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Background: Ultrasonography (US) has been suggested to assess the morphology and function of cervical muscles; but little is known about the reliability of the US measures in patients with cervical disc herniation (CDH). The purpose of this study was to evaluate within-day inter and intra-rater and between-day intra-rater reliability of US to measure dimensions of deep cervical muscles in patients with unilateral CDH., Methods: Thirty patients with unilateral CDH participated. Anterior-posterior and lateral dimension of longus colli (LC), multifidus (MF) and semispinalis cervicis (SC) were measured using B-mode ultrasound. The measurements were repeated by rater A 1 h (for within-day reliability) and one week (for between-day reliability) later. For inter-rater reliability, rater B performed all muscles measurements like rater A., Results: Within-day reliability measurement for all muscles was good to excellent with IntraClass Correlation Coefficients (ICC) ranging from 0.82 to 0.96, standard error of measurement (SEM) from 0.18 to 0.46 and minimal detectable changes (MDC) from 0.43 to 1.09. Between-day reliability was good for all muscle dimensions with ICC ranging from 0.75 to 0.89, SEM from 0.30 to 0.64 and MDC from 0.71 to 1.52. Inter-rater reliability was also good with ICC ranging from 0.75 to 0.89, SEM from 0.34 to 0.65 and MDC from 0.81 to 1.55., Conclusions: US was demonstrated to have high within-day inter and intra-rater and between-day intra-rater reliability to measure muscles dimensions in patients with unilateral CDH. It can be used to assess deep cervical muscles or to monitor the effects of interventions., Competing Interests: Declaration of competing interest No funding was received for the implementation of this study from any organization, and no conflicts of interest have been reported by the authors or any individuals in control of the content of this study., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This article reports the surgical resection of clinically benign tumours in the maxillomandibular deep lobe of the parotid gland via sternocleidomastoid muscle-parotid space (SPS) approach. The use of maxillary-mandibular planes to subdivide the deep lobe of the parotid gland in order to establish the tumour location and accessibility is introduced. This approach, which does not raise a skin flap, may preserve the superficial lobe. Ten patients with clinically benign tumours in the maxillomandibular deep lobe of the parotid gland were treated via the SPS approach. The patients were followed up for 3-5 years and the surgical outcomes were analysed. All tumours were completely enucleated via the SPS approach with an optimal aesthetic outcome. No permanent facial weakness or tumour recurrence was identified during the 3-5 years of follow-up. The SPS approach to surgical resection is an ideal option for clinically benign tumours in the maxillomandibular deep lobe of the parotid gland and demonstrates good results., (Copyright © 2020. Published by Elsevier Inc.)

Purpose: To assess preliminary associations between fatty-infiltration (FI) of cervical spine extensor musculature, cervical sagittal balance, and clinical outcomes in cervical deformity (CD) patients., Methods: Operative CD patients (C2-C7 Cobb > 10°, CL > 10°, cSVA > 4 cm, or CBVA > 25°) with pre-operative (BL) MRIs and 1-year (1Y) post-operative MRIs or CTs were assessed for fatty-infiltration of cervical extensor musculature, using dedicated imaging software at each C2-C7 intervertebral level and the apex of deformity (apex). FI was gauged as a ratio of fat-free-muscle-cross-sectional-area (FCSA) over total-muscle-CSA (TCSA), with lower ratio values indicating greater FI. BL-1Y associations between FI, sagittal alignment, and clinical outcomes were assessed using appropriate parametric and non-parametric tests., Results: 22 patients were included (Age 59.22, 71.4%F, BMI 29.2, CCI:0.75, Frailty: 0.43). BL deformity presentation: TS-CL: 29.0°, C2-C7 Sagittal Cobb:-1.6°, cSVA:30.4 mm. No correlations were observed between BL fatty-infiltration, sagittal alignment, frailty, or clinical outcomes (p > 0.05). Following surgical correction, C2-C7 (BL: 0.59 vs 1Y:0.67, p = 0.005) and apex (BL: 0.59 vs. 1Y: 0.66, p = 0.33) fatty-infiltration decreased. Achievement of lordotic curvature correlated with C2-C7 fatty infiltration reduction (R s : 0.495, p < 0.05), and patients with residual postoperative TS-CL and cSVA malalignment were associated with greater apex fatty-infiltration (R s : -0.565, -0.561; p < 0.05). C2-C7 FI improvement was associated with NRS back pain reduction (R s : -0.630, p < 0.05), and greater apex fatty-infiltration at BL was associated with minor perioperative complication occurrence (R s : 0.551, p = 0.014)., Conclusions: Deformity correction and sagittal balance appear to influence the reestablishment of cervical muscle tone from C2-C7 and reduction of back pain for severely frail CD patients. This analysis helps to understand cervical extensor musculature's role amongst CD patients., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: As one of the most common work-related musculoskeletal disorders and postural deviations, forward head posture (FHP), is considered to lead to muscle imbalance., Objectives: The aim of this study is to investigate the bilateral cross-sectional area (CSA) of the deep neck flexor muscles at rest and during five stages of the craniocervical flexion (CCF) test in individuals with FHP and the controls with normal head posture., Methods: Eighteen students with FHP and 18 controls with normal head posture, all females aged 18-35 years, participated in this study. Participants were categorized into two groups based on their craniovertebral angle. The CSA of the deep neck flexors was measured using ultrasonography while participants lay supine on the table with a pressure biofeedback unit placed under their necks in order to let the examiner measure the CSA of the muscles during rest and five stages of the CCF test including 22, 24, 26, 28, and 30 mmHg of the pressure biofeedback unit., Results: A significant effect of contraction level was observed in both groups, indicating significant increases of the CSA of the deep neck flexors during contraction (F = 64.37, P < 0.001). No significant difference was evident for the CSA of the deep neck flexors between the groups, although the increase in the CSA of the deep neck flexors was up to 28 mmHg in the normal head posture group compared to 26 mmHg in the FHP group., Conclusions: The results of the present study showed no significant difference between the performance of the deep neck flexors during the CCF test in FHP and normal head posture individuals, which challenge the common belief of the deep neck flexors weakness in individuals sustaining FHP., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: Myofascial trigger points (MTrPs) are one of the most common and important causes of musculoskeletal pain. Ultrasound is a useful modality in examining musculoskeletal disorders. By applying compressive stress and observing changes in ultrasound images, the elastic modulus (Young's modulus) can be calculated. Our objective was to develop a novel method to distinguish MTrPs from normal tissues., Methods: A total of 29 subjects with MTrP in the sternocleidomastoid muscle were assessed. A force gauge was attached to a transducer to obtain stress levels. To obtain strain, images were recorded in both with stress and without stress states. By dividing the stress level by the measured strain, the elastic modulus was determined., Results: Elastic modulus in MTrPs and the normal part of the muscle were measured to be 13379.57 ± 1069.75Pa and 7078.24 ± 482.92Pa, respectively (P = 0.001). This indicated that MTrPs were stiffer than normal parts of the muscle., Conclusion: This study presents a new method for the quantitative measurement of the elastic modulus of MTrP, thereby distinguishing MTrPs from normal adjacent muscular tissue, with more simplicity and lower cost, compared to other ultrasound methods., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The purpose of this study was to clarify the relationship between the size of the cervical flexor muscles and craniocervical (CC) flexion torque. Thirty-eight healthy men participated in this study. Thickness of the deep cervical flexor (DCF) and sternocleidomastoid (SM) muscles were measured using ultrasonography. Maximal isometric CC flexion torque was measured using dynamometry. The DCF and SM muscle thickness and CC flexion torque were normalized relative to body weight. Correlations between normalized muscle thickness and normalized CC flexion torque were determined. A significant positive correlation was observed between normalized DCF muscle thickness and normalized CC flexion torque (r = 0.361, P = 0.028), whereas there was no significant correlation between normalized SM muscle thickness and normalized CC flexion torque (r = 0.233, P = 0.166). DCF muscle thickness appears to have potential clinical application in the performance of CC flexion., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: To investigate the effect of ischemic compression on clinical outcomes of a cervicogenic headache and elastic behavior of myofascial trigger points., Design: Randomized, controlled trial., Setting: Outpatient headache clinic., Subjects: 19 subjects with a cervicogenic headache originating from myofascial trigger point within the sternocleidomastoid muscle., Interventions: Subjects were randomized in treatment group (n = 9) and control group (n = 10). Subjects in the treatment group received 4 sessions of ischemic compression in the myofascial trigger point region., Main Measures: Headache intensity, frequency, and duration, trigger point elastic modulus, trigger point area, pressure tolerance, and pressure pain threshold were assessed before and after treatment., Results: Subjects in the treatment group compared with those in control group showed significant improvements in headache intensity (P = 0.002), headache frequency (P = 0.005), headache duration (P = 0.015), pressure tolerance (P < 0.001), pressure pain threshold (P = 0.039), and myofascial trigger point area (P = 0.017). Changes in myofascial trigger point elastic modulus did not reach a significant level (P > 0.05)., Conclusion: The improvements in outcome measures suggest that ischemic compression may be effective in subjects with a cervicogenic headache associated with a myofascial trigger point in the sternocleidomastoid muscle. Data suggests that biomechanical properties of MTrP and severity of headache symptoms are not directly linked, and other mechanisms could be more influential in contributing to symptoms., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The longus colli muscle is a neck flexor believed to play an important role in pain originating in the neck region, including pain resulting from whiplash injuries. Despite the clinical importance attributed to it, the pain referral pattern of the longus colli has previously been described only in a small cohort of subjects. Here, we aim to delineate the pain referral pattern of the longus colli muscle. Thirty-five healthy volunteers underwent deep massage of the longus colli followed by dry needling of the muscle. The subjects depicted the distribution of the pain they experienced on a blank manikin. Their drawings were digitized and used to produce pain pattern histogram maps. The pain referral pattern during deep massage and needling of the longus colli was primarily local, with referral to the ipsilateral ear and lateral to the ipsilateral eye. Some subjects reported pain on the contralateral side of the neck., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The purpose of this study was to clarify the relationship between the thickness of the deep cervical flexor muscles (longus capitis and longus colli) at rest and sternocleidomastoid activity during the craniocervical flexion test (CCFT). Thirteen healthy males participated in this study. The thickness of the deep cervical flexor muscles was measured by ultrasound imaging in a relaxed supine position. Activity of the sternocleidomastoid was measured by electromyography during the CCFT at five incremental levels (22, 24, 26, 28, and 30 mm Hg). Correlations between normalized muscle thickness relative to body mass index and sternocleidomastoid activity were determined. Significant negative correlations were observed between normalized muscle thickness and activity of the sternocleidomastoid at 26 (r = -0.622, P = 0.023) and 28 mmHg (r = -0.653, P = 0.015). Individuals with smaller deep cervical flexor muscles exhibited increased activity in the sternocleidomastoid during the CCFT., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The purpose of this study was to clarify the correlation between neck slope angle and deep cervical flexor muscle thickness in healthy subjects. Forty-two healthy male (20.7 ± 2.6 years old) participated in this study. Neck slope angle was measured in a relaxed sitting posture. The deep cervical flexor muscle thickness was measured in a relaxed supine posture. The correlations between neck slope angle and normalized muscle thickness relative to body mass index were determined using Pearson's correlation coefficient. There was a moderate positive correlation between neck slope angle and normalized muscle thickness (r = 0.414, P = 0.006). The result demonstrated that participants with lower neck slope angles had smaller muscle thicknesses of the deep cervical flexor muscles. It appears that the deep cervical flexor muscle thickness might be associated with neck slope angle in a relaxed sitting posture., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The purpose of this study is to assess the reliability of a new ultrasound imaging (USI) parameter and procedure for the evaluation of the size of the deep cervical flexor (DCF) muscles. Thirty-one healthy male subjects (21.6 ± 2.5 years old) participated in this study. Two images of the diagonal dimension (DD) of the DCF of the subjects, at 1.5 fingerbreadths below the laryngeal prominence of the thyroid cartilage in a relaxed state, were taken on separate days with a 1-week interval. The intraclass correlation coefficient between the days was 0.82 (95% confidence interval, 0.65-0.91). The standard error of measurement and minimal detectable change were 0.8 mm and 2.1 mm, respectively. The results indicated that the DD may be used as a reliable USI parameter to measure the DCF thickness in healthy subjects., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Semispinalis capitis muscle (SECM) is a massive and long cervico-thoracic muscle which functions as a main head and neck extensor muscle. The aim of this study was to detect the effect of head and neck positions on the strength of neck extensor muscles and size of SECM in healthy subjects. Thirty healthy women students voluntarily participated in this study. An ultrasonography apparatus (Hitachi EUB 525) and a system of tension-meter were used to scan the right SECM at the level of third cervical spine and to measure the strength of neck extensor muscles at three head and neck positions. Neck extensor muscles were stronger in neutral than flexion or than extension positions while the size of SECM was larger in extension than neutral or than flexion position. The force generation capacity of the main neck extensor muscle was lower at two head and neck flexion and extension positions than neutral position., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Head and neck swellings often present to oral and maxillofacial surgeons. It is often unclear whether a collection of pus is present. This information is essential for decisions regarding surgical intervention. Although ultrasound scanning (USS) is widely used to investigate the presence of a collection, the reliability and validity of this investigation in this context is uncertain. A retrospective review of 4000 consecutive head and neck USS reports over a 4 year period in the Cardiff University Health Board produced 43 cases in which ultrasound had been used to look for evidence of pus collection. The management and treatment outcome of these patients were reviewed and the data analysed. 36 of 43 patients had their swelling incised in theatre, and in 92% of these cases USS and clinical findings corresponded. Of the seven not taken to theatre, four were USS negative and three USS positive; in all seven cases the swelling resolved with antimicrobial therapy. Sensitivity and specificity of USS imaging to identify pus collection were very high, 96% and 82%, respectively. The evidence in this study indicates that USS is a very reliable diagnostic tool in the diagnosis of a collection as well as providing evidence that small collections of pus can resolve without surgical drainage., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. All rights reserved.)

In this study, the reliability of the longus colli muscle (LCM) size was assessed in a relaxed state by a real time ultrasonography (US) device in a group of healthy subjects and a group of patients with chronic neck pain. Fifteen healthy subjects (19-41 years old) and 10 patients with chronic neck pain (27-44 years old) were recruited for the purpose of this study. LCM size was measured at the level of thyroid cartilage. Two images were taken on the same day with an hour interval to assess the within day reliability and the third image was taken 1 week later to determine between days reliability. Cross sectional area (CSA), anterior posterior dimension (APD), and lateral dimension (LD) were measured each time. The shape ratio was calculated as LD/APD. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were computed for data analysis. The ICC of left and right CSA for within day and between days reliability in healthy subjects were (0.90, 0.93) and (0.85, 0.82), respectively. The ICC of left and right CSA for within day and between days reliability in patients with neck pain were (0.86, 0.82) and (0.76, 0.81), respectively. The results indicated that US could be used as a reliable tool to measure the LCM dimensions in healthy subjects and patients with chronic neck pain., (Copyright © 2009 Elsevier Ltd. All rights reserved.)

Background: Some children are dependent on a tracheostomy for many years. As they grow, larger tracheostomy tubes may be required. Although tables of sizes of tracheas exist for different age groups, they are estimations of normal and may not be accurate for atypical cases. Chest radiographs and computed tomograms (CT) have been used experimentally to estimate tracheal sizes, but are not in regular use., Method: High-resolution diagnostic ultrasound imaging was used to estimate the internal and external transverse tracheal diameter, and the depth of the trachea from the skin surface. This allowed selection of the correct standard pattern tracheostomy tube, or the construction of a custom-made tube preoperatively., Results: Four children with various abnormalities who were being considered for replacement tracheostomies were scanned. In one, diagnostic ultrasound confirmed that a new larger fenestrated tube could be placed, which subsequently improved vocalisation and respiration. In the other three, the scan showed there was no space to allow a larger tube to be placed. The standard tables were not suitable for any of these patients., Conclusion: High-resolution ultrasound has a role in the non-invasive measurement of the size of the tube needed for specialised operations in children.

The aims of this study were to determine the pathways of odontogenic infection spread into the submandibular space and their relationship to the clinical symptoms. Computerized tomography (CT) and magnetic resonance (MR) images of 33 patients with submandibular involvement were analyzed. The spread of infection was evaluated by lateral asymmetry of the shape and density of the fascial spaces and tissues, and by obliteration of the interfascial fat spaces. Imaging findings were classified into three types: in 19 patients (57.6%), infection spread through the mylohyoid muscle or sublingual space (type I). In five patients (15.2%), infection spread through the bony structures of the mandible with periosteal reaction or perforation of the cortical plate (type II) and was associated with relatively mild symptoms. In four patients (12.1%), infection spread from the masticatory space (type III). Seven of 11 patients with dysphagia or fever showed submandibular involvement spreading into the parapharyngeal space. CT and MR imaging clearly demonstrated different pathways of the spread of odontogenic infection into the submandibular space, which influenced the manifestation of clinical symptoms.

Daytime submandibular electrostimulation (dSE) of suprahyoidal muscles was applied to prevent sleep-associated collapse of the tongue into the hypopharyngeal airway. By placing the stimulatory electrodes intra- and extraorally, recruitment of stimulated muscle fibers at low current densities was improved. The significant impact of electrostimulation on suprahyoidal muscle force was initially demonstrated in healthy controls as compared to placebo-treated volunteers. The morphology of suprahyoidal muscles was not affected by this treatment. A patient with obstructive sleep apnea syndrome initially presented with a respiratory disturbance index (RDI) of 13.2, an oxygen desaturation index of 23 and a minimal oxygen saturation of 75%. After two weeks of placebo treatment (TENS-stimulation), respiratory parameters remained unchanged. Two weeks of dSE treatment, however, improved the RDI to 3.9, the oxygen desaturation index from 23 to 2.8 and the minimal oxygen saturation from 75% to 88%. 3D-sonography showed considerable hypertrophy of the stimulated muscles. These results indicate that dSE may prevent episodes of apnea induced by sleep-associated hypopharyngeal collapse of the tongue.

A method of 3-dimensional (3D) sonography (US) is described in this paper. Special emphasis is laid upon the basic problem of generating well-orientated 3D visualizations on the basis of different evaluation techniques. Furthermore, some problems of data acquisition and data processing using US are presented. Alternative solutions thereto are briefly discussed.

Three-dimensional (3-D) ultrasonography is introduced as a new diagnostic method for soft-tissue lesions. This method is based on the production of absolutely parallel brightness (B)-scan tomographies with constant intervals. After adequate preparation, the sonographic primaries are processed into 3-D graphs by a specialized program called EUCLID-IS. This method promises to be useful in the evaluation of tumor patients as well as in the follow-up examination of these patients. The main advantages of the presented method are the capacity to measure accurately the volume of regions of interest and the excellent visualization of the structures examined.