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PubMed1979

Responses of Purkinje cells of the cerebellar vermis to neck and macular vestibular inputs.

1. The dynamic analysis of the control exerted by neck and macular vestibular receptors on the cerebellar cortex has been investigated in precollicular decerebrate cats submitted to sinusoidal rotation along the longitudinal axis of the animal at the frequency of 0.026 Hz and at peak amplitudes up to 10 degrees for the neck input and 15 degrees for the macular input. 2. Purkinje (P) cells located in the vermal cortex of the cerebellar anterior lobe, particularly in the longitudinal parasagittal zone which projects to the ipsilateral lateral vestibular nucleus (LVN), showed a sinusoidal modulation of the firing rate in response to sinusoidal stimulation of the neck receptors or the vestibular receptors, the phase of the responses being in most units related to the extreme neck or head position. Mossy fiber (MF) and/or climbing fiber (CF) responses of the same or different P-cells to the two inputs were observed. 3. The sensitivity of the MF-response of the P-cells to the neck input, elicited by sinusoidal rotation of the neck and expressed in per cent of the average firing rate per degree of neck rotation, corresponded on the average to 2.71 +/- 1.67, S.D. This value was significantly higher than that of the MF-response of the P-cells to the macular input elicited by sinusoidal tilt along the longitudinal axis of the whole animal, which correspond to 1.71 +/- 1.01, S.D. 4. Most of the MF-responses of the P-cells to the neck input were characterized by an excitation during side-down rotation of the neck and by an inhibition during side-up rotation, whereas most of the MF-responses of the P-cells to the macular input showed just the opposite behavior, being inhibited by side-down tilt of the animal and excited by side-up tilt. 5. Units which received a convergent input from both neck and macular receptors and showed an antagonistic pattern of response to the two inputs were tested during rotation of the head alone, in order to excite simultaneously the two kinds of receptors. Due to the higher sensitivity of the neck over the macular response, the magnitude of the combined response tended to be similar to the difference between the individual ones. Moreover, the phase of the resulting response was always modified with respect to that of the response to the neck input alone, and became in some instances related to velocity of neck rotation rather than to neck position. 6. These findings indicate that opposite responses to neck and macular inputs occur at corticocerebellar level. However, a final integration of the two inputs, leading to suppression of the conflicting responses, may occur either at medullary (LVN) or at spinal cord level.

Acoustic Maculae↗
PubMed1978

Results in suprahyoid, modified radical, and standard radical neck dissections for metastatic squamous cell carcinoma: recurrence and survival.

Two hundred sixty-one patients who underwent three types of neck dissection for cervical lymphadenopathy in association with squamous cell cancer of the head and neck are analyzed retrospectively. Patients were grouped into those with histologically negative nodes and those with histologically positive nodes. Statistical analyses for neck recurrence and survival rates were made using the sampled permutation method. The results show that suprahyoid neck dissection is associated with an unusually high recurrence rate in the neck in patients with histologically negative nodes. Modified radical neck dissection and standard radical neck dissection are equivalent with regard to recurrences in the neck and five year survival rates when the disease is above the juguloomohyoid lymph node group. The study suggests that simple upper neck dissection is contraindicated in patients with negative or positive nodes and that modified radical neck dissection can be used in selected patients instead of the formal radical neck operation.

Adult↗
PubMed1976

Neck dissection in the treatment of carcinoma of the anterior two-thirds of the tongue.

The records of 340 patients treated surgically over the 20 year period 1950 through 1969 at this clinic for primary epidermoid carcinoma of the anterior two-thirds of the tongue were reviewed to evaluate the effectiveness of elective versus therapeutic radical neck dissection in their treatment. There has been a change in the clinical presentation of this disease, with more people presenting at an earlier stage, with a smaller primary lesion and fewer cervical node metastases. The over-all survival rate has shown a marked improvement to 69 per cent at five years. The proportion of women afflicted has increased. The status of the cervical nodes is a major prognostic factor, the determining five year survival rate being reduced from 78 to 26 per cent if the nodes are metastatically involved. It cannot be directly proved that removal of occult metastasis to the neck by elective radical neck dissection before nodes are clinically detectable leads to a better survival rate partly because the two groups being compared are selected and not randomly assigned. However, the marked tendency for carcinoma of the tongue to metastasize regionally at some time in its course, the significant error in clinical evaluation of the neck, the significant conversion of clinically negative nodes to positive in patients not treated with radical neck dissection, the poor prognosis after treatment of conversion from clinically negative into positive and the fact that more than half of the deaths are due to uncontrolled disease of the neck alone, make us strongly favor the principle of elective radical neck dissection to enhance the survival time in the group of patients without clinical evidence of nodal involvement. With current surgical expertise, the mortality and morbidity rates of simultaneous radical neck dissection are low, and the potential benefit of the procedure outweighs its potential risks. Obviously, elective radical neck dissection, if beneficial, would most likely be so in patients with the highest likelihood of having occult metastasis.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Neck dissection: radical or conservative.

Four hundred and forty-five neck dissections for epidermoid carcinoma over a 10-year period are reviewed as to local recurrence of neck disease. Three hundred and forty-seven dissections were radical en bloc procedures and in 98 a modified conservative technique was utilized. Cervical lymph node classification was applied and a comparison made of the two techniques. A review of the anatomy of cervical fascias and the technique of conservative neck dissection is given. Evaluation of this series of cases indicate that the control of local disease in the neck in the N0 and N1 groups is is accomplished as well with conservative dissection as with radical neck dissection. The number of conservative neck dissections for N2 disease was too limited for accurate comparison. There were no conservative neck dissections done for N3 disease. We suggest that conservative neck dissection be utilized for subclinical and N1 disease and that the classic en bloc dissection be reserved for N2 and N3 situations.

Carcinoma, Squamous Cell↗
PubMed2026

Adding Rib Mobilization to Diaphragm Release Techniques in Patients With Non-Specific Neck Pain: Randomized Controlled Trial.

BACKGROUND: Non-specific neck pain (NSNP) is a frequent issue that can negatively affect both mobility and function. Recently, there has been growing interest in newer therapeutic approaches, including rib mobilization and diaphragm release techniques, as potential ways to address NSNP and support better outcomes for those affected. PURPOSE: To find out the immediate effects of how (DRT) combined with (RMT) affects the level of pain and the extent to which patients' functional abilities are improved in cases of NSNP. METHODS: For this prospective RCT, 96 participants aged 20 to 45 years were randomly assigned to one of three equal groups based on their pain score (VAS). Group B engaged in (DRT) for 40 minutes, three times weekly for 8 weeks, in contrast to Group A, which got both RMT combined with DRT. Group C (active control) received advice and some exercises. Measurements were collected before and after the intervention; the primary outcomes included pain severity, evaluated using a visual analog scale (VAS); active neck range of motion (ROM), measured with a cervical range of motion (CROM) device; and neck flexion endurance. Additionally, the secondary outcome of neck-related disability was assessed using the Neck Disability Index (NDI). RESULTS: No statistically significant difference was identified among the three groups at baseline; nevertheless, a treatment effect emerged after 8 weeks (p = 0.001 and f-value = 4.15, ƞ2 = 0.306). A statistically significant time-treatment interaction was seen when comparing the pre- and post-treatment periods in groups A and B (p = 0.001, f-value = 3.16, ƞ2 = 0.251). CONCLUSION: The addition of rib mobilization to diaphragm release techniques in patients with non-specific neck pain resulted in statistically significant improvements in pain intensity, cervical flexion, right lateral rotation, left lateral rotation, right rotation, and neck flexor endurance, with moderate to large effect sizes for pain reduction and cervical motion. However, no statistically significant differences were observed between groups for cervical extension, left rotation, or the Neck Disability Index (NDI), and only a marginal clinical improvement in NDI was noted in Group A. The observed benefits in the combined intervention group may not be attributable solely to rib mobilization. The increased treatment complexity and greater therapist interaction inherent in the combined approach could also have influenced the outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07133646.

Humans↗
PubMed1975

Conservative neck dissection.

The areolar tissue which fills the laterovisceral spaces of the neck is thought to be in close contact with the limiting muscle and the large vessels and nerves of the neck. The site of lymph nodes and lymphatic vessels in such tissue is not clearly defined. A more profound anatomical study shows that the areolar tissue contains the whole lymphatic system of the neck, limited by a series of aponeuroses. These are derived from the embryonal mesenchyme, surrounding muscles and vessels, giving origin to a series of compartments which are in continuity with each other. These compartments, which contain the lymphatic structures, may be entirely removed en bloc including their limiting aponeurotical membranes, as long as the latter are carefully stripped from the muscular and vascular structures. This technique of neck dissection originating with O. Suarez in Argentina, is as radical as any traditional neck dissection, providing that some technical details are respected and that the nodes are still mobile. By preserving many useful or necessary structures of the neck, which themselves are unrelated to the lymphatic spread of cancer, conservative neck dissection presents important functional and cosmetic advantages as compared with traditional neck dissection.

Humans↗
PubMed1976

Correction of extensive neck contractures with local flaps and split- and full-thickness grafts.

A technic of combined split-thickness and full-thickness skin grafts and local flap closure for extensive deep cicatricial neck contractures is presented. The head and neck are mobilized by excision of limiting tissues. The lateral neck skin is mobilized to be rotated anteriorly as flaps, and a full-thickness skin graft is applied to the central neck. Split-thickness skin grafts are placed below the full-thickness graft and flaps, and also above the full-thickness graft over the horizontal part of the neck. The success of this technic relies upon the limited contracture of full-thickness skin grafts, mobilization of lateral neck tissue, and consideration of regional units of the neck. This relatively simple operation results in a dramatic and lasting improvement of the neckline, good range of motion of the head and neck, elimination of multiple operative procedures, and early rehabilitation of the patient.

Cicatrix↗
PubMed1976

Asymmetric tonic labyrinth reflexes and their interaction with neck reflexes in the decerebrate cat.

1. Tonic labyrinth and neck reflexes were studied separately and in combination in the decerebrate cat with C1 and C2 spinal roots cut. Reflex effects were observed as changes in length of the isotonically loaded medial head of triceps. 2. The tonic labyrinth reflexes acted asymmetrically on the medial head of triceps. Side-down rotation of the head produced shortening in medial triceps, whereas side-up rotations of the head resulted in a lengthening. 3. The tonic neck reflexes acted asymmetrically on the medial head of triceps. Side-down rotations of the neck produced a lengthening of medial triceps, whereas side-up rotations of the neck resulted in shortening. 4. Labyrinth and neck reflexes produce opposite effects on the same limb extensor muscle so that, if the neck innervation is intact, head tilting produces no change in muscle length. 5. It is suggested that the interaction between the labyrinth and neck reflexes contributes to the stability of the trunk, allowing the head to move freely on the body without affecting this stability. Labyrinth and neck reflexes need therefore to be considered together as a single system.

Animals↗
PubMed1976

Anteversion versus torsion of the femoral neck.

The usual term 'torsion angle of the femur' denotes the 'anteversion' of the neck of the femur as a whole, caused by the twist in the shaft of the femur rather than the twist in the neck. This has been differentiated from the twist in the neck of the femur around its own axis, termed 'torsion neck' and the values of both have been measured. To differentiate these two different phenomena, the term 'anteversion' is used to denote the usual angel described, while 'torsion neck' is sued to denote the twist in the neck around its own axis measured in this work. 1,000 femora from 21 cites in different parts of the country have been measured and the average anteversion angle calculated. The Indian average works out to be 12 degrees with a significantly (double) high value for females. The incidence of negative angle is 7% in the normal femora. All fractured femora invariably show a negative angle. The above information should be of great significance on orthopaedic surgery of the neck of the femur in these bones. The 'torsion neck' has been measured by tracing and its average reported as 30 degrees.

Anthropometry↗
PubMed1975

The management of cervical lymph nodes in head and neck cencer.

It is suggested that the last major improvement in the surgical treatment of head and neck cancer was Crile's description of radical neck dissection in 1906, and that modifications of this procedure, including extended surgery, have made little or no difference to survival rates. It is hoped that some means may soon be found of identifying those patients with head and neck cancer who do badly--the majority. As a start, it is proposed that patients with an antral carcinoma and a gland in the neck, and patients with hypopharyngeal carcinoma and bilateral neck glands should not be treated by surgery. A retrospective analysis is made of matched pairs drawn from a personal series, one patient in each pair having had a prophylactic neck dissection, and one having been submitted to a policy of 'wait and see'. The survival rate for patients undergoing prophylactic neck dissection was worse than that of the wait and see group; this difference was statistically significant.

Female↗
PubMed1975

The metastatic spread of "head and neck" tumors in men (an autopsy study of 371 cases).

The investigation was performed by using 371 autopsy records collected by the Department of Pathology at Roswell Park Memorial Institute from 1956 till 1967. Only the "head and neck" tumors were taken into consideration. Two hypotheses were tested, i.e. whether metastases diffuse directly from the primary tumor throughout the body or if the metastatic process takes place in steps, requiring, in other words, that one or more organs be seeded first, before any generalized metastasis occurs. It appeared that the lungs and the lymphnodes of the neck are the two organs responsible for generalized metastases in the cancers of the "head and neck" area. The importance of the neck and lungs metastases in disseminating the disease was discussed in the text. It appeared that when metastases are present in the lymphnodes of the neck, the cancer is already generalized with and without metastatic deposits in the lungs. However, the absence of metastases in the neck is no guarantee that the disease is still localized to the "head and neck" area.

Adenocarcinoma↗
PubMed1977

Indications for neck dissection in carcinoma of the lip.

In the past, neck dissections have been recommended only when nodes were clinically palpable or when they became so. A retrospective ten year study of thirty-seven patients with carcinoma of the lip and with an unusually high mortality has allowed reevaluation of indications for neck dissection. (1) Ten of thirty-seven patients died of this disease and nearly all of the ten died with and because of regional metastases. (2) Seven patients with nonpalpable nodes initally had nodal metastases later which, despite neck dissection at that later time, proved lethal. (3) Two patients who, despite nonpalpable nodes, had undergone neck dissections and were found to have occult bilateral nodal metastases were effectively cured with early neck dissection. This suggests that early bilateral supramohyoid neck dissections for small carcinomas of the lip and ipsilateral radical neck dissections for large primaries may yield higher cure rates than currently achieved.

Adult↗
PubMed1975

Projections of extraocular, neck muscle, and retinal afferents to superior colliculus in the cat: their connections to cells of origin of tectospinal tract.

Unit recordings were made in the superior colliculus of cats anesthetized with chloralose and with Pentothal. Electrical stimulation of extraocular muscle afferents and neck muscle afferents excited more units in the superior colliculus than did a variety of moving and stationary visual stimuli. Units responding to neck muscle afferent stimulation fell into three populations; one population firing with a short latency and following stimulus presentation up to 1/s, a second population with a long latency and following stimulus presentation at frequencies lower than 15/min, and a third population exhibiting paired firing. The latencies and firing patterns of the third population combined the characteristics of each of the first two patterns. It is suggested that these characteristics of unit discharges stem from the existence of two pathways from neck muscle afferents to the superior colliculus. The projection is predominantly bilateral. Units responding to neck muscle afferent stimulation are distributed throughout the superior colliculus on the basis of their latencies. Long-latency responses predominate in the superficial layers of the superior colliculus and short-latency responses, while more common in the intermediate and deep layers, predominate in the tegmentum. Extraocular muscle afferent projections to the superior colliculus constitute the single richest projection found in these experiments. While the response patterns and latencies are similar to those of the neck muscle afferents, long-latency responses are the most common and dominate in all collicular regions. Few units in the tegmentum could be excited by extraocular muscle afferents. Both extraocular muscle and neck muscle afferents show considerable convergence with one another and with retinal afferents within the superior colliculus. Cells of origin of the tectospinal tract were identified within the superior colliculus and tegmentum by antidromic excitation from the upper cervical cord. These cells were distributed predominantly within the intermediate and deep layers of the superior colliculus, and sparsely in the superficial layers and tegmentum. Almost 50% of the cells of origin of the tectospinal tract receive a convergent input from extraocular muscle and neck muscle afferents and from the retina. About 30% of the cells were inexcitable to the stimuli employed in these experiments. The significance of these projections is discussed with respect to superior collicular function in the cat and i

Anesthesia, General↗