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Congenital muscular torticollis (CMT) is a common problem affecting infants and children. There is a general lack of standard clinical classification or objective assessment methods. Ultrasonographic imaging of the sternomastoid muscle (SCM) has been carried out in a consecutive series of 436 infants less than 1 y old presenting with CMT over a 5-y period. All patients were classified into three clinical groups: postural torticollis, muscular torticollis and sternomastoid tumor. The severity of the torticollis was also expressed into four subgroups according to the degree of deficits in passive rotation of the neck. The ultrasonographic image of the affected SCM included the echogenicity, texture, motility, softness and the transverse and longitudinal extent of the involvement. The disturbance in the quantitative measurement of the transverse diameter of the lower and upper third of the SCM and the ratio of the measurement to the normal side was recorded. The qualitative and quantitative changes in the SCM image were found to correlate significantly with the clinical typing and severity of rotational deficits of the neck. Ultrasonographic imaging has important potential clinical application in helping the diagnosis, prognostication and monitoring of progress of CMT longitudinally.

Subcutaneous and tissue space emphysema following surgical extraction of mandibular third molars is a rare and serious complication of dental surgery. Recognition of mediastinal emphysema following surgical extraction is difficult because there are no absolute clinical symptoms and signs. We present two cases of emphysema following extraction of a lower third molar and discuss the contribution of CT to the early recognition of the presence and spatial migration of air and to clinical management.

Muscle afferent block (MAB) is an intramuscular injection of 0.5% lidocaine and pure ethanol with a volume ratio of 10:1, introduced as an alternative to botulinum toxin injection for focal dystonia and spasticity. As in the case of botulinum toxin injection, the precise localization of target muscles is crucial to obtain the maximal effect from MAB. For this purpose, we performed ultrasonography of cervical muscles (echomyography) in 20 patients with cervical dystonia (11 men, 9 women; mean age 46.1), with ultrasonograph SSD-5500 (Aloca Co. Ltd., Japan) and a 7.5 MHz linear probe. In untreated subjects, the boundaries of muscles could be easily identified, while they tended to become ambiguous after repeated MAB sessions. At rest, there were involuntary worm-like movements of a specific muscle group observed in all patients. Contrary to our expectation, in all but one patient abnormal contraction was limited only in a part of synergists responsible for the abnormal posture. In normal subjects there was no abnormal contraction at rest, and all the synergists were simultaneously activated by the voluntary neck deviation. Normal subjects could not mimick the pattern of muscle activity in dystonic patients. The echo-guided MAB was performed in 16 patients. We could easily observe the diffusion of lidocaine and ethanol into the targeted muscle, and injected portions of the muscle stopped their activities just after MAB. The effect persisted for 3-4 days in at least 5 out of 10 patients who had follow-up examination. On the other hand, the movement stopped only temporarily after the injection of saline or lidocaine only. In 3 out of 16 patients, some of the uninjected synergists were activated as if to substitute for the treated muscle just after the injection. We conclude that cervical echomyography is useful to investigate the pattern of muscle activity in cervical dystonia and to accurately localize the contracting muscles during MAB.

Myositis ossificans circumscripta (MOC) is an uncommon disease that has been reported to develop after trauma, burns, and infections, as well as in cases in which the pathogenesis is unknown. Although most cases of MOC develop below the clavicles, it has been reported in the head and neck area, where it primarily involves the muscles of mastication. To our knowledge, there have been only 4 previous reports of MOC affecting the paraspinal muscles. We report the fifth such case, which developed in a human immunodeficiency virus-positive patient, and describe the longitudinal imaging changes of MOC.

The parapharyngeal space is a deep space of the neck, always well visible on CT and MR imaging of the head and neck; in normal circumstances, this space should look symmetrical. The parapharyngeal space is often subdivided in compartments; such subdivision is helpful when considering the site of origin of a parapharyngeal space mass. Several concepts of compartmentalization of this space exist, sometimes leading to confusion; not the names but the anatomy is important to know. This manuscript reviews shortly the anatomy of the parapharyngeal space, the use of modern cross-sectional imaging methods in the evaluation of this region, and focuses somewhat more on imaging of primary parapharyngeal lesions.

The first case of traumatic myositis ossificans (TMO) involving a strap muscle of the neck is reported. TMO typically presents with an unresolved mass following trauma or surgery, requiring differentiation from other soft tissue and bone neoplasms. Opacification may be present on soft tissue X-rays. Computed tomography (CT) scan may demonstrate a characteristic zoning phenomenon to establish the diagnosis. The disorder is frequently self-limiting but surgery may be required for persistent symptoms.

Flexion and extension lateral radiographs of the cervical spine may suggest signs of ligamentous and soft tissue injuries in a potentially unstable spine. However, patients with acute injuries and severe pain and muscle spasms may not be able to move their necks effectively, severely compromising the diagnostic yield of the radiographs. In addition, there are reports of serious neurologic injuries occurring with the use of these radiographs in acutely injured patients. The purpose of this study was to determine the effectiveness and yield of obtaining cervical spine flexion and extension radiographs in the emergency department on acutely injured patients. Review of all patients with cervical flexion and extension radiographs presenting to a Level 1 trauma center was performed. All radiographs were judged based on the adequacy of flexion and extension movement and positive findings indicative of instability by the radiologist in the emergency room. The radiographs of one patient (0.34%) revealed positive findings of instability. Of the 290 flexion and extension radiographs, 97 (33.5%) of them showed such little or inadequate flexion or extension movement that cervical stability could not be assessed. Flexion and extension cervical radiographs should not be obtained routinely in the emergency department because 1/3 of these studies will be inadequate because of pain and muscle spasms experienced by patients. Patients with cervical injuries may not be able to fully flex and extend their necks; this may lead to false reassurance to patients who actually have had an inadequate study to diagnose potential instability.

The purpose of this cross-sectional study was to evaluate the effect of different sport training regimens on the size of the neck semispinalis capitis muscle (SECM). The cross-sectional area (CSA) and the linear dimensions of the SECM were measured bilaterally by real-time ultrasonography. Ten young Finnish elite level weight-lifters, 8 freestyle wrestlers and 10 controls (all male) participated in the study. Muscle CSA was significantly larger in wrestlers than in weight-lifters or controls (P < 0.001). There was no significant difference in size between the right and left SECM in any of the subject groups, but the variation between sides (smaller vs. larger) was significantly higher in wrestlers than weight-lifters (P < 0.05). CSA correlated with the multiplied linear dimensions (r = 0.80, P < 0.000). Neck muscle: ultrasonography appeared to be a useful method in evaluating the differences between two groups of athletes.

Dropped head syndrome is characterized by gradual forward sagging of the head due to weakness of the neck extensor muscles. We report three cases in elderly patients seen by rheumatologists at our institution. There was some evidence suggestive of a neurogenic process, whereas most reported cases of dropped head syndrome have been ascribed to myopathy. Dropped head syndrome can probably be produced by multiple causes. The close ties between dropped head syndrome and acquired camptocormia in adults are discussed.

We describe the imaging and clinical features of a patient presenting with a posterior cervical space mass. The only abnormality identified on CT was a variant muscle, the levator claviculae. Radiologists are cautioned to be familiar with this muscle and its appearance to avoid misdiagnosing it as pathologic.

The contribution of the sternocleidomastoid branch of the occipital artery (superior arterial pedicle-SAP) to the irrigation of the sternocleidomastoid muscle (SCM) was evaluated in fresh human cadavers by injecting radiological dye and a resin for microvasculature corrosion casts. From its insertion in the mastoid process of the temporal bone, the SCM was divided into superior, medium, and inferior thirds. In most of the SCM, The SAP are formed by two longitudinal parallel branches. In all specimens, the radiological dye injected into the SAP reached or trespassed the middle part of the studied SCM. The SAP was poorly distributed in the lowermost region of the inferior third of the SCM, suggesting the contribution of other arteries or pedicles. The corrosion casts of the microvasculature showed a profuse network of microscopic vessels in those levels where the SAP was detected.

Objective: To find the relationship between the ultrasonographic pictures and the clinical features of patients with congenital muscular torticollis (CMT)., Design: Prospective survey of patients with clinically suspected CMT by high-resolution ultrasonography., Setting: Rehabilitation department of a tertiary care center., Participants: Two hundred fifty-six CMT patients, from the ages of 9 days to 16yrs, with a mean follow-up period of 6.7 months., Main Outcome Measures: Correlation of the ultrasound appearance of the involved sternocleidomastoid (SCM) muscles with clinical features. The pathologic findings in diseased muscles from patients who underwent surgical intervention were also evaluated., Results: Muscle abnormalities were identified ultrasonographically in 218 CMT patients (85%) and were classified into four types: a fibrotic mass in the involved muscle (type I, 15%); diffuse fibrosis mixing with normal muscle (type II, 77%) and without normal muscle in the involved muscle (type III, 5%); and a fibrotic cord in the involved muscle (type IV, 3%). Compared with type I patients, type IV patients were more likely to undergo surgical treatment (odds ratio = 31.54, p = .0196). Type III patients were more likely to undergo surgical treatment, although this tendency was not statistically significant., Conclusion: Ultrasonography can precisely identify pathologic changes in the involved SCM muscle of CMT patients. Type III and IV patients are more likely to require surgical intervention.

Background and Purpose: The levator claviculae muscle is an infrequently recognized variant in humans, occurring in 2% to 3% of the population, and has rarely been reported in the radiologic or anatomic literature. The importance of this muscle to radiologists is in distinguishing it from an abnormality; most commonly, cervical adenopathy. After discovering this muscle on the CT scans of two patients during routine clinical examinations, we conducted a study to determine the prevalence and appearance of the muscle on CT studies., Methods: We evaluated 300 CT scans that adequately depicted the expected location of the muscle. The most superior level in which the muscle could be identified and the apparent location of insertion on the clavicle were recorded for all subjects in whom the muscle was detected., Results: Seven levator claviculae muscles were identified in six subjects (2%). It was bilateral in one, on the left in four, and on the right in one. It was identified up to the level of the transverse process of C3 in all cases. The insertion was the middle third of the clavicle for two muscles and the lateral third of the clavicle for the remaining five muscles., Conclusion: Because the levator claviculae muscle will most likely be encountered during a radiologist's career, it is important to recognize this muscle as a variant and not as an abnormality.

A clinical case of epithelioid hemangioma of the scalene muscle that occupied the parapharyngeal space is reported. The patient was a 34 year old man with a 2-month history of sensation of pharyngeal foreign body and mild dysphagia. The exploration revealed a tumor of the posterior and lateral wall of the oropharynx that extended from the rhinopharynx to the hypopharynx. The diagnostic sequence included CT, MRI, Doppler echography, and arteriography, which identified a right post-styloid tumor located behind and medial to the jugular vein, internal carotid artery, and vagal nerve, but did not affect arterial blood flow. The patient underwent surgical treatment consisting of lateral cervicotomy, tumor excision, and histological study.

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.

An unusual case of myositis ossificans traumatica lesion located in the paraspinal region is reported. Despite the contiguity of the lesion with the cervical vertebrae and ominous appearance of the biopsy material, the history of antecedent trauma and computed tomography findings allowed preoperative accurate diagnosis. To our knowledge, myositis ossificans traumatica located in the cervical paraspinal region is very rare.

The existence of an interaction among bite force magnitude, jaw muscle size (e.g., cross-sectional area, thickness), and craniofacial morphology is widely accepted. Bite force magnitude depends on the size of the jaw muscles and the lever arm lengths of bite force and muscle forces, which in turn are dictated by craniofacial morphology. In this study, the relative contributions of craniofacial morphology and jaw muscle thickness to the bite force magnitude were studied. In 121 adult individuals, both magnitude and direction of the maximal voluntary bite force were registered. Craniofacial dimensions were measured by anthropometrics and from lateral radiographs. The thicknesses of the masseter, temporal, and digastric muscles were registered by ultrasonography. After a factor analysis was applied to the anthropometric and cephalometric dimensions, the correlation between bite force magnitude, on the one hand, and the "craniofacial factors" and jaw muscle thicknesses, on the other, was assessed by stepwise multiple regression. Fifty-eight percent of the bite force variance could be explained. From the jaw muscles, only the thickness of the masseter muscle correlated significantly with bite force magnitude. Bite force magnitude also correlated significantly positively with vertical and transverse facial dimensions and the inclination of the midface, and significantly negatively with mandibular inclination and occlusal plane inclination. The contribution of the masseter muscle to the variation in bite force magnitude was higher than that of the craniofacial factors.

Objective: Computed tomography and magnetic resonance imaging are the common techniques for evaluating cross-sectional areas and volumes of human jaw muscles. Because computed tomography has the disadvantage of showing cumulative biological effects and because MRI poses a problem in terms of clinical availability and cost, the purpose of this study was to determine whether ultrasonography could be used to measure local linear cross-sectional dimensions of muscles of the head and neck., Study Design: In 46 patients with signs and symptoms of temporomandibular disorders, the anterior temporalis, anterior masseter, deep masseter, anterior digastric, posterior digastric, and sternocleidomastoid muscles were measured bilaterally by ultrasonography to assess linear local cross-sectional dimensions. Measurements were made in 2 sessions with a time interval of at least 5 minutes. Data were analyzed for reliability and variability through use of the intraclass correlation coefficient (ICC) and the repeatability coefficient (RC). To assess local muscle asymmetry patterns, the absolute asymmetry index was used, with the mean maximum muscle diameters of the respective right and left sides calculated from 3 consecutive measurements., Results: Satisfactory visualization of muscles was obtained in 93.8% of 1104 imaging procedures. For the ultrasound measurements there was a significant difference in local cross-sectional dimensions between the first and second sessions for the anterior temporalis muscle only (P < .01). Acceptable intrarater reliabilities were obtained for the deep masseter (ICC = 0.92), anterior digastric (ICC = 0.91), and sternocleidomastoid (ICC = 0.86) muscles, whereas evaluation of the posterior digastric (ICC = 0.74), anterior masseter (ICC = 0.72), and anterior temporalis (ICC = 0.70) muscles was associated with moderate reliability. Variability of repeated measurements was found to be acceptable for the anterior temporalis (RC = 0.32 mm) and posterior digastric (RC = 0.48 mm) muscles. Analysis of muscle site-related local cross-sectional dimensions showed a significant difference between the right and left sides for the deep masseter muscle only (P < .05). The study population investigated revealed mean asymmetry indices ranging from 5.3% for the anterior digastric muscle to 8.7% for the deep masseter muscle., Conclusions: Ultrasonography may prove to be a reliable diagnostic technique for the evaluation of cross-sectional dimensions and areas of muscles of the head and neck.

Myositis ossificans is a non-neoplastic heterotopic bone formation within muscle or soft tissues. The most commonly involved muscles are the muscles of the upper arm and thigh. Occurrence in the head and neck is rarely encountered clinically. A 53-year-old Turkish man (farmer) was operated on for traumatic myositis ossificans circumscripta in his neck. During the operation the mass was found to originate from the scalenus medius muscle and was readily and completely dissected from surrounding tissues. The histologic examination of the specimen revealed focal cartilage and mature bone tissue, which was compatible with the late stage of myositis ossificans. In 5 years of follow-up, the patient has remained asymptomatic and no signs of recurrence have been noted.

A case of pseudotumour of the sternocleidomastoid muscle in a three-week old child is reported. The tumour resolved spontaneously within four months. Seventeen months later there was no sign of torticollis. This tumour is the most common cause of torticollis in newborn children. In 80-90% of the cases the tumour disappears within six months, the rest develop either a progressive or delayed torticollis, known as congenital muscular torticollis (CMT). Thus, CMT is a related condition, usually appearing at three to four years of age, and it may require surgical correction.

Statement of Problem: Patients with temporomandibular disorders may have a cluster of joint and muscle disorders characterized primarily by pain, joint sounds, and irregular or deviating jaw function., Purpose: This study evaluated changes in local cross-sectional dimensions of muscles of the head and neck associated with short-term application of "splint therapy" using the diagnostic approach of high resolution gray-scale ultrasonography., Material and Methods: The study included 15 subjects with signs and symptoms of temporomandibular disorders, 10 in the internal derangement type (IDT) III-a group, and 5 in the myalgia type I (MT I) and myalgia type II (MT II) group. Ultrasonographic investigation was performed with a linear (B-scan) 7.5 MHz small-part transducer to visualize the anterior temporalis, anterior and deep masseter, anterior and posterior digastric, and sternocleidomastoid muscles. The absolute asymmetry index was used to assess local muscle asymmetry patterns and to evaluate the respective effect of occluding splints, with the mean maximum muscle diameter of the respective right and left sides calculated from 3 consecutive measurements before and after splint therapy., Results: A comparison of pretreatment with 2-month follow-up values revealed a slight decrease in the overall mean local cross-sectional dimensions in the internal derangement type III-a group (0.3 mm) and a moderate decrease in the myalgia type I/II group (3.3 mm). With an overall mean pretreatment absolute asymmetry index of 1.3% for the internal derangement type III-a group and 0.5% for the myalgia type I/II groups, the 2-month follow-up showed the internal derangement type III-a group to be associated with a moderate (1.2%) and the myalgia type I/II groups with a slight (0.1%) decrease in the respective overall mean pretreatment absolute asymmetry indices., Conclusion: This study suggests that stabilization-type splints are effective in the reduction of local muscle thicknesses and asymmetries. Further studies are necessary to evaluate muscle-site specific effects in patient and nonpatient groups and to relate these effects to variables such as bite force, preferred chewing side, facial structure, and occlusion.

Purpose: This study examined the value of ultrasonography as a diagnostic tool in the treatment of superficial acute odontogenic fascial space infections., Patients and Methods: The study group consisted of 50 patients in whom both radiographic and sonographic examinations, as well as a needle aspiration, were performed., Results: Purulent fluid was aspirated in 22 of the 50 patients. Six patients diagnosed as suffering from cellulitis had a repeated ultrasonography scan. In four, abscess formation was diagnosed on the third day., Conclusions: Ultrasonography is an effective diagnostic tool to confirm abscess formation in the superficial fascial spaces and is highly predictable in detecting the stage of infection.

This study was undertaken to evaluate the diagnostic accuracy of comparison of the echogenicity of the thyroid gland with the sternomastoid muscle in diagnosis of thyroid disorders. Fifty healthy subjects underwent a thyroid ultrasound, and 80 patients with archived thyroid ultrasound examinations (50 thyrotoxicosis and 30 thyroiditis) were reviewed. Images were measured for the image density of the thyroid gland and the sternomastoid muscle, using a transmission densitometer. Healthy thyroid was relatively hyperechoic when compared with the sternomastoid muscle (100%). Of the thyrotoxic patients, 70% showed a relatively hyperechoic thyroid compared to 47% of the thyroiditis patients. Mean image density difference in healthy thyroid, thyrotoxicosis and thyroiditis ranged from 0.1 to 1, -0.42 to 0.83, and -0.55 to 0.58, respectively. In conclusion, the relative echogenicity of the thyroid gland when compared with the sternomastoid muscle may be useful to differentiate healthy thyroid from thyrotoxicosis and thyroiditis, but does not help to distinguish thyrotoxicosis from thyroiditis. An image density difference of less than 0.1 may be considered to be abnormal, whereas a value greater than 0.83 may be considered to be normal.

Purpose: We describe the variable sonographic appearances of fibromatosis colli, a disease that presents as a mass-like enlargement of the sternocleidomastoid muscle during the first 8 weeks of life., Methods: Sonograms and records of 12 infants who presented with a sternocleidomastoid mass or torticollis before they were 12 weeks old were retrospectively reviewed for sonographic features (presence of a mass, diffuse muscle enlargement, and echogenicity), medical history, and follow-up data., Results: Sonographically, 6 infants had only a mass in the sternocleidomastoid muscle, 2 had a mass with fusiform muscle enlargement, and 4 had only muscle enlargement. Five masses were hyperechoic, and 1 mass was of mixed echogenicity. The 2 masses associated with muscle enlargement were hypoechoic. Three cases of diffuse muscle enlargement were of mixed echogenicity, and 1 was hypoechoic. Unusual variations included (1) a mass split longitudinally into 2 components and (2) a diffusely enlarged muscle with a striated pattern of mixed echogenicity. Follow-up in 10 patients at 4 months and in 7 patients at 6 months showed clinical improvement., Conclusion: Fibromatosis colli usually appears sonographically as a hyperechoic mass or diffuse sternocleidomastoid enlargement of mixed echogenicity. Variations in its appearance should not prevent the correct diagnosis as long as the abnormality is intramuscular and adjacent soft tissues are normal.

Correlating findings on imaging studies with those on histopathologic examination can define the limitations and strengths of the radiologist's imaging armamentarium. Although CT is particularly strong in identifying the character of the matrix of a head and neck lesion, MR imaging has proved superior in the mapping of most malignant neoplasms. Sometimes the combination of CT and MR imaging characteristics of a lesion may yield a specific diagnosis; however, in most instances, the radiologic appearance is sufficiently nonspecific that aspiration cytology or biopsy is required. This article reviews the effectiveness of imaging for characterizing and outlining lesions.

A 67-year-old woman had had a neck mass for 10 years, which recently increased in size. Sonographic, CT, and MR examinations showed a mass in the carotid and posterior spaces (triangle) extending from below the submandibular gland to the supraclavicular fossa, displacing the common carotid artery and the sternomastoid anteriorly. The mass was solid, noncalcified with lobulated outlines, hypoechoic on sonograms, of soft-tissue density on CT scans, isointense on T1-weighted MR images, hyperintense on T2-weighted MR images, and enhanced mildly after injection of contrast material on CT and MR studies. Histologic examination revealed a carcinoma showing thymiclike differentiation, a rare tumor of the neck and thyroid gland.

1. The authors report on three patients with severe antecollis that developed after chronic treatment with antipsychotics. These patients had been treated with neuroleptics for their delusions and hallucinations. Antecollis is a rare form of tardive dystonia that has drawn little attention. To our knowledge, there have been no reports on this disorder. 2. The patients developed the symptom after receiving a number of antipsychotics for 4 months to 14 years. Neither discontinuation of antipsychotics nor administration of anticholinergic agents affected the symptom. 3. Although spontaneous improvement of dystonia was obtained after several months without any specific treatment in one patient, the symptom persisted for several years in another. The last patient could not be followed after discharge from our hospital since she and her family did not come to the hospital. 4. Severe antecollis may cause disturbances in various functions, such as vision, speaking and swallowing. Forward bending of the neck may cause inspiratory obstruction. Severe antecollis may not be unusual and psychiatrists should be aware of this symptom in routine clinical practice.

Conventional x-ray films (orthopantomogram, teleradiogram) visualize many signs of dysfunction of the manducatory apparatus (DAM). Progress in our knowledge of the pathophysiology of DAM has brought new light to these radiographic signs. The orthopantomogram allows an assessment of modifications in muscle insertion zones secondary to their dysfunction and, more difficulty, the articular remodeling of the TMJ, mainly of the mandibular condyle and the articular space. The lateral teleradiogram studied by architectural and structural analysis provides information on the biomechanical balance of the cranio-facial structures and, especially, on the position of the mandibular rami. These standard radiograms are indispensable in the differential diagnosis, useful in the etiological diagnosis and are preliminary examinations prior to using other imaging techniques (MRI, CT). Standard films are easily reproducible for post-therapy follow-up.

Calcium hydroxyapatite deposition disease may occasionally involve the superolateral portion of the longus colli muscle. Clinical symptoms include headache, neck pain, and dysphagia. Characteristic prevertebral calcifications with the epicenter at the C1-C2 level are depicted on lateral radiographs of the cervical spine.

Objective: To examine the reliability of measurements of semispinalis capitis muscle (SECM) cross-sectional area (CSA) in prone and sitting positions, and to compare the muscle size in these two positions., Design: Semispinalis capitis CSA was measured twice a day on two successive days with a real-time ultrasound apparatus., Subjects: Eighteen males (aged 19-34 years) and 28 females (aged 19-34 years) were studied for the reliability test. Seven males and 12 females were randomly selected to compare SECM size in sitting and prone positions., Results: The intraclass correlation coefficient (ICC) for repeatability measurements was r = 0.98 for the two positions. The correlation of the CSA in sitting and in prone positions was r = 0.93 (p < 0.01). There were no significant differences between CSA, linear dimensions and shape ratio of SECM in the two positions., Conclusions: In this study SECM ultrasonography appeared to be an accurate method in both positions, and position as such had no significant effects on the SECM cross-sectional size. Such accuracy allows neck muscle evaluation in clinical diagnosis and in follow-up studies during neck rehabilitation programmes.

This is a case report and literature review involving congenital absence of the sternocleidomastoid muscle (SCM) and simultaneous herniation of the left lung into the neck. To date there have been eight cases of absence of the SCM muscle, but no records of lung herniation alone or in combination with SCM muscle absence. Included is the management course taken to correct this patient's defect, CAT scans of the neck, fluoroscopic imaging of the lung and neck, and photographic documentation of the defect.

Clinically apparent hematogenous skeletal muscle metastases from lung cancer are extremely rare. We present a 72-year-old man with a large cell lung carcinoma metastatic to nuchal muscle. Cervical computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a well-defined mass in the left splenius capitis muscle. A percutaneous needle biopsy was performed to establish a diagnosis. Localized skeletal muscle swelling may rarely prove to be metastases in patients with lung cancer, but should be investigated in the case of muscle swelling.

Background: Congenital muscular torticollis (CMT) in infancy is caused by the fibrotic change of the sternocleidomastoid muscle (SCMM). The etiology and management strategies remain controversial., Methods: One hundred ninety-seven infants and children aged 1 month to 16 years who had CMT were examined by real-time ultrasonography of the SCMM between June 1995 and September 1996 in a prospective and longitudinal study. A total of 362 examinations were performed. There were 122 boys and 75 girls., Results: The right side was involved in 117 patients (59.3%), the left side in 79 patients (40.1%), and both sides in one patient. The sonographic findings were homogeneous or heterogeneous (patchy) hyperechoic lesion within the SCMM, and all were diagnostic. The ultrasonographic appearance of the SCMM in this study has a close resemblance to the clinical course of CMT. The extent of fibrosis as represented by the cross section of lesion to muscle ratio (L/M ratio) decreased from 83.6% at 2 months to 59.9% at 9 months of age and further decreased to 40% beyond 1 year of age. This consistent decrease in fibrosis was caused by the increased normal muscle volume at the periphery and by the regenerated muscle fibers within the lesion. In this series of 197 patients, 32 (16.2%) eventually underwent surgery to release the SCMM because of persistent head tilt, chin deviation and limited range of neck motion beyond 1 year of age. The L/M ratio of the operative group was 62.7 +/- 16.0% compared with an L/M ratio of 54.5 +/- 14.2% (P = .035) for the nonoperative group at 1 year of age. The extent of fibrotic change in the cross section of the muscle was a significant factor in determining prognosis. In the longitudinal section, the fibrotic change was limited to only the lower third of the SCMM in 27 patients, and all of them recovered without operation. In 95 patients, the fibrotic lesion was limited to the middle and lower third or middle third only, and only six (6.3%) underwent operation. However, in 75 cases the entire length of muscle was involved, and 26 (34.7%) required surgical release of the contracted muscle. Whole-length muscle involvement was also important for predicting recovery without operative intervention., Conclusions: Ultrasonographic study of the SCMM is not only a valuable diagnostic tool but can also serve as a useful guideline for the treatment of infants who have congenital muscular torticollis.

Purpose: This study was performed to determine the detailed anatomy of the thoracic outlet in normal subjects using helical computed tomography (CT), with particular attention to vascular compression with arm movement., Methods: Ten volunteers underwent detailed clinical evaluation and helical CT scanning of the upper thorax and neck with the arm in a neutral position and with the arm abducted 90 degrees or greater and externally rotated. Anterior scalene-clavicle distance (SC), costoclavicular distance (CC), and vessel diameters were measured with electronic calipers in each position. Comparisons were made with Student's t test., Results: With abduction the SC decreased from 18.4 +/- 3.9 mm to 5.2 +/- 2.4 mm (p < 0.001), and the CC decreased from 12.6 +/- 2.7 mm to 6.3 +/- 3.3 mm (p = 0.005). At these same anatomic planes, the vein diameter decreased from 11.0 +/- 1.6 mm at the neutral position to 5.1 +/- 1.5 mm (p < 0.001) and from 16.1 +/- 3.0 mm to 7.4 +/- 2.6 mm with the arm abducted (p < 0.001). The artery diameter changed from 6.6 +/- 0.8 mm to 6.2 +/- 0.5 mm (p = 0.08) and from 7.2 +/- 0.8 mm to 6.0 +/- 0.5 mm (p = 0.001) with arm movement., Conclusions: Both the distances between the anterior scalene muscle and the clavicle and between the clavicle and the first rib are significantly reduced with abduction of the upper extremity. Venous compression is universal at both the SC and CC spaces in normal subjects with this maneuver. Arterial narrowing occurs less frequently and appears to be minor. Minor changes in these thoracic outlet dimensions (SC/CC) may produce venous compression without movement.

Background: To the best of our knowledge, only one patient with calcium hydroxyapatite deposition disease (CHADD) of the longus colli muscle has been reported in the otolaryngology literature., Methods: Clinical findings and results of imaging studies in such a patient are reported., Results: Two particular imaging findings of this disorder are discussed. First, disappearance of calcifications over the short time frame of a week, accompanied by the resolution of clinical symptoms. Second, the presence of an extensive region of high signal intensity extending from the skull base to the lower border of C5, on T2-weighted spin-echo magnetic resonance (MR) images., Conclusions: Knowledge of the characteristic clinical spectrum and imaging features of this disorder are crucial for a correct diagnosis of this uncommon cause of odynophagia and dysphagia.

The magnetic resonance imaging (MRI) and sonographic appearances of congenital muscular torticollis were studied in a 6-week-old female infant who presented with a firm mass in the right sternocleidomastoid muscle and clinical signs of torticollis. MRI and ultrasound were performed to exclude neoplasm. MRI showed a diffusely enlarged, right sternocleidomastoid muscle that was isointense to normal muscle on T1-weighted conventional spin-echo images. The muscle became progressively brighter and more heterogeneous in signal intensity on proton density- and T2-weighted conventional spin-echo sequences. A thin rim of bright signal intensity on the T2-weighted images surrounded most of the muscle. Ultrasound demonstrated fusi-form enlargement with patchy inhomogeneous areas of increased echogenicity. At 14 weeks there were signs of clinical improvement, with softening of the mass and decreased torticollis.

A diagnosis of the deep plunging ranula usually is based upon the history and clinical examination of the patient. The case presented here highlights the role of the CT scan in facilitating a definitive diagnosis. Visualization of the anatomic relations of the accumulated secretion, as it dissects its way through the cervical tissue planes, also is made possible.

In vivo demonstration of hypoxia is of significance for tumour patient management. Fluorine-18 fluoromisonidazole ([18F]FMISO) is a proven hypoxic imaging agent. We developed an [18F]FMISO tumour to muscle retention ratio (TMRR) for the detection of tumour hypoxia in nasopharyngeal carcinoma (NPC). Data were acquired by positron emission tomography (PET) of the nasopharynx and neck after intravenous injection of 370 MBq of [18F]FMISO. Two imaging protocols were adopted: a long protocol for comprehensive dynamic information and a short protocol for a simple, clinically convenient imaging procedure. Tomograms were reconstructed and evaluated visually. ROI analysis on the basis of time-activity curve evaluation was performed to calculate the TMRR of NPC or cervical nodal metastases (CNMs) in relation to the suboccipital muscles at 2 h. The calculation of the TMRR was exactly the same for both the long and the short protocol as two 30-min composite frames had been created immediately after intravenous injection and 2 h after injection of [18F]FMISO in the long protocol. The normal tissue to muscle retention ratio (NTMRR) was derived similarly from the normal nasopharynx. The data of 12 controls and 24 patients with NPC were analysed. The long protocol was used in 15 patients, and the short protocol in nine. In controls, the mean NTMRR+/-1 SD was 0.96+/-0.14. The mean TMRRs for NPC and CNMs were 2.56+/-1.50 and 1.35+/-0.51, respectively; these values were significantly higher than the mean NTMRR for normal controls (P<0.005 in each case). At the retention threshold value of 1.24, tumour hypoxia occurred in 100% of the primary lesions of NPC and 58% of CNMs. The TMRR for undifferentiated carcinoma was significantly lower than that for non-keratinized carcinoma (P<0.05). The [18F]FMISO TMRR is a simple and clinically useful index for detecting tumour hypoxia in NPC.

The objective of this research is to compare the ultrasonographic (USG) and sialographic contributions for the diagnosis of Recurrent Parotitis in Childhood (RPC). Bilateral USG of the parotid gland was performed among 16 children with RPC and 16 healthy children. The image of the normal parotid glands was compared with the image of the parotid gland with RPC. A pathologic USG pattern for RPC was obtained which consisted in a homogeneous, micronodular parenchyme with a diffuse increase density, sometimes with multiples hypoechogenous areas, that were considered solid hypoechogenous nodules suggesting inflammatory nodes. A glandular contour finely granulated was described with normal peri-parotidareas and with aponeurotic-muscular planes. Then 16 USG of the parotid gland of the children with RPC were compared with 16 Sialography previous obtained. The possibilities of diagnosis of the disease with both techniques was not different (p > 0.05). When the clinic was correlated with the USG it was possible to obtain parameters of severity of the glandular damage and to visualise the degree of changes of the parenchyma of each child with RPC. In some cases, bilateral damage was observed in children with clinical unilateral symptoms. The USG was performed in children in the acute phase of disease, visualising the microabscess in the gland and confirming the previous diagnosis. Finally, it was possible to conclude the utility of USG in the study of the disease. Being a not invasive exam, harmless, unpainfully echography, was easily accepted by the child. Also, we obtain information not only about the diagnosis of the disease, but also about the severity, prognosis, treatment and follow-up of the infant patients.

Purpose: To evaluate the reproducibility of real-time ultrasonography as a method for measuring the size of the splenius capitis muscle (SPCM)., Material and Methods: Ten right-handed women (non-athletes) aged 19-29 years were studied. Muscle cross-sectional area (CSA), anterior-posterior dimension (APD), and lateral dimension (LD) were measured bilaterally on 2 successive days, twice each day., Results: The coefficient of variation (CV) of CSA was 2.7% between times, and 3.0% between days. No significant correlations were found between muscle CSA and the anthropometric variables (neck girth, height, weight, fat percentage and body mass index). A significant correlation between CSA and the multiple of the 2 linear dimensions (MLD = LD x APD) was found (r = 0.76, p = < 0.01). CSA of SPCM was larger on the dominant side (p < 0.05)., Conclusion: The results suggest that real-time ultrasonography is a useful method for evaluating the size of the SPCM.

Unlabelled: We have observed a pattern of symmetrically increased uptake of [18F]fluorodeoxyglucose (FDG) in the neck and thoracic paravertebral regions of several patients referred for whole-body PET. The distribution is suggestive of uptake in contracting skeletal muscle in tense patients., Methods: To test this hypothesis, six successive patients who exhibited this pattern of uptake underwent rescanning using an identical imaging protocol but with oral diazepam before injection of FDG., Results: The increased neck and paravertebral uptake was significantly reduced or abolished with diazepam, confirming the supposition that this increased neck and paravertebral uptake represents a normal variant of muscle uptake., Conclusion: Oral diazepam, given before the uptake period can be helpful in such patients to exclude the masking of potential abnormalities by this characteristic pattern of FDG uptake.