Search Results (45)

The internal branch of the superior laryngeal nerve (IbSLN) plays a critical role in the sensory innervation of the supraglottic larynx. It is essential for protective reflexes such as coughing and swallowing. This nerve is frequently at risk during surgeries involving the cervical region, including thyroidectomy, carotid endarterectomy, and anterior cervical spine procedures. Injury to the IbSLN may lead to postoperative complications. A comprehensive review of the morphological and topographic characteristics of the IbSLN is presented, focusing on its anatomical course, relationships with key vascular structures, branching patterns, and clinically significant variations. Full article

Gynecologic tumors are a leading cause of cancer-related mortality in women worldwide, with endometrial, ovarian, and cervical types being the most prevalent. Aberrant glycosylation, a key post-translational modification, plays a crucial role in tumor development, metastasis, and immune evasion. Specific glycosylation changes, such as altered sialylation and fucosylation, have been identified in gynecologic cancers and are associated with disease progression and prognosis. Understanding glycosylation alterations in gynecologic cancers holds promise for novel diagnostic and therapeutic approaches, ultimately enhancing patient outcomes. In this study, the serum N-glycome was analyzed in patients with myoma uteri, endometriosis, and cervical carcinoma by hydrophilic-interaction liquid chromatography (HILIC-UPLC) with fluorescence (FLR) and mass-spectrometric (MS) detection in order to identify their biomarker potential. Individual serum samples were deglycosylated by PNGase F digestion followed by procainamide labeling and solid-phase-extraction-based purification. All disease groups exhibited consistently higher levels of specific bi-antennary glycans (A2G2 and A2G2S1) compared to control patients. Additionally, significantly higher levels of agalactosylated and mono-sialylated glycans were found in cervical cancer, while a notable decrease in bisected N-glycans, alongside an increase in highly branched tetra-sialylated glycans, was found in endometriosis. Our study serves as proof-of-concept, demonstrating that discovering biomarkers within the serum N-glycome is a promising approach for identifying non-invasive indicators of gynecologic conditions. Full article

Background: The superficial temporal artery (STA) typically bifurcates into frontal and parietal branches in the temporal region. This study describes a rare anatomical variation identified during a cadaveric dissection where the STA presented an early cervical bifurcation. Methods: A cadaveric dissection was performed on a 58-year-old Caucasian female specimen injected with synthetic polymers. The STA was meticulously dissected, and anatomical findings were documented through photographs and measurements. Results: An unusual cervical bifurcation of the STA was observed. The frontal and parietal branches originated at the level of the posterior belly of the digastric muscle, ascending separately. The anterior branch, identified as the frontal branch, coursed below the facial nerve and stylomastoid artery, reaching the temporal line without further branching after giving the transverse facial artery as the only collateral branch. The posterior parietal branch extended posteriorly to the external acoustic meatus, compensating for the absence of the posterior auricular artery. This anatomical variation might influence surgical approaches to the head and neck region, particularly in parotid and reconstructive surgeries. Discussion: Variations in STA anatomy can significantly impact clinical practices, including reconstructive surgery, vascular interventions, and esthetic procedures. Imaging techniques, though useful, may not detect such rare variants. Cadaveric dissection remains a crucial tool for detailed anatomical assessment. Conclusions: This study highlights the importance of recognizing the STA’s vascular variations for safe surgical planning and improving patient outcomes. Further studies correlating imaging findings with cadaveric dissections are recommended. Full article

Vaginal intraepithelial neoplasia (VAIN), linked to HPV infection, is a condition that is often overlooked during colposcopy, especially in the vaginal vault area, as clinicians tend to focus more on cervical lesions. This oversight can lead to missed or delayed diagnosis and treatment for patients with VAIN. Timely and accurate classification of VAIN plays a crucial role in the evaluation of vaginal lesions and the formulation of effective diagnostic approaches. The challenge is the high similarity between different classes and the low variability in the same class in colposcopic images, which can affect the accuracy, precision, and recall rates, depending on the image quality and the clinician’s experience. In this study, a dual-branch lesion-aware residual network (DLRNet), designed for small medical sample sizes, is introduced, which classifies vaginal lesions by examining the relationship between cervical and vaginal lesions. The DLRNet model includes four main components: a lesion localization module, a dual-branch classification module, an attention-guidance module, and a pretrained network module. The dual-branch classification module combines the original images with segmentation maps obtained from the lesion localization module using a pretrained ResNet network to fine-tune parameters at different levels, explore lesion-specific features from both global and local perspectives, and facilitate layered interactions. The feature guidance module focuses the local branch network on vaginal-specific features by using spatial and channel attention mechanisms. The final integration involves a shared feature extraction module and independent fully connected layers, which represent and merge the dual-branch inputs. The weighted fusion method effectively integrates multiple inputs, enhancing the discriminative and generalization capabilities of the model. Classification experiments on 1142 collected colposcopic images demonstrate that this method raises the existing classification levels, achieving the classification of VAIN into three lesion grades, thus providing a valuable tool for the early screening of vaginal diseases. Full article

Background/Objectives: Pre-treatment depiction of the cervical arteries is important for better intra-arterial infusion therapy of malignant head and neck tumors. There have not been any studies on the image quality of ultra-high-resolution computed tomography (U-HRCT) for cervical CT angiography (CTA). The aim of this study is to evaluate the advantages of U-HRCT over conventional HRCT for cervical CTA; Methods: Forty-one patients underwent cervical CTA prior to selective intra-arterial infusion chemotherapy for malignant head and neck tumors. Twenty-two patients were scanned on conventional HRCT, while the remaining nineteen on U-HRCT. U-HRCT super-high-resolution (SHR) mode was used in 8 patients, while high-resolution (HR) mode was used in 11 patients. On CTA, the visibility of 18 branches from bilateral external carotid arteries was evaluated using a 5-point scale by three radiologists in consensus. Prior to the patient study, a head–neck CT phantom study regarding mock arterial density and its visibility was performed; Results: Regarding the patient study, the mean score of the SHR mode for visibility was significantly higher than that of conventional HRCT in 17 of 18 arteries (p < 0.05). The mean score of the HR mode for visibility was significantly higher than that of conventional HRCT in all arteries (p < 0.05). Regarding the phantom study, the maximum density of the SHR mode was significantly higher than that of conventional HRCT for mock proximal and peripheral arteries (p < 0.01). In addition, the visual score of the SHR mode for mock arteries was significantly higher than that of conventional HRCT (p < 0.05); Conclusions: U-HRCT provides higher image quality in terms of visualization of the arteries than conventional HRCT in cervical CTA. Full article

Background/Objectives: The anesthetic block of the sensory branches of the superficial cervical plexus renders a specific area of the face, head, and anterior neck insensible and painless. Chronic pain in these areas can be difficult to diagnose and treat. In this report, we briefly review the existing evidence on the topic of the superficial cervical plexus block (SCPB) to set the context for our research. We then share our own clinical experience with the SCPB for managing chronic pain syndromes from both cancerous and non-cancerous etiologies. Methods: We first performed a comprehensive literature search and narrative review of clinical cases and studies that utilized the SCPB as an analgesic technique. We then conducted a retrospective case series of all patients who had received an SCPB at our pain clinic since 2020. Results: Our literature review found only a few cases reported, with most of them focusing on acute painful emergencies and perioperative pain syndromes and only very few addressing chronic pain. In our pain clinic, 14 patients received one or more SCPBs for chronic pain management. In 43% of these cases, the pain was related to cancer. The most common areas of pain corresponded to the regions supplied by the transverse cervical and great auricular nerves. The procedures were uneventful in all cases, and patients rated them as effective and worthwhile 71% of the time. Conclusions: Despite the lack of high-quality studies on SCPBs in pain management, the authors’ experience suggests that it is a valid minimally invasive alternative for managing chronic face, head, and neck pain. Full article

Background/Objectives: Cervical facet joint syndrome (CFJS) is a frequent cause of neck pain and motor disability. Among the available therapies for CFJS, ultrasound (US)-guided injections are becoming more and more widespread, but the evidence about their accuracy and effectiveness is still debated in the scientific literature. The aim of this systematic review is to assess efficacy, accuracy and feasibility of US-guided cervical facet injections for the related chronic neck pain treatment. Methods: This review was conducted following the preferred reporting items for systematic reviews and meta-analysis 2020 (PRISMA) statement guidelines. The scientific articles were identified through the PubMed, Google Scholar and Cochrane Library databases. Qualitative assessment of the selected studies was carried out using the modified Oxford quality scoring system. Nine studies with a total of 958 patients were included in this review. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered at PROSPERO 2024 (n°CRD42024512214). Results: The results of this review suggest that the US-guided cervical facet injection for CFJS treatment is an effective technique in terms of accuracy (using the lateral technique it ranges from 92% to 98%), and efficiency (it grants pain relief with a decrease in the procedure time and fewer needle passes in comparison with the X-ray-guided technique, which also involves radiation exposure). Conclusions: US-guided injections are a safe and effective method to treat this musculoskeletal disease, granting a high functional recovery and long-lasting pain relief, net of the used drugs. However, these procedures are strictly operator-dependent and require important training to acquire good expertise. Full article

Cervical cancer, as the fourth most common cancer in women, poses a significant threat to women’s health. Vaginal colposcopy examination, as the most cost-effective step in cervical cancer screening, can effectively detect precancerous lesions and prevent their progression into cancer. The size of the lesion areas in the colposcopic images varies, and the characteristics of the lesions are complex and difficult to discern, thus heavily relying on the expertise of the medical professionals. To address these issues, this paper constructs a vaginal colposcopy image dataset, ACIN-3, and proposes a Fusion Multi-scale Attention Network for the detection of cervical precancerous lesions. First, we propose a heterogeneous receptive field convolution module to construct the backbone network, which utilizes combinations of convolutions with different structures to extract multi-scale features from multiple receptive fields and capture features from different-sized regions of the cervix at different levels. Second, we propose an attention fusion module to construct a branch network, which integrates multi-scale features and establishes connections in both the spatial and channel dimensions. Finally, we design a dual-threshold loss function and introduce positive and negative thresholds to improve sample weights and address the issue of data imbalance in the dataset. Multiple experiments are conducted on the ACIN-3 dataset to demonstrate the superior performance of our approach compared to some classical and recent advanced methods. Our method achieves an accuracy of 92.2% in grading and 94.7% in detection, with average AUCs of 0.9862 and 0.9878. Our heatmap illustrates the accuracy of our approach in focusing on the locations of lesions. Full article

The clinical neurophysiological tests allow us to determine the type, extent, and nature of brachial plexus damage. They are crucial in decision making regarding surgical procedures or conservative treatment. This report aimed to present an algorithm for rehabilitation procedures in patients with brachial plexus injury of various origins based on the results of neurophysiology findings for the selection of procedures supporting the process of nerve and muscle regeneration. The research group consisted of patients whose medical documentation was analysed concerning the reason, level, and localization of damage to the brachial plexus structures, surgical and or rehabilitative treatment, as well as the MRI results. Among the group of fourteen patients, the clinical studies showed the greatest incidence of brachial plexus injuries of the mixed (both pre- and postganglionic), all trunks, and cervical root injuries, respectively. Results of the motor evoked potentials (MEP) and electroneurography (ENG) recordings induced at levels of spinal roots and Erb’s point showed a decrease of more than 40% in amplitudes on the symptomatic side in comparison to the asymptomatic side. This diffeence was recorded for the axillary and radial innervation and the C5, C6, and C7 root domains, ranging from 57% to 66%; the lowest decrease was recorded following electrical stimulation at Erb’s point for the ulnar nerve (34%). The latency prolongation on the symptomatic side in CMAP and MEP tests ranged from 0.2 to 1.7 ms, with the most following magnetic stimulation of the C5 cervical root for the axillary innervation. Most of the results indicated the axonotmesis and neuropraxia type of injury in motor fibers (40%) confirmed by EMG results. The sensory conduction studies (SNCS) in distal nerve branches did not confirm the severe advancement of the brachial plexus injury (63%). The proposed algorithm of the physiotherapeutic procedures should be mainly targeted for recovery of motor dysfunction as the consequence of brachial plexus injury. Rehabilitation should incorporate the treatment supporting nerve regeneration, muscle strengthening, and maintaining functional ranges of motion of the injured extremities. The rehabilitation treatment for patients with brachial plexus injuries is an individualised process, and the selection of procedures and the effectiveness of the treatment undertaken should be confronted with results of neurophysiological tests verifying the motor neural transmission from the level of the cervical motor centre to the effector, peripheral nerve function, and muscle’s motor unit activity. Full article

The ansa cervicalis (AC) is a neural loop within the carotid triangle of the anterior neck. The loop is traditionally formed by nerve roots C1–C3 of the cervical plexus and extends multiple motor branches. The current case was discovered during a routine dissection as an anatomical variation of the right AC in an 86-year-old Caucasian male cadaver. In this variation, the C1 nerve root did not form the typical loop with the C2 and C3 nerve roots, but instead, remained independent, traveling deep to the superior belly of the omohyoid muscle to supply the sternothyroid muscle. Because no loop was formed, the anatomy of the current case was not an ansa according to the Latin origin of the word, meaning handle or loop. The AC is an important anatomical landmark within the neck and is implicated in laryngeal reinnervation and respiratory nerve stimulation for patients with sleep apnea. The current anatomical variant contributes to a relatively limited catalog of identified anomalies. Knowledge of new AC variations can guide future surgical interventions and further develop the current base of knowledge surrounding the neuromuscular structures of the head and neck. Full article

(1) Background: Considering that the specialty literature supplies only general data about the variability of the cervical branch of the facial nerve, this study aimed to determine this branch’s variation and individual peculiarities depending on the nerve branching pattern and anthropometric type of the head. (2) Methods: The study was conducted on 75 hemifaces of adult formalized cadavers. Ahead of anatomical dissection, each head was measured to establish the anthropometric type, according to Franco and colleagues. The branching patterns were then distributed according to the Davis classification. (3) Results: The number of cervical branches (CB) of the facial nerve varied from one to five branches, with the following rate: 1 CB (61.3%), 2 CB (28%), 3 CB (6.7%), 4 CB (2.7%), and 5 CB (1.3%). Seven branching patterns of the facial nerve were revealed: Type I in 18.7%, Type II in 14.7%, Type III in 20%, Type IV in 14.6%, Type V in 5.3%, Type VI in 18.7%, and Type NI in 8% (bizarre types). According to the branching pattern, the mean numbers of the cervical branches were as follows: Type I—1.6 ± 1.02; Type II—1.4 ± 0.50; Type III—1.4 ± 0.50; Type IV—1.4 ± 0.67; Type V—2.0 ± 1.41; Type VI—1.8 ± 1.12; and Type-NI—1.8 ± 0.75; p = 0.599. According to the anthropometric type of the head, the mean number of CB in the mesocephalic type (MCT) was 1.5 ± 0.82, in the dolichocephalic type (DCT), 1.7 ± 0.87, and in the brachycephalic type, (BCT) 1.8 ± 1.04; p = 0.668. (4) Conclusions: The cervical branch of the facial nerve varies depending on the facial nerve branching pattern and the anthropometric type of the head. The highest degree of variation was characteristic of BCT and Type V and the lowest, of MCT and Types II, III, and IV. Full article

Oral cavity defects occur after resection of lesions limited to the mucosa, alveolar gum, or minimally affecting the bone. Aiming at esthetical and functional improvements of intraoral reconstruction, the possibility of harvesting a new galeo-pericranial free flap was explored. The objective of this study was to assess the technical feasibility of flap harvesting through anatomical dissections and surgical procedure simulations. Ten head and neck specimens were dissected to simulate the surgical technique and evaluate the vascular calibers of temporal and cervical vessels. The procedure was therefore reproduced on a revascularized and ventilated donor cadaver. Anatomical dissections demonstrated that the mean cervical vascular calibers are compatible with superficial temporal ones, proving to be adequate for anastomosis. Perforating branches of the superficial temporal vascularization nourishing the pericranium were identified in all specimens. In conclusion, blood flow presence was recorded after anastomosing superficial temporal and facial vessels in the revascularized donor cadaver, demonstrating both this procedure’s technical feasibility and the potential revascularization of the flap and therefore encouraging its potential in vivo application. Full article

The concept of machines learning and acting like humans is what is meant by the phrase “artificial intelligence” (AI). Several branches of dentistry are increasingly relying on artificial intelligence (AI) tools. The literature usually focuses on AI models. These AI models have been used to detect and diagnose a wide range of conditions, including, but not limited to, dental caries, vertical root fractures, apical lesions, diseases of the salivary glands, maxillary sinusitis, maxillofacial cysts, cervical lymph node metastasis, osteoporosis, cancerous lesions, alveolar bone loss, the need for orthodontic extractions or treatments, cephalometric analysis, age and gender determination, and more. The primary contemporary applications of AI in the dental field are in undergraduate teaching and research. Before these methods can be used in everyday dentistry, however, the underlying technology and user interfaces need to be refined. Full article

Background and Objectives: Ventriculoperitoneal (VP) shunt placement is the most common treatment for cerebrospinal fluid diversion. Head and neck pain occurring after a long period following VP shunt insertion is rarely reported. Here, we present a rare case of head and neck pain occurring 2 years after surgery due to irritation of the superficial cervical plexus by the VP shunt. Case Description: A 46-year-old female patient received VP shunt placement surgery. Two years after the surgery, she experienced a left temporal headache with neck pain on the left side, which extended to the left para-auricular and fascial region. Ultrasound (US) scanning revealed that the VP shunt passed within the superficial cervical fascia and through the left sternocleidomastoid muscle (SCM). Additionally, friction of the branches of the superficial cervical plexus and of the greater auricular and lesser occipital nerves caused by the VP shunt was found underneath the lateral border of the SCM. Subsequently, the blocking and hydro-release of the left superficial cervical plexus were performed. After four series of treatments, the patient’s head and neck pain vanished, and the frequency of the headaches was substantially reduced. The patient was regularly followed-up in the outpatient department of neurosurgery. Conclusions: Head and neck pain caused by the malpositioning of a VP shunt catheter with an unusually delayed onset is a rarely reported complication and could be easily neglected. Patients with head and neck pain following VP shunt insertion should be checked using US scanning to identify the potential origin of the pain and receive adequate treatments. Intraoperative US-guided tunnelling is suggested to avoid the malpositioning of the VP shunt catheter. Full article

Background: Cluster headache (CH) is a type of headache that has a global prevalence of 0.5–3/1000 people, provokes severe, strictly unilateral pain through the first branch of the trigeminal nerve, and is associated with observable autonomous responses. CH provokes intense pain and decreases quality of life. Objective: In this study, we aimed to carry out a systematic review of the effectiveness of non-invasive neuromodulation of the vagus nerve in patients with cluster headaches, which was registered on PROSPERO No. CRD42021265126. Methods: Six databases were used from their date of inception to February 2023 to obtain studies with the group intervention of non-invasive neuromodulation of the vagus nerve for cluster headache, with outcomes based on pain attacks, duration, and disabilities. Data on the subjects, group intervention, main outcomes, and results were collected by two authors. Results: The search provided 1003 articles, with three clinical trials being eligible for inclusion in the review. The methodological quality scores ranged from 6 to 8 points (mean: 7.3, SD: 0.8) out of a maximum of 10 points. The post-treatment results showed some positive effects using n-VNS as a treatment for cluster headache, more specifically regarding cervical neuromodulation of the vagus nerve. Conclusions: The systematic review found moderate-to-high-quality evidence supporting that n-VNS and cervical n-VNS may have some positive effects at the end of the treatment being effective to relieve the frequency and intensity of cluster headaches. The poor quantity of studies available and the lack of homogeneity in the study protocols did not allow the pooling of data for a meta-analysis. Full article