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Purpose: To evaluate the contribution of splenius capitis, sternocleidomastoid, and upper fibers of trapezius activation to the gains in rate of force development (RFD) of the head and neck during maximum voluntary ballistic contractions. Methods: RFD gain was facilitated by a single-session intervention for maximum voluntary ballistic contractions in the anterior direction, oriented at 45° to the midsagittal plane, which require active restraint of axial rotation. Muscle activation for the agonist (sternocleidomastoid) and 2 antagonists (splenius capitis and upper fibers of trapezius) was evaluated. The study sample included 12 physically active men (mean age, 22.6 y). RFD (N·m·s−1; 0–100 ms) and integrated muscle activity (50 ms before and 100 ms after force onset) were measured at 10 minutes, 20 minutes, and 2 days postintervention, relative to baseline. Muscle activation predictive of RFD gains was evaluated by linear regression analysis. RFD reproducibility was evaluated using the coefficient of variation of the typical error. Results: The intervention yielded a 1.95- to 2.39-fold RFD gain (P ≤.05), with greater RFD gain for participants with a lower peak moment of force (<10.9 N·m) than those with a higher peak moment (≥10.9 N·m) at baseline (P ≤.002). For the low group, 65% to 74% of the RFD gain was predicted by ipsilateral sternocleidomastoid activation, with ipsilateral splenius capitis activation predicting 77% to 92% of RFD gain for the high group. Absolute peak and impulse of static force were greater for the high than for the low group (P ≤.04). RFD reproducibility was high (coefficient of variation of the typical error ≤ 14.4%). Conclusions: The agonist- and antagonist-focused synergies might reflect different functional priorities, higher RFD gain compared with higher head–neck force. [ABSTRACT FROM AUTHOR]

Congenital Dermoid Fistula of the Anterior Chest Region (CDFACR) is a subcutaneous fistula that ends caudally in the subcutaneous tissue close to the sternoclavicular joint, originating from the skin at the anterior border of the sternocleidomastoid. The fistulous track is lined by keratinised stratified squamous epithelium with hair follicles, sebaceous glands and sweat glands. It presents clinically as a cutaneous pit, sinus, or infected mass. It is rare and can be complicated by recurrent infection and abscess formation. Before surgery, imaging the complete extent of the sinus is essential to prevent recurrence. Authors hereby, report a case of a 20-year-old male presenting with discharge from the anterior chest wall. On radiological and histopathological examination, it was diagnosed as a congenital dermoid fistula. In the present report, authors present a case of CDFACR confirmed through comprehensive evaluation, including sonography, Computed Tomography (CT) sinography, Magnetic Resonance Imaging (MRI) and histopathology. The present case also represents the first documented instance of CDFACR from India, highlighting the importance of multimodal imaging in the diagnosis and management of this rare congenital anomaly. [ABSTRACT FROM AUTHOR]

Congenital Dermoid Fistula of the Anterior Chest Region (CDFACR) is a subcutaneous fistula that ends caudally in the subcutaneous tissue close to the sternoclavicular joint, originating from the skin at the anterior border of the sternocleidomastoid. The fistulous track is lined by keratinised stratified squamous epithelium with hair follicles, sebaceous glands and sweat glands. It presents clinically as a cutaneous pit, sinus, or infected mass. It is rare and can be complicated by recurrent infection and abscess formation. Before surgery, imaging the complete extent of the sinus is essential to prevent recurrence. Authors hereby, report a case of a 20-year-old male presenting with discharge from the anterior chest wall. On radiological and histopathological examination, it was diagnosed as a congenital dermoid fistula. In the present report, authors present a case of CDFACR confirmed through comprehensive evaluation, including sonography, Computed Tomography (CT) sinography, Magnetic Resonance Imaging (MRI) and histopathology. The present case also represents the first documented instance of CDFACR from India, highlighting the importance of multimodal imaging in the diagnosis and management of this rare congenital anomaly.

Background: Sternocleidomastoid (SCM) a chief rotator and flexor of the neck divides the side of the neck into anterior and posterior triangles and acts as an important landmark for clinicians. It protects the vital structures of the neck such as the cervical plexus and vessels. The depression between the two heads of SCM, the lesser supraclavicular fossa is used by clinicians as a landmark for various procedures. Methodology: The study included 15 males and 6 females cadavers, in the Anatomy Department, at Kasturba Medical College, Manipal. The parameters measured were SCM length along the anterior and posterior border, mastoid tip to the exit of greater auricular nerve and spinal accessory nerve along the posterior border of SCM, and origin of superior thyroid artery to SCM origin along the posterior border. Results: SCM length along the anterior border was 19.91 cm and 16.48 cm in males and females, respectively. Along the posterior border was 16.04 cm and 13.88 cm. Greater auricular nerve point of exit to the mastoid tip is 7.29 cm and 5.93 cm in males and females respectively. All results were more in males compared to females. Conclusion: This detailed morphometric analysis of the sternocleidomastoid (SCM) muscle offers important insights into its anatomical relationships and variations, which are crucial for clinical practice. The gender-specific measurements of SCM length, nerve exit points, and vascular landmarks provide surgeons with precise anatomical guidance for procedures in the neck area.

Isolated cysticercosis of the sternocleidomastoid is a rare entity caused by the ingestion of eggs of Taenia solium. The case reported here is of a 24-year-old male who presented to the hospital with complaints of a firm, non-tender, isolated, progressively increasing swelling of the right side of his neck for 3 months. Diagnosis of cysticercosis was made on high-resolution ultrasound and the patient was managed medically with complete resolution. The relevant findings of the case are discussed herein.

Purpose: To report the morphologic and spatial relationships of a bilateral sternalis muscle variant. Methods: Routine cadaveric dissection in an undergraduate anatomy laboratory revealed two sternalis muscles parasternal to the sternal body. Subsequent fine prosection of the anterior thoracic wall and neck was carried out to uncover the soft tissue attachments of both sternalis muscles. Positional relationship to neighboring anterior thoracic and neck structures, and geometric dimensions of the muscle bellies and tendons, were documented. Results: Both sternalis muscles were imbedded in the pectoral fascia, with their muscle fibers running obliquely to the midsternal line. The right sternalis muscle was notably larger in length, width, and thickness compared to the sternalis muscle on the left. The right sternalis muscle featured a distinct superior cord-like intermediate tendon that traversed superolateral and fused directly with the contralateral sternomastoid and sterno-occipital portions of the left sternocleidomastoid muscle. The superior tendon of the left sternalis muscle was aponeurotic and affixed to the cord-tendon of the right sternalis muscle. A distinct tendinous entheses for the sternal head for both sternocleidomastoid muscles were noted at the manubrial body. Conclusions: This case report describes a unique bilateral sternalis muscle variant with conjoined sternocleidomastoid muscle integration. This anatomical description of a sternalis-sternocleidomastoid muscle morphology may supplement radiographic interpretations and support diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Objective While the transcondylar approach is technically challenging, it provides generous ventral and caudal exposure to the craniovertebral junction. This approach requires navigation around multiple eloquent neurovascular structures including the lower cranial nerves, vertebral artery and its branches, and the brainstem. Superficial exposure, including incision location and muscle dissection, can dramatically affect the surgical angle and maneuverability at depth. Methods We demonstrate the transcondylar approach in a step-by-step fashion in a formalin-embalmed, latex-injected cadaver head. Dissection within each layer of the suboccipital muscles was performed. A small cohort with an illustrative case is also included herein. Results The sternocleidomastoid (SCM) muscle was retracted anteriorly; the splenium capitis, semispinalis capitis, and longissimus capitis muscles were disconnected from the superior nuchal line and reflected inferomedially. The suboccipital muscle group was fully exposed. The superior and inferior oblique muscles were disconnected from the transverse process of C1. The superior oblique and the rectus capitis posterior major muscles were then dissected off the inferior nuchal line, and the suboccipital muscle group was retracted inferomedially en bloc. The greater auricular nerve was retracted laterally with the SCM, and the greater occipital nerve was retracted inferomedially with the suboccipital muscle group. Conclusion This technique avoids the obstructive muscle bulk that results from a myocutaneous approach while maximizing deep exposure. Understanding the detailed muscular anatomical relationship with the insertion location and suboccipital nerves is key to complete and safe extracranial dissection. Diligent dissection helps minimize postoperative pain and muscle spasm while optimizing the closure technique. [ABSTRACT FROM AUTHOR]

Background: Cysticercosis is a parasitic infection caused by the larval form of the tapeworm Taenia solium, typically characterized by cystic formations within various human tissues, most commonly found in the brain and orbit. However, cysticercosis occurring in the craniofacial region, aside from the cerebral and orbital regions, is considered atypical. Case Presentation: In this report, we present an unusual case of a patient who presented with lateral neck swelling. Upon thorough evaluation, the patient was diagnosed with solitary cysticercosis of the sternocleidomastoid muscle (SCM). This case is exceptional due to its infrequency and highlights the importance of considering parasitic infections in the assessment of neck swelling cases. Effective management of this medical condition is achievable through medical interventions. High-resolution sonography has proven to be a reliable diagnostic tool and is valuable for ongoing surveillance. Conclusion: This case report emphasizes the significance of timely identification and proper treatment of cysticercosis, even in atypical anatomical sites such as the SCM.

The sternocleidomastoid muscles (SCM) are prominent paired muscles of the neck connecting proximally the manubrium sterni and the clavicle to the mastoid process and the occipital bone distally. Following their points of attachment sternomastoid, sternooccipital, cleidomastoid and cleidooccipital portions of this muscle have been described. Altogether 23 case reports from year 2000 till 2020 with 29 subjects related to the SCM supernumerary variations were searched and analysed where parameters such as supernumerary proximal variation types (sternal vs. clavicular), insertional variation, unilaterality/bilaterality of the variation, study type, reported gender of the subjects and the country of research were extracted. The research shows that 48.3% of the subjects had bilateral presentation of SCM variations. If present unilaterally, three quarters of the cases were on the left side. The most frequent variation is located at the clavicular side of the proximal SCM head whereas isolated sternal sided proximal head variation or an insertional variation alone are very rare. Interestingly, with 96.6%, most of cases in the literature were discovered in cadavers during anatomical dissections. Male gender represented with 82.8% higher prevalence than females. The higher male prevalence in the body donor system, predominantly in the Asian continent could play a decisive role in the outcome as more than half of the reported cases stemmed from India in this period. Importantly, the knowledge of different anatomical variations of the SCM is highly relevant for surgical, clinical or radiological approaches in the neck. [ABSTRACT FROM AUTHOR]

Congenital Muscular Torticollis (CMT) is a neuromuscular disease in children, which leads to exacerbation of postural deformity and neck muscle dysfunction with age. Towards facilitating functional assessment of neuromuscular disease in children, topographic electromyography (EMG) maps enabled by flexible and stretchable surface EMG (sEMG) electrode arrays are used to evaluate the neck myoelectric activities in this study. Customed flexible and stretchable sEMG electrode arrays with 84 electrodes were utilized to record sEMG in all subjects during neck motion tasks. Clinical parameter assessments including the cervical range of motion (ROM), sonograms of the sternocleidomastoid (SCM), and corresponding histological analysis were also performed to evaluate the CMT. The muscle activation patterns of neck myoelectric activities between the CMT patients and the healthy subjects were asymmetric during different neck motion tasks. The CMT patients presented significantly lower values in spatial features of two-dimensional (2D) correlation coefficient, left/right energy ratio, and left/right energy difference (p < 0.001). The 2D correlation coefficient of activation patterns of neck rotation and extension in CMT patients significantly correlated with clinical parameter assessments (p < 0.05). The findings suggest that the spatial features of muscle activation patterns based on the sEMG electrode arrays can be utilized to evaluate the CMT. The flexible and stretchable sEMG electrode array is promising to facilitate the functional evaluation and treatment strategies for children with neuromuscular disease.

The activity of muscles during motion in one direction should be symmetrical when compared to the activity of the contralateral muscles during motion in the opposite direction, while symmetrical movements should result in symmetrical muscle activation. The literature lacks data on the symmetry of neck muscle activation. Therefore, this study aimed to analyse the activity of the upper trapezius (UT) and sternocleidomastoid (SCM) muscles at rest and during basic motions of the neck and to determine the symmetry of the muscle activation. Surface electromyography (sEMG) was collected from UT and SCM bilaterally during rest, maximum voluntary contraction (MVC) and six functional movements from 18 participants. The muscle activity was related to the MVC, and the Symmetry Index was calculated. The muscle activity at rest was 23.74% and 27.88% higher on the left side than on the right side for the UT and SCM, respectively. The highest asymmetries during motion were for the SCM for the right arc movement (116%) and for the UT in the lower arc movement (55%). The lowest asymmetry was recorded for extension–flexion movement for both muscles. It was concluded that this movement can be useful for assessing the symmetry of neck muscles' activation. Further studies are required to verify the above-presented results, determine muscle activation patterns and compare healthy people to patients with neck pain. [ABSTRACT FROM AUTHOR]

The sternocleidomastoid muscle (SCM) consists of a sternal and a clavicular head which merge together and inserts distally posterolateral on the mastoid process and superior nuchal line, hence separating the anterior from the posterior triangle of the neck. Many types of structural variations in SCM have already been reported before. A unique variation of this muscle was discovered in an aged Caucasian male cadaver during an anatomical dissection at the Paracelsus Medical University in Nuremberg, Germany. This study reports a right unilateral accessory muscular branch at the sternal head of the SCM which formed a tendon on the level of omohyoid muscle before dividing into anterior and posterior fascicles. The posterior fascicle attached to the external carotid artery at the site where a common trunk for lingual and facial artery branched off, drawing external carotid artery inferiorly to build an inferior loop, whereas the anterior fascicle passed further superior and broadened to form a muscular belly. This superior muscular belly extended to the posterior and lateral side of the pharynx to ultimately merge into the superior constrictor pharyngeal muscle. Such anatomical variation has never been reported before. Therefore, we propose the nomenclature of this variational structure as a sternopharyngeal branch of the SCM. This report helps not only to inform the clinicians regarding the possible variation of this muscle during surgical procedures or radiological diagnostics but also encourage developmental researches in the future. [ABSTRACT FROM AUTHOR]

This study investigates the influence of soft stabilization splints on electromyographic patterns in masticatory and neck muscles in healthy women. A total of 70 healthy women were qualified for the research. The resting and clenching electromyographic patterns of the temporalis (TA), masseter (MM), digastric (DA), and sternocleidomastoid (SCM) muscles were measured using the BioEMG III™ apparatus. The interaction between splint application and resting muscle activity affected the results in all examined muscles except the temporalis muscle. A large effect size was observed in masseter (2.19 µV vs. 5.18 µV; p = 0.00; ES = 1.00) and digastric (1.89 µV vs. 3.17 µV; p = 0.00; ES = 1.00) both-sided RMS activity. Significant differences between the two conditions were observed in all Functional Clenching Indices (FCI) for MM, SDM, and DA muscles. All FCI values for the MM and DA muscles were significantly lower with than without the splint. We observed an increase in all activity indices due to splint application, which suggests a masseter muscle advantage during measurement. The soft stabilization splint influenced resting and functional activity in the MM, SDM, and DA muscles. During tooth clenching, a soft stabilization splint changed the involvement proportions of the temporalis and masseter muscles, transferring the main activity to the masseter muscles. Using a soft stabilization splint did not affect the symmetry of the electromyographic activity of the masticatory and neck muscles. [ABSTRACT FROM AUTHOR]

Background: Sternocleidomastoid muscle is main muscle of neck region which is attached proximally to mastoid process and lateral half of the superior nuchal line and distally to the sternum and clavicle. It is related to numerous important neurovascular structures. Avariation in its anatomy is clinically important especially for neck surgeries and catheterization of internal jugular vein. Aim and Objectives: To establish the incidence, number and variations of supernumerary head of ternocleidomastoid muscle in cadavers. Material and Methods: We studied the variations in the heads of the ternocleidomastoid muscle in the 84 cadavers (n=168, Right= 84; Left=84) which were used for undergraduate teaching in our college. Muscle was exposed by doing meticulous dissection. Proximal and distal attachments were carefully cleaned and number of supernumerary heads with their origin and insertion were noted. Results: Present study observed supernumerary heads of sternocleidomastoid muscle in 32.73% cadavers. In majority of cases the supernumerary heads (which may be 2, 3, 4) was found to be arising from superior surface of medial 2/3 clavicle. Conclusion: Detailed knowledge of this variation is crucial for head and neck surgeons, radiologist, anesthetists and clinicians dealing with this region.

The "cleidooccipital branches" are integral muscular branches of the sternocleidomastoid muscles (SCM), as well as the trapezius muscles, which construct the anterior and posterior borders of the posterior triangle of the neck, respectively. The term "cleidooccipital muscle", in the literature, generally describes the accessory muscle, which is proximally attached to the middle portion of the clavicle, separate from the clavicular attachment of the SCM or trapezius muscle, and crosses the posterior triangle of the neck obliquely. With proximity to either the trapezius or the SCM, the accessory cleidooccipital muscles can be divided into posterior and anterior accessory cleidooccipital muscles, respectively. At present, most of the descriptions in the literature associated with the accessory cleidooccipital muscles concern the posterior accessory cleidooccipital muscles. The anterior accessory cleidooccipital muscles are mostly recognized as a proximal clavicular-head-sided supernumerary variation of the SCM. We propose a new classification of these muscles, with nomenclatures to help researchers to differentiate the cleidooccipital branches or muscles from one another. Introducing this classification, we hope that more clarity can be achieved when addressing the so-called "cleidooccipital muscle" in the future. [ABSTRACT FROM AUTHOR]

Introduction:A congenital cervical mass is a considerable health problem worldwide; however, accessory tragus (AT) in the neck is extremely rare. The cervical variant of AT or congenital cartilaginous rest of the neck (CCRN) is a rare anomaly related to the branchial arch located at the lateral of the neck that typically presents as an asymptomatic papule or nodule along the anterior border of sternocleidomastoid (SCM) muscle. It is detected since birth or in the first few years of life. Diagnosis is based on the clinical characteristics of the lesion, surgical findings, and histopathologic studies. Case Report:A young man with no underlying diseases or known congenital anomaly was referred by a dermatologist for an asymptomatic pedunculated papule in the left mid-cervical area. Physical examination reveals a firm and mobile papule with a size of 1*1 cm on the anterior middle 1/3 border of the SCM. Radiologic findings illustrated a mass nearby the SCM with a long tract beneath it extending upward. The lesion was finally resected, and during surgery, a long tract was discovered, and histopathologic examination confirmed the diagnosis of a CCRN. Conclusions:Although rare, the cervical variant of AT or CCRN should be considered in a differential diagnosis of benign masses in the neck.

Abstract Background Previous studies on sternocleidomastoid flaps, have defined the importance of preserving sternocleidomastoid (SCM) branch of superior thyroid artery (STA). This theory drew criticism, as this muscle is known to be a type II muscle, i.e., the muscle has one dominant pedicle (branches from the occipital artery at the superior pole) and smaller vascular pedicles entering the belly of muscle (branches from STA and thyrocervical trunk) at the middle and lower pole respectively. It was unlikely for the SCM branch of STA to supply the upper and lower thirds of the muscle. We undertook a cadaveric angiographic study to investigate distribution of STA supply to SCM muscle. Methods It is a cross-sectional descriptive study on 10 cadaveric SCM muscles along with ipsilateral STA which were evaluated with angiography using diatrizoate (urograffin) dye. Radiographic films were interpreted looking at the opacification of the muscle. Results were analyzed using frequency distribution and percentage. Results Out of ten specimens, near complete opacification was observed in eight SCM muscle specimens. While one showed poor uptake in the lower third of the muscle, the other showed poor uptake in the upper third segment of muscle. Conclusion Based on the above findings we suggest to further investigate sternocleidomastoid muscle as a type III flap, as the STA branch also supplies the whole muscle along with previously described pedicle from occipital artery. However, this needs to be further corroborated intra-operatively using scanning laser doppler. This also explains better survival rates of superior thyroid artery based sternomastoid flaps.

Introduction: The bilateral sternocleidomastoid (SCM) muscle is a contralateral rotator and ipsilateral flexor of the head and neck that typically consists of one sternal head (SH) and one clavicular (CH) head. Variations in SCM muscle topography, attachments, existence, and number of muscle bellies have been reported with clinical considerations but accompanying mechanical analyses and three-dimensional modeling are scarce. The objective of this study was to investigate a case of bilateral SCM accessory clavicular heads (ACH) discovered in an adult human cadaver and determine the biomechanical implications with three-dimensional modeling. Materials and methods: Left and right SCMs were dissected, photographed, and eviscerated. Fascicle bundle lengths, attachment site locations, pennation angles, and muscle belly masses were recorded for each head. Sarcomere lengths were measured from transmission electron microscopy (TEM) imaging to normalize fascicle lengths from current post-mortem state to that of optimal human skeletal muscle sarcomeres. Physiological cross-sectional area (PCSA) was calculated to determine each head's maximal isometric force (Fmax) generating capacity. SCM specifications were modeled virtually in three dimensions for broader visualization of ACH in anatomical position and calculation of ACH and CH torques the clavicle. Results are discussed as averages of the left and right heads. Results: SH, CH, and ACH fusiform muscle bellies weighed 18.03 g, 9.30 g, and 3.41 g with PCSAs of 1.24 cm2, 0.65 cm2, and 0.25 cm2, respectively. TEM examination of the SCM tissue revealed a mean sarcomere length of 3.19 μm, 0.55 μm more than the optimal human sarcomere length. Fascicle bundle lengths for SH, CH, and ACH were normalized and determined to be able to generate 27.84 N, 14.56 N, and 5.57 N, respectively. Despite only being able to generate 38.3% the Fmax of CH, the ACH effectively doubles the SCM torque on the distal clavicle (31.01 N⋅cm plus 32.32 N⋅cm) due to its further distal attachment from sternoclavicular joint (5.6 cm vs. 2.3 cm) and more perpendicular angle of attachment (83.8° vs. 74.8°, respectively). Conclusions: Presence of a smaller but more laterally located ACH can generate considerably more force from the distal clavicle on posteroinferior skull than a typical SCM. Gross imaging, biomechanical analysis, and three-dimensional modeling of the SCM with ACH as presented in this study may serve as a new and important resource for healthcare providers, massage therapists, myofascial workers, and medical educators when considering musculoskeletal anomalies of the head and neck.

Background: Sternocleidomastoid muscle is main muscle of neck region which is attached proximally to mastoid process and lateral half of the superior nuchal line and distally to the sternum and clavicle. It is related to numerous important neurovascular structures. A variation in its anatomy is clinically important especially for neck surgeries and catheterization of internal jugular vein. Aim and Objectives: To establish the incidence, number and variations of supernumerary head of sternocleidomastoid muscle in cadavers. Material and Methods: We studied the variations in the heads of the sternocleidomastoid muscle in the 84 cadavers (n=168, Right= 84; Left=84) which were used for undergraduate teaching in our college. Muscle was exposed by doing meticulous dissection. Proximal and distal attachments were carefully cleaned and number of supernumerary heads with their origin and insertion were noted. Results: Present study observed supernumerary heads of sternocleidomastoid muscle in 32.73% cadavers. In majority of cases the supernumerary heads (which may be 2, 3, 4) was found to be arising from superior surface of medial 2/3 clavicle. Conclusion: Detailed knowledge of this variation is crucial for head and neck surgeons, radiologist, anesthetists and clinicians dealing with this region. [ABSTRACT FROM AUTHOR]

Abstract Background Pediatric neck masses are a common complaint in children. The most common etiologies include congenital lesions, lymphadenopathy, vascular malformations, inflammatory, and malignant lesions. Spontaneous sternocleidomastoid hematoma is exceptional in infant. Case presentation We describe a case of spontaneous cervical hematoma diagnosed in a 4-month-old child. Past history did not reveal a neck trauma, a history of difficult labor, a bleeding disorder or a pertinent family history. The diagnosis was suspected based on the imaging features and confirmed after surgical removal. Conclusions Sternocleidomastoid swelling is commonly encountered in infancy. Ultrasound still remains the initial modality of choice. The management modalities are controversial.

Aims: The aim is to identify the epidemiological, diagnostic, therapeutic, evolutionary aspects, and risk factors related to the occurrence of this condition. Subjects and Methods: It was a retrospective and descriptive study of a series of 26 cases of fibromatosis colli collected over a period of 3 years (from January 1, 2017 to December 31, 2019). We studied the following parameters: frequency, age, sex, delay of consultation, motive of consultation, gravidity, parity, type of delivery, notion of birth trauma, birth weight, examination findings, ultrasound results, type of treatment, and evolutionary modalities. The data were collected from patients' files. The analysis was done on Excel 2016. Results: The frequency was 6.5 cases/year. The mean age was 2.1 months. The average delay of consultation was 6.3 weeks. A notion of obstetrical trauma was found in 16 cases (61.5%). Primiparity was noted in 15 cases (57.5%). Associated torticollis was noted in 03 cases. Cervical ultrasonography was performed in all cases (n = 26/26) enabling diagnostic confirmation. Surveillance was the main treatment (84.6%). After a mean follow-up of 20.8 months, evolution was favorable in the majority of patients. The average time of complete regression of the mass was 3.8 months. Conclusions: Rare condition of the newborn and infant for which the diagnosis is clinical and the confirmation is based on ultrasound. The management is simple and based on surveillance. The evolution is most often toward spontaneous regression.

Sternocleidomastoid (SCM) pseudotumors, also known as fibromatosis colli or congenital torticollis, are painless benign neck lumps found in newborns. Whilst unilateral cases are relatively common, bilateral SCM pseudotumors are a rare phenomenon with only a handful of cases reported internationally. We present the case of a 5-week-old infant who was brought to the emergency department with painless, bilateral, palpable anterior neck masses following a slightly traumatic but otherwise uncomplicated spontaneous delivery. An ultrasound scan of his neck revealed well-defined soft tissue lesions within both of the SCM muscles. He was subsequently diagnosed with bilateral SCM pseudotumors. This case emphasizes the importance of considering this entity as a differential diagnosis in infants presenting with bilateral palpable neck masses.

The activity of muscles during motion in one direction should be symmetrical when compared to the activity of the contralateral muscles during motion in the opposite direction, while symmetrical movements should result in symmetrical muscle activation. The literature lacks data on the symmetry of neck muscle activation. Therefore, this study aimed to analyse the activity of the upper trapezius (UT) and sternocleidomastoid (SCM) muscles at rest and during basic motions of the neck and to determine the symmetry of the muscle activation. Surface electromyography (sEMG) was collected from UT and SCM bilaterally during rest, maximum voluntary contraction (MVC) and six functional movements from 18 participants. The muscle activity was related to the MVC, and the Symmetry Index was calculated. The muscle activity at rest was 23.74% and 27.88% higher on the left side than on the right side for the UT and SCM, respectively. The highest asymmetries during motion were for the SCM for the right arc movement (116%) and for the UT in the lower arc movement (55%). The lowest asymmetry was recorded for extension–flexion movement for both muscles. It was concluded that this movement can be useful for assessing the symmetry of neck muscles’ activation. Further studies are required to verify the above-presented results, determine muscle activation patterns and compare healthy people to patients with neck pain.

The article presents a study which examined the sex differences in the changes in cervical musculature during contact-heavy ice hockey practices of National Collegiate Athletic Association (NCAA) ice hockey teams. The research collected data like head-neck segment length, neck circumference, isometric length, and electromyography (EMG) activity for flexion and extension. Based on the results, the sternocleidomastoid (SCM) muscles of males have higher peak force than females.

BACKGROUND: Studies had shown that the mechanical properties of the shoulder and neck muscles in cervical spondylotic radiculopathy are altered and correlated with the degree of symptoms. OBJECTIVE: To compare the mechanical properties of upper trapezius and sternocleidomastoid muscle in cervical spondylotic radiculopathy patients by MyotonPRO, and to explore the causes of shoulder and neck muscle imbalance in cervical spondylotic radiculopathy patients so as to provide a basis for the prevention and treatment of the disease and rehabilitation exercises. METHODS: Totally 25 patients with cervical spondylotic radiculopathy and 25 normal people matched with baseline data were selected. MyotonPRO was used to measure the tension and hardness of sternocleidomastoid muscle and superior trapulus muscle for comparison. The muscle performance imbalance of cervical spondylotic radiculopathy patients and normal people was compared by calculating the asymmetry index. Visual analogue scale score and Northwick Park Neck Pain Questionnaire scores of cervical spondylotic radiculopathy patients were collected for correlation analysis. RESULTS AND CONCLUSION: (1) The mean values of upper trapezius and sternocleidomastoid muscle tension and stiffness on both sides of cervical spondylotic radiculopathy group were higher than those of the healthy group. The upper trapezius tension and stiffness of the affected side were higher than those of the contralateral side in the cervical spondylotic radiculopathy group, and the differences were statistically significant (all P < 0.05). (2) The upper trapezius and sternocleidomastoid muscle tension and stiffness asymmetry indexes in cervical spondylotic radiculopathy group were significantly different from those in the healthy group (all P < 0.05). These indicated that the muscle tension and stiffness in the cervical spondylotic radiculopathy group were higher than those in the normal group. (3) Visual analogue scale score and Northwick Park Neck Pain Questionnaire score were significantly positively correlated with upper trapezius tension and stiffness (all P < 0.05). (4) Due to the influence of local soft tissue inflammation, pain and posture, cervical spondylotic radiculopathy patients usually show increased tension and stiffness of the superior trapezius muscle and sternocleidomastoid muscle. There is an obvious imbalance of tension and stiffness of the left and right sides. This change in muscle mechanics was positively correlated with pain and quality of life. Therefore, in the prevention and treatment of cervical spondylotic radiculopathy, attention should be paid to the imbalance of muscle tension and stiffness, and the imbalance should be corrected. [ABSTRACT FROM AUTHOR]

Background: Previous studies on sternocleidomastoid flaps, have defined the importance of preserving sternocleidomastoid (SCM) branch of superior thyroid artery (STA). This theory drew criticism, as this muscle is known to be a type II muscle, i.e., the muscle has one dominant pedicle (branches from the occipital artery at the superior pole) and smaller vascular pedicles entering the belly of muscle (branches from STA and thyrocervical trunk) at the middle and lower pole respectively. It was unlikely for the SCM branch of STA to supply the upper and lower thirds of the muscle. We undertook a cadaveric angiographic study to investigate distribution of STA supply to SCM muscle. Methods: It is a cross-sectional descriptive study on 10 cadaveric SCM muscles along with ipsilateral STA which were evaluated with angiography using diatrizoate (urograffin) dye. Radiographic films were interpreted looking at the opacification of the muscle. Results were analyzed using frequency distribution and percentage. Results: Out of ten specimens, near complete opacification was observed in eight SCM muscle specimens. While one showed poor uptake in the lower third of the muscle, the other showed poor uptake in the upper third segment of muscle. Conclusion: Based on the above findings we suggest to further investigate sternocleidomastoid muscle as a type III flap, as the STA branch also supplies the whole muscle along with previously described pedicle from occipital artery. However, this needs to be further corroborated intra-operatively using scanning laser doppler. This also explains better survival rates of superior thyroid artery based sternomastoid flaps. [ABSTRACT FROM AUTHOR]

Background & Importance: Congenital Muscular Torticollis (CMT) is a common cause of torticollis in children. Despite the easy diagnosis, rare cases may be neglected and untreated during the management of the patients, which can not only impose cosmetic problems for them but also affect the cervical spine with accelerated degeneration. Most patients with CMT can be managed non-surgically with medical and physical therapies but surgery is indicated in some cases when non-surgical attempts are unsuccessful. Case Presentation: Herein, we are reporting a 16-year-old female with neglected CMT, and neck pain secondary to severe degenerative changes. We believe that neglected and untreated CMT cases may present with accelerated spine degeneration and surgical intervention should be considered promptly to reverse this process. Conclusion: Surgical intervention not only produces good cosmetic results but also reverses the degeneration process and protects the patient from disabling deformities later in life.

Background: Spinal Accessory Nerve (SAN), which innervates the sternocleidomastoid (SCM) and trapezius muscles, is closely related to the internal jugular vein (IJV) in the anterior triangle of the neck and passes superficially in the posterior triangle. Injury to SAN is a major complication of level II neck dissection, leading to shoulder syndrome. The present study aims to assess the course and its relation to the SCM muscle and IJV in the Tamil ethnolinguistic groups in South India., Methods and Materials: The anterior and posterior triangles of the neck were dissected in 28 formalin-fixed adult cadavers. The course of the SAN and the entry and exit points of SAN along the SCM muscle were assessed using the mastoid process as the reference. Recorded data was analyzed using SPSS software., Results: The SAN was anteriorly related to the IJV in 58.73%, posteriorly in 37.5%, and pierced through the IJV in 3.57% of the specimens. The entry and exit points of SAN from the mastoid process were 37.86±7.26mm and 48.55±8.22mm, respectively. In 86.67% of the cases, the SAN traversed through the SCM muscle, and in 13.33%, it was deep to the SCM., Conclusion: The present study reports that the SAN is variable in its course, and relation to SCM and IJV. Knowledge about the variant anatomy of the SAN in the triangles of the neck is important and it aids surgeons to prevent iatrogenic injuries to SAN or IJV and enhance surgical safety in neck procedures., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Aims: The aim is to identify the epidemiological, diagnostic, therapeutic, evolutionary aspects, and risk factors related to the occurrence of this condition. Subjects and Methods: It was a retrospective and descriptive study of a series of 26 cases of fibromatosis colli collected over a period of 3 years (from January 1, 2017 to December 31, 2019). We studied the following parameters: frequency, age, sex, delay of consultation, motive of consultation, gravidity, parity, type of delivery, notion of birth trauma, birth weight, examination findings, ultrasound results, type of treatment, and evolutionary modalities. The data were collected from patients' files. The analysis was done on Excel 2016. Results: The frequency was 6.5 cases/year. The mean age was 2.1 months. The average delay of consultation was 6.3 weeks. A notion of obstetrical trauma was found in 16 cases (61.5%). Primiparity was noted in 15 cases (57.5%). Associated torticollis was noted in 03 cases. Cervical ultrasonography was performed in all cases (n = 26/26) enabling diagnostic confirmation. Surveillance was the main treatment (84.6%). After a mean follow-up of 20.8 months, evolution was favorable in the majority of patients. The average time of complete regression of the mass was 3.8 months. Conclusions: Rare condition of the newborn and infant for which the diagnosis is clinical and the confirmation is based on ultrasound. The management is simple and based on surveillance. The evolution is most often toward spontaneous regression. [ABSTRACT FROM AUTHOR]

Background: Pediatric neck masses are a common complaint in children. The most common etiologies include congenital lesions, lymphadenopathy, vascular malformations, inflammatory, and malignant lesions. Spontaneous sternocleidomastoid hematoma is exceptional in infant. Case presentation: We describe a case of spontaneous cervical hematoma diagnosed in a 4-month-old child. Past history did not reveal a neck trauma, a history of difficult labor, a bleeding disorder or a pertinent family history. The diagnosis was suspected based on the imaging features and confirmed after surgical removal. Conclusions: Sternocleidomastoid swelling is commonly encountered in infancy. Ultrasound still remains the initial modality of choice. The management modalities are controversial. [ABSTRACT FROM AUTHOR]

The purpose of this research is to identify and correlate the referred pain evocated by myofascial trigger points (TrPs) pressure pain threshold (PPT) in the sternocleidomastoid muscle using thermal infrared imaging (IR). Facial IR images of 46 volunteers (21 male and 25 female, average age 32 ± 6.3) undergoing PPT of five TrPs locations on the sternocleidomastoid belly were recorded. Each PPT lasted 10 s, with an interstimulus interval of 2 min. Sixteen thermal IR images were recorded for each subject: at baseline (t0), 2 s before PPT (t1), 2 s (t2) and 60 s (t3) after PPT of each TrPs location. During the interstimulus interval, subjects were asked to draw over a head–neck template displayed on a computer screen the areas of referred pain eventually evoked by the stimulation and the referred pain intensity by means of a Visual Analogue Scale (VAS). The VAS template was then superimposed with the IR records. Two temperature (T) variations were calculated: ΔT1 = T(t2) − T(t1) and ΔT2 = T(t3) − T(t1). Differences in ∆T range ≥ 0.2 °C have been considered significant. In 77% of the superimpositions, the referred pain area corresponded to a ΔT2 ≥ 0.2 °C while only the 59% corresponded to a ΔT1 ≥ 0.2 °C. In 19% of superimpositions, a ΔT2 ≥ 0.2 °C did not correspond to a referred pain area indicated by the patient, and this percentage lowers to 4% for ΔT1 ≥ 0.2 °C. None of the areas that reported a VAS of 0 or 1 showed a ΔT1 ≥ 0.2 °C or a ΔT2 ≥ 0.2 °C. Considering the limitations of this pilot study, IR could be used to identify referred pain evocated by TrPs on sternocleidomastoid muscle. [ABSTRACT FROM AUTHOR]

Context: For the past few decades, the number of people practicing yoga is increasing in number. Yogasanas need smooth body movements in the process of attaining defined postures that the person must hold on to activate specific muscles of the body related to that asana. Yogasanas should be performed with perfection to derive maximum benefits. Objective: The objective of this study was to introduce a mathematical method to understand muscle functionalities while doing Yogasanas. Materials and Methods: Used Delsys surface electromyography (sEMG) – TrignoTM (Delsys Inc.) sensors for data recording and analyzing muscle activation patterns. Results: Performance analysis was quantified using normalized sEMG signals. The sEMG data during final posture were fit to a straight line using linear regression analysis. Conclusion: The results suggested that the slope of the best fit line is a good metric for monitoring the muscle activity during Yoga performance. The advantages of this method are the slope of the line is a good indicator for monitoring the muscle activity while doing Yogasana and the method suggested in this study can be extended for analyzing other asanas as well.

There has been much debate concerning whether startling sensory stimuli can activate a fast‐neural pathway for movement triggering (StartReact) which is different from that of voluntary movements. Activity in sternocleidomastoid (SCM) electromyogram is suggested to indicate activation of this pathway. We evaluated whether SCM activity can accurately identify trials which may differ in their neurophysiological triggering and assessed the use of cumulative distribution functions (CDFs) of reaction time (RT) data to identify trials with the shortest RTs for analysis. Using recent data sets from the StartReact literature, we examined the relationship between RT and SCM activity. We categorised data into short/longer RT bins using CDFs and used linear mixed‐effects models to compare potential conclusions that can be drawn when categorising data on the basis of RT versus on the basis of SCM activity. The capacity of SCM to predict RT is task‐specific, making it an unreliable indicator of distinct neurophysiological mechanisms. Classification of trials using CDFs is capable of capturing potential task‐ or muscle‐related differences in triggering whilst avoiding the pitfalls of the traditional SCM activity‐based classification method. We conclude that SCM activity is not always evident on trials that show the early triggering of movements seen in the StartReact phenomenon. We further propose that a more comprehensive analysis of data may be achieved through the inclusion of CDF analyses. These findings have implications for future research investigating movement triggering as well as for potential therapeutic applications of StartReact. [ABSTRACT FROM AUTHOR]

Salivary gland tumors account for 3% of all head and neck tumors, among which parotid gland tumors account for 80% of all salivary gland neoplasms. Superficial or deep parotidectomy is routinely advised according to the extent of the tumor. Surgery is challenging due to the close relation of the seventh cranial nerve to the parotid gland. Although facial nerve palsy being the most dreaded complication, patients also complain of facial contour deformity. In this study, we have divided the patients who presented with parotid swellings and underwent parotidectomy into two groups with and without the usage of the sternocleidomastoid flap. The sternocleidomastoid flap is an acceptable modality to fill the depressed concave facial contour in parotidectomy patients, which helps in decreasing the incidence of skin necrosis and Frey's syndrome and also helps in a significant degree of patient satisfaction. [ABSTRACT FROM AUTHOR]

BACKGROUND: The cervical vestibular evoked myogenic potential (cVEMP) can be affected by the recording parameters used to quantify the response. OBJECTIVE: We investigated the effects of electrode placement and montage on the variability and symmetry of sternocleidomastoid (SCM) contraction strength and cVEMP amplitude. METHODS: We used inter-side asymmetries in electrode placement to mimic small clinical errors in twenty normal subjects. cVEMPs were recorded at three active electrode sites and referred to the distal SCM tendon (referential montages: upper, conventional and lower). Additional bipolar montages were constructed offline to measure SCM contraction strength using closely-spaced electrode pairs (bipolar montages: superior, lower and outer). RESULTS: The conventional montage generally produced the largest cVEMP amplitudes (P < 0.001). SCM contraction strength was larger for referential montages than bipolar ones (P < 0.001). Inter-side electrode position errors produced large variations in cVEMP and SCM contraction strength asymmetries in some subjects, producing erroneous abnormal test results. CONCLUSION: Recording locations affect cVEMP amplitude and SCM contraction strength. In most cases, small changes in electrode position had only minor effects but, in a minority of subjects, the different montages produced large changes in cVEMP and contraction amplitudes and asymmetry, potentially affecting test outcomes. [ABSTRACT FROM AUTHOR]

Background: Decreased respiratory muscle strength and muscle mass is key in diagnosing respiratory sarcopenia. However, the role of reduced diaphragm activity, expressed as the maximal level of diaphragmatic excursion (DEmax), in diagnosing respiratory sarcopenia in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to characterize patients with COPD and low DEmax and maximal inspiratory pressure (MIP), a measure of inspiratory muscle strength, and assess the role of DEmax in respiratory sarcopenia., Methods: Patients with COPD underwent spirometry, exercise tolerance (VO 2peak ) test, and MIP measurement. DEmax and sternocleidomastoid thickness at the maximal inspiratory level (TscmMIL) were assessed using ultrasound sonography., Results: Overall, 58 patients with COPD (median age, 76 years; median %FEV 1 , 51.3 %) were included, 28 of whom showed a %MIP of ≥80 %, defined as having preserved MIP. Based on the %MIP of 80 % and median value of DEmax (48.0 mm) as thresholds, the patients were stratified into four groups: both-high (n = 18), %MIP-alone low (n = 11), DEmax-alone low (n = 10), and both-low (n = 19) groups. The both-low group exhibited the lowest %FEV 1 , Δinspiratory capacity, VO 2peak , and TscmMIL, and these values were significantly lower than those of the both-high group. Except for %FEV 1 , these values were significantly lower in the both-low group than in the %MIP-alone low group despite adjusting DEmax level for body mass index., Conclusion: Measuring DEmax along with MIP can characterize patients with COPD, reduced exercise capacity, and decreased accessory respiratory muscle mass and can help diagnose respiratory sarcopenia., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2024 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

Fibromatosis colli or congenital torticollis is a rare pseudotumor of the sternocleidomastoid muscle of the newborn and infant which the mechanism of occurrence is controversial. The diagnosis is clinical. Ultrasounds make the diagnosis and eliminate other causes of torticollis. The evolution is towards spontaneous regression in a few months or with physiotherapy. We report the collected observations of two infants aged 8 and 12 weeks, respectively presenting a right and left lateral cervical mass. The clinical and ultrasound appearance strongly evoked the diagnosis. The follow-up was ultrasonographic with good clinical evolution and spontaneous regression in a few months.

The aim of this study was to investigate the performance of mechanomyography (MMG) and electromyography (EMG) in monitoring the sternocleidomastoid (SCM) as accessory respiratory muscles when breathing during singing. MMG and EMG were used to record the activity of the SCM in 32 untrained singers reciting a monotonous text and a standard folk song. Their voices were recorded and their pitch, or fundamental frequency (FF), and intensity were derived using Praat software. Instants of inhale and exhales were identified during singing from their voice recordings and the corresponding SCM MMG and EMG activities were analysed. The SCM MMG, and EMG signals during breathing while singing were significantly different than breathing at rest (p < 0.001). On the other hand, MMG was relatively better correlated to voice intensity in both reading and singing than EMG. EMG was better, but not significantly, correlated with FF in both reading and singing as compared to MMG. This study established MMG and EMG as the quantitative measurement tool to monitor breathing activities during singing. This is useful for applications related to singing therapy performance measure including potentially pathologically effected population. While the MMG and EMG could not distinguish FF and intensity significantly, it is useful to serve as a proxy of inhalation and exhalation levels throughout a particular singing session. Further studies are required to determine its efficacy in a therapeutic setting. [ABSTRACT FROM AUTHOR]

The wearing of ballistic helmets commonly coordinated with a night vision device (NVD) often imposes a load to the neck of a soldier. A lighter ballistic helmet promises comfort and enhanced combat performance, but technological developments have not provided a complete solution satisfying all the requirements, including cost. Moreover, the change in munition has led to increasing demand for the attachment of more accessories to the helmet, providing advanced functions but additional weight. Therefore, the current study quantified the neck muscle strain caused by the varying weight of a ballistic helmet, particularly during simulated infantry activities with moderate neck flexion and neck extension against a head-weight in the prone position. Eight healthy males participated on four separate days. On each day, different loads were placed on the head: 0 kg (no helmet, NH) to 2.07 kg (1.5 kg helmet with a 0.5 kg night vision device, HH&NVD). The results showed that prone shooting imposed substantial muscular strain on the splenius capitis (neck extensor), resulting in a 7–9% maximal voluntary contraction depending on the overall helmet loads. In addition, a gradual increase in the subjective neck load and pain in proportion to the overall weight of the helmet assembly was noted, and the heaviest loads caused severe complaints for muscular discomfort. This paper recommends strategies for designing and developing ballistic helmets as well as further methodological issues on evaluating neck muscle strain caused by the helmet weight. [ABSTRACT FROM AUTHOR]

Tuberculosis, a chronic infectious disease caused by Mycobacterium tuberculosis, may invade all organs but mainly affect the lungs. We report a case of disseminated tuberculosis with pulmonary, hepatic, pleural, skeletal muscle, spleen, intestines, cervical and mediastinal lymph node involvement and a review of the relevant literature. A 25-year-old male was admitted with cervical swelling and pain abdomen near umbilicus associated with low grade fever, fatigue, nausea, anorexia, weight loss. A chest X-ray showed right upper zone infiltrates and a computed tomographic scan of the thorax and abdomen revealed a consolidation in right upper lobe with necrotic mediastinal lymphadenopathy with mild pleural effusion, focal abscess in right sternocleidomastoid muscle, focal liver lesion and micro abscess in spleen. Liver and cervical lymph node biopsy revealed granulomatous lesions with central caseating necrosis. Tuberculosis is usually associated with atypical clinical manifestations. Imaging examination combined with histopathological features, a high index of clinical suspicion and improvement with antitubercular therapy are necessary to confirm a diagnosis, especially in the cases of extrapulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Description of a novel use of a submandibular gland (SMG) flap pedicled on the facial vessels to restore facial volume after parotidectomy, and comparison of clinical outcomes with alternative modes of reconstruction.Study Design: Retrospective chart review.Methods: The surgical technique for a SMG flap is described. Retrospective chart review of cases of parotidectomy at a single tertiary medical center was conducted (n = 43). Cases were grouped in three cohorts of consecutive patients depending on reconstruction technique: SMG flap (n = 13), sternocleidomastoid muscle (SCM) flap (n = 15), and no flap (n = 15). Cohort characteristics and complication rates are reported.Results: The SMG flap was more often used for a malignant pathology (92%) and in conjunction with a neck dissection (100%), compared to the SCM flap (47% and 15%) or no flap (0% and 0%), respectively. The mean House-Brackmann score in the immediate postoperative period in the SMG-flap group was slightly elevated compared to the other groups: 1.6 (standard deviation [SD] ± 0.5) versus 1.1 (SD ± 0.3) and 1.0 (SD ± 0.0). Otherwise, the complication rate was similar across groups.Conclusions: The SMG flap is a safe and effective option for volume restoration after parotidectomy. It provides durable volume that will not atrophy and is already exposed in the field of dissection for patients undergoing concurrent level I neck dissection.Level Of Evidence: 3 Laryngoscope, 130:E155-E162, 2020. [ABSTRACT FROM AUTHOR]

Fibromatosis colli is a rare, usually self-limiting condition caused by a benign tumor in the sternocleidomastoid muscle. The tumor occurs most often during infancy and can be clinically associated with torticollis. Accurate diagnosis of fibromatosis colli is important to avoid unnecessary invasive interventions. Radiographic imaging is fundamental to differentiating this benign tumor from other causes of neck masses/swelling in infants. In this article, we discuss the case of a 4-month old child who presented with a head tilt and had imaging that favored a diagnosis of fibromatosis colli. [ABSTRACT FROM AUTHOR]