPK examinations. Pedigree analysis indicated x-linked recessive inheritance.

Adult↗

Laser morphometric analysis of the glenoid fossa of the scapula.

We have assessed the topography of the articular surface of the glenoid fossa using a laser morphometric technique. Eighteen cadaveric scapulae from individuals aged 66 to 90 years were scanned and the degree of version of five lines constructed in the horizontal plane was determined. The lines comprised a transverse reference line (equatorial midline) located midway between the superior and inferior tubercles of the fossa, lines at 45% of the height of the glenoid fossa above and below the equatorial line, and further lines midway between these pairs. The cartilage-covered glenoid articular surface displayed differences in version between its superior and inferior aspects; the mean difference in version between the superior and inferior lines was 11.2 degrees, with the most superior line being retroverted 8.2 degrees with respect to the equatorial midline and the most inferior line anteverted 3.2 degrees. These data may be of importance in understanding the kinematics of the glenohumeral joint and in translating this knowledge to joint replacement surgery.

Aged↗

Congenital undescended scapula (Sprengel deformity): a case study.

This study describes a congenital deformity of the shoulder joint in a 5-year-old female, associated with an undescended scapula and the presence of an omovertebral bone. Dissections on 16 cadavers were done to identify structures in danger of injure before operating on the patient. Surgeons need to take specific note of the dorsal scapular nerve.

Child, Preschool↗

Proposal for classification of the suprascapular notch: a study on 423 dried scapulas.

The present study proposes a simple and reproducible method to classify the morphology of the suprascapular notch (SSN), on the basis of specific geometrical parameters that clearly distinguish one type from another. Four hundred twenty-three dried scapulas from the Department of Anatomy in the University of Cologne, Germany, were examined. Five types of SSN were observed: type I, without a discrete notch, 35 (8.3%); type II, a notch that was longest in its transverse diameter, 177 (41.85%); type III, a notch that was longest in its vertical diameter, 177 (41.85%); type IV, a bony foramen, 31 (7.3%); type V, a notch and a bony foramen, 3 (0.7%). For the vertical diameter, we took the maximal diameter of the notch perpendicular to the imaginary line that joins the two superior corners of the notch. For the transverse diameter, we took the diameter perpendicular to the midpoint of the vertical diameter. This classification based on the vertical and the transverse diameters of the SSN suggested a clear distinction of the notch types. This simple classification included all the anatomical variations of the SSN. Using this method, the clinician will be able to define easily and quickly the notch type on a plain radiograph, and perhaps be able to correlate suprascapular nerve entrapment with a specific type of SSN.

Anthropometry↗

Myoclonus of the scapula after acute long thoracic nerve lesion: a case report.

We describe a patient who presented myoclonus in the left scapula 3 months after a traumatic lesion of the left long thoracic nerve. Myoclonic activity was recorded as pseudorhythmic electromyographic bursts repeated at a frequency of 2 to 4 Hz, each lasting between 100 and 200 msec, in the left serratus-dorsalis muscle region, trapezius, and deltoid muscles. A combination of peripheral and central mechanisms may have induced the myoclonus in this case.

Acute Disease↗

Case report 823: Fibro-osseous pseudotumor of the scapula.

A unique lesion discovered in the scapula of a 36-year-old woman is presented. The lesion has microscopic features resembling those of fibrous dysplasia and osteoid osteoma which we believe is identical to an entity previously only documented in the rib (fibro-osseous lesion of rib). We are of the opinion that the lesion probably represents a reactive response to trauma rather than a neoplasm and suggest the name of "fibro-osseous reparative pseudotumor" for this entity.

Adult↗

[Osteosynthese in scapula fractures (author's transl)].

Fractures of the scapula can be mostly conservativly. Dislocated fractures can be easily adjusted by suitable approaches. Rigid fixation allows early mobilisation, which is of very importance for the shoulderjoint. Some dislocated cases have been described and the problems of conservatively treated fractures have been discussed. Follow-up of some with stable fixation treated scapulafractures show that it is possible to gain a perfect functional result and a painless shoulderjoint in some hopeless cases.

Acromion↗

Case report 803: Gorham's disease (Gorham-Stout syndrome) of scapula.

In summary, a 36-year-old man presented with pain and limited motion in the shoulder. Clinical examination revealed obliteration of normal scapular landmarks in the conspicuous absence of any palpable soft tissue mass. Roentgenograms showed progressive osteolysis of the scapula. Biopsy confirmed the diagnosis of Gorham's disease. MRI played a key role in defining the extent of disease involvement and in displaying the distinct soft tissue anatomy. These MRI features are to our knowledge previously undescribed.

Adult↗

Congenital syphilitic osteitis of scapulae and ribs.

A newborn with congenital syphilis presented radiographically with a lack of ossification of the medial portions of several ribs and massive sclerosis and decalcification of scapulae. The uniqueness of syphilitic scapular and rib involvement is discussed. The infant also went on to develop skin lesions which appeared following penicillin therapy and also developed an extrahepatic biliary atresia.

Humans↗

[Scapula fractures following electrical accidents].

Injuries to the skeletal system caused by electro-accidents are rare. The authors present two cases of scapula fractures caused by electro-accidents. Cardiac and neurologic symptoms as well as thermal damages are found in most cases of electro-accidents indeed, however, injuries of the skeletal system may not be overlooked and have to be treated according to the principles of traumatology.

Adult↗

[Fractures of the glenoid surface of the scapula].

The communications of literature regarding osteosynthesis in glenoid fractures of the scapula are reviewed, and six own cases are presented. The results are better than expected even in case of comminuted fractures. The indication for surgical reconstruction should therefore be adopted in dislocated fractures of the shoulder joint surface. Although the adequate operation technique is still under discussion, there seems to be a trend towards screwing and a narrow DC plate.

Follow-Up Studies↗