Feeling Broken or Destroyed Measure (original) (raw)
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The cervical plexus: anatomy and ultrasound guided blocks
Cervical plexus has a complex anatomy and is considered as a plexus of loops. It is often described as deep and superficial cervical plexus. The deep plexus provides the muscular branches and the superficial plexus provides the innervation of the skin of the head and neck. Ultrasound guided blocks for cervical plexus are fairly new entrant and are easier to understand with knowledge of the landmark techniques that are briefly described in this article. The superficial and intermediate plexus blocks are fairly easy to perform. The deep plexus block is described in various forms, from extension of brachial plexus block, injection around the carotid and lastly the classical deep cervical plexus block. The C4 transverse process is the key to performing the deep plexus block and in this article we, for the first time, describe the "thumbs up" sign that helps to easily identify C4 level and perform this block. The article also describes the complications that can be expected with these blocks and how they can be avoided.
Horner’s Syndrome after Superficial Cervical Plexus Block
Western Journal of Emergency Medicine, 2015
Ultrasound-guided nerve blocks are becoming more essential for the management of acute pain in the emergency department (ED). With increased block frequency comes unexpected complications that require prompt recognition and treatment. The superficial cervical plexus block (SCPB) has been recently described as a method for ED management of clavicle fracture pain. Horner's syndrome (HS) is a rare and self-limiting complication of regional anesthesia in neck region such as brachial and cervical plexus blocks. Herein we describe the first reported case of a HS after an ultrasoundguided SCPB performed in the ED and discuss the complex anatomy of the neck that contributes to the occurrence of this complication. [West J Emerg Med. 2015;16(3):428-431.]
International Journal of Morphology, 2012
Anatomical variations of the sternocleidomastoid muscle are rare and concern its origin, insertion, and the number of heads. We report on a rare bilateral variant of the sternocleidomastoid muscle with aberrant and supernumerary muscular heads, observed in a cadaveric subject. On the right side of the neck, a typical sternomastoid head of the sternocleidomastoid muscle, and three aberrant clavicular heads of variable thickness, origin, and termination were noticed. On the left side, two sternomastoid heads were present; the medial one was of typical pattern, while the lateral was supernumerary. The cleidomastoid portion of the left sternocleidomastoid muscle was fused with the double sternomastoid segment. A strap-like muscle originating from the middle third of the clavicle and inserting onto the transverse process of the C3 vertebra was noticed. This is known as the cleidocervical muscle. On the right side of the neck, the posterior cervical triangle was diminished, the minor supraclavicular fossa was considerably narrow, whereas on the left, it was diminished in addition to a bilateral shortening of the major supraclavicular fossa minimizing space needed for potential surgical access. These findings are of prominent significance for anesthetists in ultrasound guided needle positioning in brachial plexus block, as well as in subclavian or external jugular vein catheterization, and in surgical interventions involving structures lying under the sternocleidomastoid muscle.
A supraomohyoidal plexus block designed to avoid complications
Surgical and radiologic anatomy : SRA, 2006
Interscalene blocks of the brachial plexus are used for surgery of the shoulder and are frequently associated with complications such as temporary phrenic block, Horner syndrome or hematoma. To minimize the risk of these complications, we developed an approach that avoids medially directed needle advancement and favors spread to lateral regions only: the supraomohyoidal block. We tested this procedure in 11 cadavers fixed by Thiel's method. The insertion site is at the lateral margin of the sternocleidomastoid muscle at the level of the cricoid cartilage. The needle is inserted in the axis of the plexus with an angle of approximately 35 degrees to the skin, and advanced in lateral and caudal direction. Distribution of solution was determined in ten cadavers after bilateral injection of colored solution (20 and 30 ml) and followed by dissection. In an eleventh cadaver, computerized tomography and 3D reconstruction after radio contrast injection was performed. In additional five c...
International Journal of Morphology, 2023
This study aimed to classify and investigate anatomical variations of the sternocleidomastoid (SCM) muscle, which is commonly used as an anatomical landmark to indicate the correct position for central venous catheterization, in a Thai population. Thirtyfive embalmed cadavers from the Northeast Thailand (19 females and 16 males) were systemically dissected to reveal the SCM muscles in both sides for gross human anatomy teaching. Variations in the SCM origin and insertion were observed and recorded. The prevalence of anatomical variations was approximately 11.4 % (4 of 35 cadavers) and was not different by sex. Such variations were classified into 5 types based on origin, insertion, and presence of additional heads, as follows: type I (n=31; 88.6 %), type II (n=1; 2.85 %), type III (n=1; 2.85 %), type IV (n=1; 2.85 %), and type V (n=1; 2.85 %). Clinical considerations and prevalence of variant SCM muscle have also been discussed. Since the incidence of this anatomical variations was more than 10 %, the cervical surgeons should seriously consider this issue before insertion of a central venous catheter to avoid complications.
BILATERAL FOUR AND SIX HEADS OF THE STERNOCLEIDOMASTOID MUSCLE. A CADAVERIC FINDING
International Journal of Pharmaceutical Research, 2019
Background: The sternocleidomastoid muscle present a wide patterns of variations which including supernumerary muscular heads. Aim: The aim of the present study is report bilateral four and six heads of the sternocleidomastoid muscle. Materials and Methods: The anatomical variation was found during routine dissection performed in the laboratory of Morphology of the University of Pamplona. Findings: On the right side, two sternal head were a continuous sheet with a small gap of 1 mm; the third head originating from sternoclavicular joint until the clavicular head. The fourth, clavicular head that arose from the medial and middle third of the clavicle. On the left side of the neck, two sternal heads were lying side by side. Of the four clavicular heads, two were superficial and another two lying in a deep plane. Conclusions: Knowledge of these anatomical variations is important for any therapeutics and diagnostic intervention in the region neck.
A RARE CASE OF BILATERAL STERNOCLEIDOMASTOID MUSCLE VARIATION
International Journal of Pharmaceutical Research, 2019
Background: The abnormal origin, presence of additional head and layered arrangement of fibers are the reported variations of sternocleidomastoid muscle. Aims: The aim of the present study is report a rare bilateral anatomical variation of the sternocleidomastoid muscle. Materials and Methods: The anatomical variations were found during a routine dissection performed in the laboratory of Morphology of the University of Pamplona. Findings: In accordance with their origin, insertion, in the right side, in the superficial layer were dissected muscular bundle considered as sternocleidooccipital and sternomastoid muscle. In the deep layer, muscular bundles considered as cleidomastoid and sternocleidomastoid muscle was observed. In the left side, additional head originated from the investing deep layer of cervical fascia in the roof of the lesser supraclavicular fossa, traversed obliquely downward, backward, fused with clavicular head. Conclusion: The presence of this anatomical variation it might cause difficulty in assessing the vital neurovascular structures of the neck.