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PubMed1980

Prevention of injury to the great auricular nerve during rhytidectomy.

The great auricular nerve is the one most commonly injured during rhytidectomy. The main trunk is closest to the surface over the midtransverse belly of the sternocleidomastoid muscle. At this point, the nerve is 6.5 cm below the caudal edge of the bony external auditory canal. The external jugular vein is parallel and 0.5 cm ventral to the nerve at the same point. A simple technique using these fixed anatomic landmarks helps the surgeon avoid injury to the great auricular nerve and the jugular vein.

Dermatologic Surgical Procedures↗
PubMed1980

The anatomy of the platysma muscle.

Platysma muscle was studied in 50 cadavers. The principal anatomic variation concerned the medical fibers. In 75 percent of the cases, the fascicles are separate in the suprahyoid region but interlace with those of the opposite side, 1 to 2 cm below the chin. In 15 percent, the fascicles come together at the level of the thyroid cartilage, like a single muscle in the suprahyoid region. In 10 percent of the cadavers, the fibers were separate, but inserted in the subcutaneous muscles of the chin without decussating. The posterosuperior fibers of the platysma always pass behind the angle of the jaw and over important structures, the most significant being the mandibular branch of the facial nerve.

Adult↗
PubMed1981

Regrowth of platysma following platysma cervical lift: etiology and methodology of prevention.

Platysma regrowth after platysma cervical lift is a new complication. We postulate that the platysma reestablishes itself by hypertrophy of muscle fibers contained in its posterior SMAS sheath as well as by muscle regrowth along the posterior sheath. We now routinely cut both platysma and posterior sheath. We also recommend excision of anterior platysma not connected to the posterior sheath. Closure of platysma should be from the mentum to the upper thyroid cartilage utilizing nonabsorbable sutures.

Adult↗
PubMed1988

The cessation of cervical nerve root pain following modified SMAS rhytidectomy.

The cessation of cervical nerve root pain following modified SMAS rhytidectomy is reported. CAT scans and radiographs demonstrating substantial changes in the intervertebral relationships are documented. No previous report exists demonstrating the biomechanical response to platysma muscle surgery. The potential for alterations in the cervical spine either positive, as in this case, or perhaps negative with exacerbation or creation of symptoms not existing prior to surgery, is presented. The complex biomechanical influence of the procedure indicates that further study and appreciation of the biomechanical changes are necessary to thoroughly understand the ramifications of the SMAS rhytidectomy.

Adult↗
PubMed1999

Fibrodysplasia ossificans progressiva and associated osteochondroma of the coronoid process in a child.

The article reports the occurrence of osteochondroma in a fibrodysplasia ossificans progressiva patient. A 5-year-old boy presented with limited mouth opening and firm swelling of the right zygomatic complex area. The boy had bilateral hallux valgus of the great toes and heterotopic endochondral ossification of facial and neck regions. Associated osteochondroma of the coronoid process and aggressive heterotopic ossification of masticatory and neck muscles were found in response to traumatic injuries. Natural and clinical histories of fibrodysplasia ossificans progressiva were reviewed. An early diagnosis and avoidance of factors that aggravate ossification are key factors in reducing the expected degree of physical disabilities of patients. An early recognition of congenital skeletal deformities, early detection of abnormal ossification, and awareness of the disease by the involved physicians are important factors in the early diagnosis of the disease and in reducing any unnecessary trauma. Bone scintigrams and CT scans are effective noninvasive tools for an early detection of ossification and for monitoring the progression of the disease. Further investigation of its pathogenesis at a molecular level is important to understand better the nature of the disease and to develop an effective treatment protocol.

Child, Preschool↗
PubMed1991

Topographic variations in the peripheral course of the greater occipital nerve. Autopsy study with clinical correlations.

The description of the peripheral course of the greater occipital nerve (GON) varies in the literature. An autopsy study was done on 20 cases without known headache problems. These findings showed a marked variation in the relation between the GON and nuchal muscles. The trapezius muscle was penetrated by the GON in 45% of cases, the semispinal muscle of the head was penetrated in 90% of cases, and the inferior oblique muscle of head was penetrated in 7.5% of cases. Macroscopic findings of possible compression were made in 11 cases (27.5%), indicating that nerve compression per se may be of minor importance since it seems to exist in the absence of headache.

Aged↗
PubMed2000

The fine connective tissue architecture of the human ligamentum nuchae.

STUDY DESIGN: An anatomic study of the posterior midline structures of the cervical spine was performed using a new sheet-plastination (E12) technique in conjunction with gross anatomic dissection. OBJECTIVES: To clarify the structural status of the human ligamentum nuchae. SUMMARY OF BACKGROUND DATA: Little is known about the arrangement of connective tissue attachments of the neighboring neck muscles to the ligamentum nuchae. In addition, it is not clear whether the cervical supraspinous ligaments form part of the ligamentum nuchae. METHODS: This study used a combined approach of a detailed gross anatomic study on eight cadavers and a macroscopic and microscopic study of the connective tissue organization of the posterior midline structures on serial horizontal thin (2.5 mm) plastinated slices of the cervical spine (occiput-T1) from an adult female cadaver. RESULTS: The dorsal and ventral portions of the ligamentum nuchae are a single entity formed by the aponeurotic fibers of the trapezius, splenius capitis, rhomboideus minor, and serratus posterior superior muscles. CONCLUSIONS: The regional differences in the connective tissue organization of the ligamentum nuchae and its well-defined attachments to the C6 and C7 vertebrae suggest that it is designed to function in the lower cervical spine.

Aged↗
PubMed2001

Innervation of the sternocleidomastoid and trapezius muscles by the accessory nucleus.

Images moving over the retina at velocities as low as a few degrees per second, in movements as head turning, can degrade visual acuity. Visual acuity requires that even minute motion of the head be compensated for, primarily via optokinetic and vestibular reflexes. Whereas we have a good understanding of some the neuronal networks involved in these reflexes, other components of this network, such as the innervation of the paired muscles that turn and tilt the head, are not as well understood. The involvement of the sternomastoid, cleidomastoid, or trapezius muscles with lesions of the cervicomedullary junction is often not in conformity with the prevailing neuroanatomic descriptions of their innervation by the accessory nuclei. We discuss evidence that: 1) the XI nucleus has a rostral and a caudal portion; 2) analogous to the VII nerve, the rostral portion receives projections from both cerebral hemispheres, whereas the caudal portion is innervated preferentially by the contralateral hemisphere; 3) the caudal XI nucleus innervates the ipsilateral cleidomastoid and trapezius with a predominantly crossed corticonuclear innervation; and 4) The rostral XI nucleus innervates both sternomastoids. Each rostral portion receives projections from both cerebral hemispheres. These anatomic features explain the seemingly discrepant findings in patients with cervicomedullary lesions.

Accessory Nerve↗
PubMed2004

Who will benefit from combination therapy? The role of 5 alpha reductase inhibitors and alpha blockade: a reflection from MTOPS.

PURPOSE OF REVIEW: The purpose of this review is to revisit the medical treatment of benign prostatic hyperplasia in the light of the most recent data concerning the association of alpha-blockers and 5alpha-reductase inhibitors. Combining these two drugs is not a new concept in treating benign prostatic hyperplasia patients. Alpha blockers are believed to improve symptoms and flow rate by inducing relaxation of the smooth muscle neck and prostate area (dynamic component), while 5alpha-reductase inhibitors are believed to improve symptoms and flow rate by shrinking the transition zone of the prostate through hormonal mechanisms (static component). The proof of this concept, however, could not be clinically demonstrated up until now. The design of previous studies investigating combination therapy with the 5alpha-reductase inhibitor finasteride has been questionable. RECENT FINDINGS: Extrapolated from the Medical Therapy of Prostatic Symptoms (MTOPS) study, not yet fully published, again raises the question of the effectiveness of such a combination. There is now some evidence to suggest that combining alpha-blockers and finasteride may be more effective in relieving and preventing the progression of symptoms than either of the two drugs alone. SUMMARY: Patients most likely to benefit from combination therapy are those in whom baseline risk of progression is significantly higher, generally patients with larger glands and higher prostatic specific antigen values.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2004

Case report: whiplash-associated disorder from a low-velocity bumper car collision: history, evaluation, and surgery.

STUDY DESIGN: Case report of a patient with a whiplash-associated disorder following a bumper car collision. Imaging studies failed to provide an anatomic explanation for the debilitating symptoms. OBJECTIVES: To report a chronic, debilitating pain syndrome after a low-velocity bumper car collision while using complex range-of-motion data for the diagnosis, prognosis, and surgical indication in whiplash-associated disorder. SUMMARY OF BACKGROUND DATA: The controversy of whiplash-associated disorder mainly concerns pathophysiology and collision dynamics. Although many investigations attempt to define a universal lesion or determine a threshold of force that may cause permanent injury, no consensus has been reached. METHODS: Eight years after a low-velocity collision, the patient underwent surgical excision of multiple painful trigger points in the posterior neck. Computerized motion analysis was used for pre- and postoperative evaluations. RESULTS: Surgical treatment resulted in an increase in total active range of motion by 20%, reduced intake of pain medication, doubled the number of work hours, and generally led to a dramatic improvement in quality of life. CONCLUSIONS: This case of whiplash-associated disorder after a low-velocity collision highlights the difficulty in defining threshold of injury in regard to velocity. It also illustrates the value of computerized motion analysis in confirming the diagnosis of whiplash-associated disorder and in the evaluation of prognosis and treatment.

Accidents↗
PubMed2003

Stiff and sore neck.

Explore the source record for details and available documents.

Anti-Bacterial Agents↗
PubMedDate not supplied

Psychophysiologic treatment of chronic tinnitus: a randomized clinical trial.

BACKGROUND: Tinnitus seems to be associated with psychophysiological over-activation (e.g., of head and shoulder muscles). Therefore we aimed to develop and evaluate a new intervention program including a psychophysiological approach. METHODS: Forty-three tinnitus sufferers were randomized to 2 groups, one receiving a psychophysiologically oriented intervention lasting 7 intervention sessions (plus 2 assessment sessions), whereas the other group waited for a comparable time period. Afterward, patients on the waiting list also received the intervention. Physiological variables were muscle activity of head and shoulders and electrodermal activity. Psychological assessments took place at pretreatment, post-treatment, and 6 months later. Follow-up data were available from 95% of participants. Major outcome variables were self-rating scales (e.g., tinnitus annoyance assessed by the Tinnitus Questionnaire), and diary data (self-control, daily time of perceiving the tinnitus). RESULTS: On most tinnitus specific variables, patients in the treatment group improved significantly more than patients on the waiting list. Main effect sizes for tinnitus-specific variables were up to 0.89. Muscle reactivity of head muscles at the beginning predicted significant treatment effects. CONCLUSION: Compared with meta-analytical reviews of psychological interventions for tinnitus sufferers, the presented treatment is brief and in the upper range of effectiveness.

Cognitive Behavioral Therapy↗
PubMed2005

Basicranium malformation with anterior dislocation of right styloid process causing stylalgia.

Differential diagnosis of stylalgia is broad, and many causes should be taken into account, such as temporomandibular joint disorders, carotidynia, compression of nerve fibers by neoplasms, cranial nerve neuralgias, chronic pharyngotonsillitis, pharyngeal or base of tongue tumors and elongation of styloid process, or Eagle syndrome. Basicranium malformation can determine a rare form of stylalgia that is caused by dislocation of styloid process. This can produce a reduction of maxillo-vertebropharyngeal space and irritation of nerve fibers together with stylopharyngeal muscular chronic contraction. This case report illustrates the diagnostic dilemma and surgical strategy experienced in a rare case of stylalgia caused by a dislocation of styloid process produced by a basicranium malformation. Basicranium malformation should be considered in the pathogenesis of stylalgia when a styloid process with normal dimension is encountered.

Atlanto-Occipital Joint↗
PubMed1988

Pain in the sternocleidomastoid muscle and occlusal interferences.

The EMG of the sternocleidomastoid muscle and the masticatory muscles during function has been observed in relation to opposing occlusal contacts. The purpose was to investigate the possible developmental mechanism of pain which can occur in the muscles. Six subjects with normal function and ten patients were studied. EMG activities of temporal, masseter, sternocleidomastoid (insertion) and sternocleidomastoid (middle) were recorded by surface and needle electrodes. EMG activity was recorded from the insertion of the sternocleidomastoid during activity of the masticatory muscles in tapping, clenching, and mastication. On the other hand little activity was registered from the middle of the sternocleidomastoid. The amplitude of the EMG of SCM-I increased as the occlusal force increased. During chewing the sternocleidomastoid muscle was functioning more actively on the working side than on the non-working side. On the patients, EMG activities of the muscles were of low amplitude and low frequency with no synchronization with the chewing movement, suggesting hyperactivity of the muscle.

Adult↗
PubMed1990

Human jaw-opening muscle responses elicited by multiple-site electrical stimulation.

Electrical stimuli were applied to subjects' upper and/or lower gingivae around the right canines; (i) during maintained relaxation of masticatory muscles; (ii) at an active opening position; (iii) while clenching in an incisal edge-to-edge contact (IEC) position; and (iv) at the wide-open position. Reflex responses of the suprahyoid and jaw-closing muscles were obtained using surface electrodes. The electrical stimulation produced segmented reflex excitation(s) in the suprahyoid muscle and conventional reflex excitation and/or inhibition in the jaw-closing muscles when some background activity was maintained in the muscle(s). The excitatory reflex in the suprahyoid muscle responded to multiple site electrical stimulation which was delivered on both the upper and lower jaw simultaneously rather than to single site stimulation. Also, the responses depended on the intensity of the electrical stimulation. In particular, stronger intensities resulted in longer latencies. The results support the suggestions in our previous studies with mechanical stimuli, i.e. that the human jaw-opening reflex can be obtained only when some background activity is maintained in the jaw openers, perhaps due to low threshold afferent input, and that spatial summation may be effective for the reflex.

Adult↗
PubMed2004

Influence of masticatory muscle pain on electromyographic activities of cervical muscles in patients with myogenous temporomandibular disorders.

The present study tested the hypothesis that the resting electromyographic (EMG) activities of sternocleidomastoid and trapezius muscles of myogenous temporomandibular disorder (TMD) patients would be significantly greater than healthy individuals. Eight masticatory muscle pain patients without disc interference disorders (DID) and 30 patients with DID along with 41 matched control subjects were included in the study. The resting EMG activities of sternocleidomastoid and trapezius muscles were recorded with a portable EMG machine. Pain intensities described over the muscles were recorded with a 100 mm visual analogue scale. The two groups of patients had significantly higher resting activities compared with control subjects. Patients (in both groups) who had pain in sternocleidomastoid and trapezius muscles reported significantly higher resting activities in the respective muscles than patients who were free of pain and the controls. The presence of pain over the examined muscles showed significant association with the myogenous TMDs without DID. The observed association of the cervical muscles with myogenous TMDs is expected to be a result of functional link between masticatory and cervical muscles. The present findings suggest that the myogenous TMDs without DID could be a distinct sub-group that can be a part of broader regional or generalized diseased entity.

Adult↗
PubMed2005

Breathing type and body position effects on sternocleidomastoid and suprahyoid EMG activity.

The objective of this study was to determine the effects of breathing type and body position on sternocleidomastoid and suprahyoid electromyographic (EMG) activity. The sample included 18 subjects with upper costal breathing type (study group) and 15 subjects with costo-diaphragmatic breathing type (control group). All individuals had natural dentition and bilateral molar support. EMG recordings at rest and while swallowing saliva were carried out by placing surface electrodes on the left sternocleidomastoid and left suprahyoid muscles. EMG activity was recorded while standing, seated upright, and in the lateral decubitus position. Upper costal breathing type subjects showed a significantly higher suprahyoid EMG activity at rest than costo-diaphragmatic subjects in all body positions studied (mixed model with unstructured covariance matrix). In the lateral decubitus position, both breathing types showed a significantly higher sternocleidomastoid EMG activity at rest and while swallowing saliva. The suprahyoid muscles demonstrated a significantly higher EMG activity at rest as well as in the lateral decubitus position (mixed model with unstructured covariance matrix). These results are relevant because sternocleidomastoid and suprahyoid muscles play an important role in controlling the head posture and mandible dynamics. The neurophysiological mechanisms involved are discussed.

Adult↗
PubMed2005

Clinical evaluation of tinnitus in patients with sleep bruxism: prevalence and characteristics.

Evaluation of the prevalence and characteristics of tinnitus in a Brazilian series of sleep bruxism patients. In this descriptive study, 100 patients (80 women and 20 men) were selected through the self-report of grinding teeth during sleep, confirmed by room mate or family member. They were evaluated according to a systematized approach: a questionnaire for orofacial pain and the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders. The patients were divided into two groups: group A, 54 patients with complaint of tinnitus and group B, 46 patients without tinnitus complaint. The mean age was 37.85 (13-66 years) and 34.02 years (20-59 years), respectively, for groups A and B (P = 0.1164). There was statistically significant difference between the two groups, with higher prevalence for the group A, in relation to: presence of chronic facial pain (P = 0.0007); number of areas painful to palpation in the masticatory and cervical muscles (P = 0.0032); myofascial pain in the masticatory muscles (P = 0.0003); absence of teeth without prosthetic replacement (P = 0.0145) and indices of depression (P = 0.0234). Structural alterations of the TMJ, like disc displacement and vertical dimension loss did not differ for the two groups. Tinnitus frequency was higher in patients with sleep bruxism and chronic facial pain. Myofascial pain, number of areas painful to palpation in the masticatory and cervical muscles, higher levels of depression and tooth absence without prosthetic replacement were more frequent in the group with tinnitus.

Adolescent↗