Surgical Anatomy of the Neck
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Inferiorly the sternocleidomastoid has both sternal and clavicular origins as two separate heads. The sternal head arises as a thick tendon, attached to the anterior and lateral surface of the manubrium. The clavicular head is fan shaped, arising from the medial third of the clavicle. Superiorly it inserts into the lateral aspect of the mastoid tip and the superior nuchal line. Although classified as a single muscle the two heads are functionally distinct with most of the sternal head attaching to the superior nuchal line and the clavicular head mainly to the mastoid tip. The action is complex; causing tilting of the head to the ipsilateral side and rotation of the head to the contralateral side. When both sides contract simultaneously it aids in head flexion and can assist in raising the thorax when the head is fixed, acting as an accessory muscle of respiration.
Use of the stomach as an esophageal substitute
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
To create the substernal plane, a small pocket is developed by dividing the tissue posterior to the xiphoid process. This plane is developed with blunt dissection and extended in a cephalad direction. Great care is taken to stay directly behind the sternum, as lateral dissection risks injury to the internal mammary arteries and pleura. In the neck, dissection is commenced directly behind the manubrium in a similar fashion. It should be possible to connect both substernal tunnels using finger dissection. The colon is then divided with a linear stapler at the second marking stitch at the proximal colonic end. The colon is brought up and laid on the chest to ensure adequate length and nontwisted mesentery (see Figure 31.4). A wire is passed from the neck in a caudal direction with either a tape or Foley catheter attached. To allow atraumatic passage of the conduit and mesentery, the conduit is placed in a laparoscopic camera sleeve and then ligated to the distal end of the Foley catheter. Historically, Mousseau-Barbin tubes have been used with good effect but are no longer readily available. The sleeve is lubricated with warm water and then the conduit
Upper Limb Muscles
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo in Handbook of Muscle Variations and Anomalies in Humans, 2022
Sternoclavicularis is considered a variant of pectoralis major and pectoralis minor. It may be present when pectoralis major is deficient (Macalister 1875; Snosek and Loukas 2016). It can originate from the manubrium, the capsule of the sternoclavicular joint, the anterior sternoclavicular ligament, or the first or second costal cartilage (Macalister 1875; Knott 1883a; Mori 1964; Bergman et al. 1988; Sakuma et al. 2007; Sontakke et al. 2013; Snosek and Loukas 2016). It may insert into the middle or distal portions of the clavicle (Macalister 1875; Knott 1883a; Mori 1964; Smith et al. 2015; Bergman et al. 1988; Snosek and Loukas 2016). When sternoclavicularis is present bilaterally, a tendinous band can connect the muscles, which is referred to as musculus interclavicularis (Knott 1883a) or interclavicularis anticus digastricus (Sakuma et al. 2007; Snosek and Loukas 2016). It attaches onto the manubrium via a tendinous intersection and connects the two clavicles (Bergman et al. 1988). If sternoclavicularis inserts into the coracoid process, it may be referred to as coraco-clavicularis anticus (Knott 1883a).
Salmonella aortitis successfully treated with antibiotics without surgery
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Gabriel Melki, Mina Fransawy Alkomos, FNU Komal, Vinod Kumar, Sushant Nanavati, Sugabramya Kuru, Linda Laham, Yasmeen Sultana, Shaker Barham, Walid Baddoura
We suspected sternal osteomyelitis as an explanation for the patient’s chest pain. A subsequent bone scan was ordered and revealed increased uptake in the region of the manubrium and upper body of the sternum. (Appendix A) This was suspected to be secondary to chronic inflammatory changes associated with his prior sternotomy. CT angiogram showed peri aortitis with a small air bubble/locule of gas suggesting that this may be infectious etiology, thus confirming the diagnosis of aortitis [Appendix B]. The sternal biopsy was positive for osteomyelitis and blood cultures grew Salmonella Enteritidis. Antibiotics were switched to IV Ceftriaxone, and the patient was treated for six weeks inpatient. The patient responded positively to treatment with no further complications and remained asymptomatic and inflammatory markers normalized at 2 weeks follow up (ESR, CRP, and WBCs).
Sternal Route More Effective than Tibial Route for Intraosseous Amiodarone Administration in a Swine Model of Ventricular Fibrillation
Published in Prehospital Emergency Care, 2018
James M. Burgert, Andre Martinez, Mara O'Sullivan, Dawn Blouin, Audrey Long, Arthur D. Johnson
Intuitively, the SIO route may be an advantageous infusion site for the administration of resuscitative drugs during cardiac arrest in civilian populations. The SIO infusion site is rapidly and easily located as the sternal notch is readily palpable and there is usually little subcutaneous tissue overlying the manubrium. There are IO devices specifically designed to safely access the sternal manubrium, the FAST- 1 and the more recent FAST Responder (Pyng Medical, Vancouver, BC, Canada).47,48 The venous drainage of the manubrium leads directly to the central circulation, and the effect site of many resuscitative drugs, via the right and left internal thoracic veins, to the brachiocephalic veins, and then to the superior vena cava. The hydraulic action of chest compressions could accelerate the movement of SIO administered drugs into the circulation compared to the TIO, HIO, and IV routes that do not benefit from pumping action. The combination of proximity to the heart and rapid hydraulic movement of drugs during CPR make the SIO an appealing choice for the administration of resuscitative drugs during cardiac arrest when IV access cannot be rapidly obtained.
Comparison of furosemide-loading cervical vestibular-evoked myogenic potentials with magnetic resonance imaging for the evaluation of endolymphatic hydrops
Published in Acta Oto-Laryngologica, 2020
Ko Shiraishi, Noriko Ohira, Takaaki Kobayashi, Mitsuo Sato, Yasuhiro Osaki, Katsumi Doi
FVEMP was performed as described previously [8]. All tests were performed by a single well-trained neurotologist (8 years of experience). Briefly, the active electrode was placed on the upper half of the sternocleidomastoid muscle, while the reference and ground electrodes were placed on the upper manubrium sterni and forehead, respectively. Using tone burst stimuli at a frequency of 500 Hz (rise/fall time: 4 ms; plateau time: 4 ms) and repetition rate of 5 Hz, the p13-n23 peak-to-peak amplitude of cVEMP was recorded by Eclipse® (Interacoustics, Middelfart, Denmark; Figure 1). Measurements were obtained before and 60 min after the intravenous administration of 20 mg furosemide. Subsequently, the improvement rate (IR) was calculated using the following formula: IR = 100 × (AA − AB)/AB (%), where AA represents the p13-n23 peak-to-peak amplitude after administration and AB represents the corresponding amplitude before administration. A positive result was defined as an IR >14.2% or the detection of the p13-n23 biphasic wave only after the administration of furosemide [8].
Related Knowledge Centers
- Cartilage
- Xiphoid Process
- Thorax
- Lung
- Heart
- Blood Vessel
- Flat Bone
- Rib
- Rib Cage
- Clavicle