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OBJECTIVE The aim: To determine the peculiarities of the morphometric parameters of suprahyoid region of the human prefetuses. PATIENTS AND METHODS Materials and methods: Thirty specimens of human prefetuses of 14.0-80.0 mm parietococcygeal length (PCL) (7-12 weeks of IUD) were studied using a complex of modern methods of morphological research. RESULTS Results: On the basis of obtained digital indicators of the main morphometric parameters of human SHR in the dynamics of the prenatal period of IUD the critical periods of development of the region were clarified and mathematical functions that describe the normal course of organogenesis of SHR were created, which can be useful for creating diagnostic algorithms for the norm when carrying out prenatal diagnostics and monitoring the state of the fetus. It has been established that the 9-10th week of IUD is a critical period in the development of SHR, since during this time, intensive growth processes occur, which are manifested by a sharp change in the size of the organ, and this can lead to the appearance of variants of the structure and possible congenital defects of the SHR and the dental-maxillary apparatus in general. CONCLUSION Conclusions: 1.Age-depended dynamics of changes in the anterior angle of the SHR shows an almost linear decrease in the angle by the end of the 9th week of IUD almost to 76°, after which it increases to almost 90° by the end of the 10th week. From the 11th week of the IUD, the anterior angle decreases again to 77 °, but begins to increase at the 12th week and by the end of the prefeal period. 2.The lateral length of SHR increases almost uniformly until the 9th week of IUD, during which its growth rate slows down. Starting from the end of the 10th week of IUD, this morphometric parameter begins to grow rapidly until the end of the prenatal period of ontogenesis. The growth rate of the lateral length of the SHR is described by the function: L lat = 1.1025 + 0.0015 x + 0.001 x2. 3.The width of the SHR from the 10th week of IUD begins to grow rapidly until the end of the prenatal period of development. The growth rate of the width of SHR is described by the function: W = 1.1025 + 0.0015 x + 0.001 x2. 4.Analysis of the age dynamics of the area of SHR demonstrates the exponential dependence on the age of the prefetuses, which is described by a mathematical function: A = 1,2452exp(0,0424x). Meanwhile, there is a slight slowdown in its growth rate at the 10th week of IUD with subsequent recovery of growth by the end of the prenatal period of ontogenesis. 5.The 9-10th week of IUD is a critical period in the development of SHR, since during this time, intensive growth processes occur, which are manifested by a sharp change in the size of the mandible.

Elucidation of the features of morphogenesis and topographic changes of suprahyoidregion (SHR) of the neck and its structures in the dynamics of human intrauterinedevelopment (IUD) remains a relevant area of morphological research. Refined,comprehensive data on gender, age and constitutional features of the structure andtopography of organs and structures of the SHR of the neck during the prenatal periodof human ontogenesis will make it possible to develop new criteria for the interpretationof medical diagnostic imaging data, the degree of fetal viability, improve existing anddevelop new methods of surgical correction of congenital neck defects.Purpose of the work: to clarify the morphometric features of the suprahyoid region ofthe neck in the prefetal period of human ontogenesis.Material and methods. Thirty preparations of human prefetuses of 14.0-80.0 mm parietococcygeal length (PCL) (7-12th weeks of IUD) were studied using a complexof modern methods of morphological research: anthropometry, morphometry, threedimensional reconstruction and statistical analysis. The morphometric parametersof SHR were determined: width (distance between the inner surfaces of the condylarprocesses of the mandible), anteroposterior length (distance from the anterior surfaceof the hyoid bone to the lower edge of the mental symphysis), lateral length (length ofthe lateral border of the SHR – distance from the inner surface of the angle of mandibleto the lower edge of the mental symphysis), the anterior angle of the SHR (the anglebetween the lateral borders of the SHR).Results. On the basis of the obtained digital indicators of the main morphometricparameters of human SHR in the dynamics of the prenatal period of IUD the criticalperiods of development of the region were clarified and mathematical functions thatdescribe the normal course of organogenesis of SHR were created, which can be usefulfor creating diagnostic algorithms for the norm when carrying out prenatal diagnosticsand monitoring the state of the fetus. It has been established that the 9-10th week of IUDis a critical period in the development of SHR, since during this time, intensive growthprocesses occur, which are manifested by a sharp change in the size of the organ, andthis can lead to the appearance of variants of the structure and possible congenitaldefects of the SHR and the dental-maxillary apparatus in general.Conclusions.1. At the 10th week of the prefetal period of IUD, there is an accelerated increase in theanteroposterior size of the LAP (y = -6.3851 + 1.041 * x; r = 0.9374; p = 0.00001).2. At the 11th week of the prefetal period of IUD, there is an accelerated increase in thelateral length of the SHR (y = -6.1289 + 1.1277 * x; r = 0.8891; p = 0.00001).3. During the clarification of the regularities of the dynamics of changes in the widthof the SHR, it has been found that at the beginning of the prefetal period of the IUD,the growth rates of the indicator are slow, but from the 9th week of IUD, its acceleratedgrowth is observed (y = -4.5904 + 1.1074 * x; r = 0.8662; p = 0.00001).4. Features of the change in the value of the anterior angle of SHR in the prefetal periodof human ontogenesis demonstrate a general tendency towards its decrease during thisperiod of development – from 90.18±0.55° (7th week) to 82.12±1.17° (12th week), butafter a sharp decrease in this angle until the end of the 8th week of the development(79.32±1.03°), its intensive growth begins during the 9th week and until the end of theprefetal period (y = 93, 8224 – 0.9577 * x; r = -0.4140; p = 0.0229).

Актуальность. Изучение особенностей пространственно-временных преобразований и вариантной анатомии надподъязычной области (НПЯО) является актуальным направлением морфологического исследования. Цель. Выяснить особенности динамики морфометрических и топографо-анатомических изменений надподъязычного треугольника передней шейной области у плодов человека. Методы. Исследовано 61 препарат плодов человека 160,0-480,0 мм теменно-копчиковой длины (ТКД) (4-10-й месяцы ВУР), среди которых 34 – мужского пола и 27 – женского. Применен комплекс методов морфологического исследования, который включал антропометрию, морфометрию, рентгенологические методики, препарирование, трехмерное реконструирование, статистический анализ. Результаты. Установлено, что передний угол НПЯО у мужского пола незначительно уменьшается в течение плодного периода ВУР, кроме долихоморфных объектов, у которых имеет тенденцию к увеличению с середины плодного периода, тогда как у женского – почти не меняется у мезоморфный объектов. У мезоморфных плодов мужского пола и долихоморфных плодов женского пола передний угол НПЯО уменьшается на 7-м месяце ВУР, тогда как у брахиморфных объектов женского пола – увеличивается. Длина боковой и задней границ, передне-задняя длина и площадь НПЯО имеют тенденцию к уменьшению у брахиморфных плодов мужского пола. У долихоморфных плодов женского пола происходит его уменьшение до 6-го месяца ВУР с последующим ростом до конца плодного периода развития. Неравномерная временная динамика изменений этих морфометрических параметров НПЯО наблюдается у долихоморфных плодов мужского пола и у брахиморфных плодов женского пола, где обнаружен ускоренный рост на 6-м месяце ВУР и замедленный – в течение 7-го месяца развития. Заключение. Критическими периодами морфогенеза НПЯО плодов человека – временем изменения темпов роста области в зависимости от пола и конституционного типа – являются 6-7-й месяцы ВУР, что может свидетельствовать о формировании в этот период вариантов строения, и о возможном возникновении врожденных пороков шеи и челюстно-лицевой области., Актуальність. Вивчення особливостей просторово-часових перетворень та варіантної анатомії надпід’язикової ділянки (НПЯД), є актуальним напрямком морфологічного дослідження. Мета. З’ясувати динаміку особливості морфометричних та топографо-анатомічних змін надпід’язикового трикутника передньої шийної ділянки у плодів людини. Методи. Досліджено 61 препарат плодів людини 160,0-480,0 мм тім’яно-куприкової довжини (ТКД) (4-10-й місяці ВУР), серед яких 34 – чоловічої статі та 27 – жіночої. Застосовано комплекс методів морфологічного дослідження, який включав антропометрію, морфометрію, рентгенологічні методики, препарування, тривимірне реконструювання, статистичний аналіз. Результати. Встановлено, що передній кут НПЯД у чоловічої статі незначно зменшується впродовж плодового періоду ВУР, крім доліхоморфних об’єктів, у яких має тенденцію до збільшення із середини плодового періоду, тоді як у жіночої – майже не змінюється у мезоморфних об’єктів. У мезоморфних плодів чоловічої статі та доліхоморфних плодів жіночої статі передній кут НПЯД зменшується на 7-му місяці ВУР, тоді як у брахіморфних об’єктів жіночої статі – збільшується. Довжина бічної та задної меж, передньо-задня довжина та площа НПЯД мають тенденцію до зменшення у брахіморфних плодів чоловічої статі. У доліхоморфних плодів жіночої статі відбувається його зменшення до 6-го місяця ВУР з наступним зростанням до кінця плодового періоду розвитку. Нерівномірна часова динаміка змін цих морфометричних параметрів НПЯД спостерігається у доліхоморфниї плодів чоловічої статі та у брахіморфних плодів жіночої статі, де виявлене прискорене зростання на 6-му місяці ВУР та уповільнене – впродовж 7-го місяця розвитку. Підсумок. Критичними періодами морфогенезу НПЯД плодів людини – часом змін темпів росту ділянки залежно від статі та конституційного типу – є 6-7-й місяці ВУР, що може свідчити про формування в цей період варіантів будови, та є часом можливого виникнення вроджених вад шиї та щелепно-лицевої ділянки., Background. The study of the features of spatio-temporal transformations and the variant anatomy of the suprahyoid region (SHR), the clarification of the critical periods of development and topography of its structures in the fetal period of intrauterine development (IUD) is an important area of morphological research, the development of which contributes to the improvement of methods of prevention, early diagnosis and effective correction of congenital malformations and acquired diseases of the human neck and face. Objective. To find out the dynamics of morphometric and topographic-anatomical changes of the suprahyoid triangle of the anterior cervical region in human fetuses. Methods. 61 specimens of human fetuses 160.0-480.0 mm of parieto-coccygeal length (TCD) (4-10 months of VUR) were investigated, among which 34 were male and 27 were female. A set of methods of morphological research was applied, which included anthropometry, morphometry, X-ray techniques, preparation, three-dimensional reconstruction, statistical analysis. Results. It was found that the anterior angle of SHR in males decreases slightly during the fetal period of IUD, except for dolichomorphic objects, which tend to increase from the middle of the fetal period, while in females – almost unchanged in mesomorphic objects. In mesomorphic males and dolichomorphic females, the anterior angle of the SHR decreases at 7th month of IUD, while in brachymorphic females it increases. The length of the lateral and posterior borders, anterior-posterior length and area of SHR tend to decrease in male brachymorphic fetuses. In dolichomorphic female fetuses, it decreases by the 6th month of IUD with subsequent growth by the end of the fetal period of development. Irregular temporal dynamics of changes in these morphometric parameters of SHR is observed in dolichomorphic male fetuses and in brachymorphic female fetuses, where accelerated growth was detected in the 6th month of IUD and slowed down during the 7th month of development. Conclusion. The critical periods of morphogenesis of the SHR of human fetuses – the time of the change in the growth rate of the region depending on gender and constitutional type – are 6-7 months of IUD, which may indicate the formation of variants of the structure during this period, and the possible occurrence of congenital defects of the neck and maxillofacial region.

OBJECTIVES Persistent or recurrent disease following excision of a thyroglossal duct cyst/sinus (TGDC) is often found in the suprahyoid region. Cadaver dissections were performed to identify and name important surgical landmarks in the suprahyoid area; a histopathologic analysis of surgical specimens was completed to determine the incidence and extent of microscopic disease; and clinical outcomes were compared to determine the efficacy of a specific anatomic dissection. STUDY DESIGN Retrospective case series. METHODS Standardized dissections of four adult cadavers were performed. Consecutive surgical specimens were examined for evidence of microscopic TDGC disease in the suprahyoid region, measuring the greatest width and length of disease. A retrospective review of all consecutive TGDC procedures was completed. RESULTS The important surgical landmarks in the suprahyoid area were identified in all cadavers. Microscopic disease in the suprahyoid area was found in 79% (37 of 47) of surgical specimens. The mean greatest length and width of microscopic disease was 12.4 mm and 1.4 mm, respectively. Following identification of these landmarks, the incidence of recurrent or persistent disease decreased (P = .02) from 5% (8 of 159) to 0% (0 of 112). CONCLUSION The majority of pediatric patients with a TGDC will have microscopic disease in the suprahyoid area. The surgical landmark of the fascial plane between the geniohyoid and genioglossus muscles demarcates the anterior and lateral borders of resection in the suprahyoid area. This approach can be used as a reliable and easily reproducible technique in TGDC surgery to increase confidence of achieving complete removal of disease in the suprahyoid area, avoiding persistent or recurrent disease and a revision procedure. LEVEL OF EVIDENCE 4 Laryngoscope, 131:553-558, 2021.

Objective: Variations of the bellies of the digastric muscle is reported for a long time and is not uncommon. However, there is still not a full consensus about the classifications and many different types of variations. The aim of this study was to examine the variations of the digastric muscle on cadaver dissections and to create a pictorial collection of variations related to present-day by combining with existing knowledge. Method: In the present study, a total of 40 formalin-fixed cadavers and head specimens’ digastric muscles were analyzed bilaterally. Results: Previous results were utilized for classification of the variations. Anterior belly, intermediate tendon, and posterior belly variations were evaluated according to unilateral, bilateral and unclassified types. 10 variations were identified in the digastric muscle of 40 cadavers. Thus, five of the variations were unilateral and rest of them were bilateral. Two of the variations were residing in the central area. One accessory muscle bundle was found obliquely residing between the left and right sides of the anterior bellies. Remaining variation was the crossing of the accessory anterior belly of digastric muscle fibers at the central line. Intermediate tendon variation as piercing the stylohyoid muscle was observed in only one case. Posterior belly exhibited no variation. Conclusion: Reporting the abnormalities and variations of the digastric muscle is very important in surgical attempts and evaluation of the lymphadenopathy of the submental area and in the floor of the mouth tumors, numerous clinically significant esthetic surgeries for head and neck surgeons, radiologists and plastic surgeons. Objectif. — Les variations des chefs du muscle digastrique ont été remarquées depuis longtemps et ne sont pas rares. Cependant, il n’y a toujours pas un consensus total sur les classifications et les différents types de variations. L’objet de cette étude a été d’examiner les variations du muscle digastrique par dissection des cadavres et de créer une collection illustrée des variations précédement rapportées à nos jours, en les combinant avec les connaissances actuelles. Méthode. — Dans la présente étude, un total de 40 muscles digastriques de spécimens de tête et de cadavres fixés par le formol ont été analysés bilatéralement. Résultats. — Les résultats antérieurs ont été utilisés pour la classification des variations. Les variations des chefs antérieurs, des tendons intermédiaires et des chefs postérieurs ont été évaluées selon les types unilatéraux, bilatéraux et non classifiés. Dix variations ont été identifiées dans les muscles digastriques des 40 cadavres. En conséquence, on a constaté que cinq variations étaient unilatérales et le reste bilatéral. Deux variations se trouvaient dans la région centrale. Un faisceau de muscle accessoire a été trouvé comme situé obliquement entre le côté gauche et le côté droit des chefs antérieurs. L’autre variation était le croisement du chef antérieur accessoire des fibres musculaires digastriques sur la ligne centrale. La variation du tendon intermédiaire, comme la perforation du muscle stylohyoïdien, n’a été observée que dans un cas. Le chef postérieur n’a montré aucune variation. Conclusion. — L’observation des anomalies et des variations du muscle digastrique est très importante dans les interventions chirurgicales et l’évaluation de la lymphadénopathie de la région sous-mentale, les tumeurs du plancher buccal, les nombreuses opérations chirurgicales esthétiques concernant la chirurgie de la tête et du cou, la radiologie et la chirurgie plastique.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2020-10-27T20:47:12Z No. of bitstreams: 1 ANDRÉIA CRISTINA DE OLIVEIRA SILVA.doc.pdf: 2344727 bytes, checksum: 4226c1e68539a684dab18e8a416eff0d (MD5) Made available in DSpace on 2020-10-27T20:47:12Z (GMT). No. of bitstreams: 1 ANDRÉIA CRISTINA DE OLIVEIRA SILVA.doc.pdf: 2344727 bytes, checksum: 4226c1e68539a684dab18e8a416eff0d (MD5) Previous issue date: 2019-12-16 Introduction: Neck pain is described as an unpleasant sensory and emotional experience that begins at the upper nuchal line and continues to the level of the scapular spine. Although it may be associated with degenerative processes and other pathologies, often the local tissue that produces pain remains unidentified in these cases neck pain may be considered non-specific (NS-NP). Thus, this condition may be related to functional anatomic imbalances between structures that interconnect with the cervical region, such as the mandible, tongue and hyoid bone. Objective: To evaluate the effect of manipulation of the suprahyoid region and tongue on cervical pain, mobility and disability in individuals with chronic NS-NP. Methods: This was a randomized, double-blind controlled trial consisting of 40 individuals with chronic NS-NP, randomly divided into two groups: i) Control - received multimodal treatment (manual therapy and exercise program), ii) Experimental - received the same treatment as the control group plus a protocol for manipulation of the suprahyoid region and tongue. The treatment was performed twice a week for 3 weeks (total of 6 sessions). The primary endpoint evaluated was cervical pain, as assessed by the Numeric Pain Rating Scale (NPRS), and the secondary end points: the intensity of Pain Catastrophizing Scale (PCS) about cervical pain, the degree of neck disability, the patient's specific functional scale, cervical mobility, amplitude of mouth opening, and TMJ-related symptoms. Possible differences between groups were tested using linear mixed models considering differences between groups and intention to treat. Paired T-test was used for intragroup analyzes. Results: Between the groups, only the right neck rotation movement and the PCS showed significant differences between the groups (p

The crossbow is an ancient ranged weapon originally conceived for war and hunting. Although nowadays its use in warfare has been surpassed by firearms, it continues to be used in hunting, sports and recreation. The authors present the case of a 40-year-old man who suffered from severe depression. When his condition further deteriorated, doctors ordered a forced hospitalization but, just a few hours before the measure became effective, the man committed suicide using a crossbow. The autopsy and police investigation showed possession of the crossbow darts which the man used to shoot himself in the head. The forensic pathologist found the dart stuck in the skull: the entry wound was in the suprahyoid region while the arrow tip emerged in the left parietal region meaning the arrow crossed the tongue, the middle fossa, the brain and the cranial wall. All the wounds presented a three-pointed star shape consistent with the three sharp blades of the dart. An extensive blood infiltration affected the subdural and subarachnoid space, particularly where the dart had passed. The severe brain injury, extensive subdural and subarachnoid bleeding and brain swelling following the trauma caused the death. Even though the use of the crossbow is only permitted in sporting/hunting contexts, the reported case highlights the sharp contrast between its potential for harm and the easy access to this kind of weapon, even for those affected by mental illness.

Occurrence of accessory bellies of anterior belly of digastric muscle (ABD) in the submental region is not uncommon. However reporting of different pattern of accessory bellies is of tremendous clinical significance for head and neck surgeons, radiologists and plastic surgeons. Herein we report a rare asymmetrical variant of ABD in the suprahyoid region. Accessory bellies were observed on either side of midline. On the right side accessory belly had two segments; one segment extended between the lower part of the ABD and hyoid bone, other one extended between the digastric fossa of mandible to the body of hyoid bone. On the left side accessory belly extended between mylohyoid muscle and to the lower part of the ABD.Bangladesh Journal of Medical Science Vol.16(3) 2017 p.461-463

The digastric muscle is an important surgical landmark. Several anatomical variants of the digastric muscle are reported in literature and, in particular, the presence of accessory anterior bellies of the muscle is not uncommon. Here, an unreported symmetrical variant of the digastric muscle was found during a dissection of the suprahyoid region. The dissection showed digastric muscles with an accessory anterior belly, which originated from the anterior belly of muscles in proximity and anteriorly to the intermediate tendon. The accessory bellies were fused together on the midline and were attached with a unique tendon to the inner surface of the mental symphysis. These muscles completely filled the submental triangle. This unreported anatomical variant could be considered an additional contribution to description of the anatomical variants of the digastric muscle, with several implications in head and neck pathology, diagnosis and surgery.

We describe a case of Castleman's disease in a 8-year-old-boy who presented with a slowly growing mass in the upper neck. MRI showed a well-defined homogeneous mass with nonspecific signal features. Unusual features were a kidney-bean shape and the deep location in the suprahyoid region, the mass originating in the left retropharyngeal space.

Burn is a devastating condition and post-burn sequelae are common after deep burns. Post-burn ectropion of the lower lip is one of them. The usual treatment is release of ectropion of the lower lip and resurfacing of the defect with a split thickness skin graft. Several other procedures have been described in literature. We have used a new concept to transport the defect, resulting after releasing the lower lip ectropion, to the suprahyoid region. The mental defect is covered by a bipedicled flap transposed from the suprahyoid region and the donor defect is grafted with a split thickness skin graft. We have used this technique in three adult females with post-burn lower lip ectropion obtaining good aesthetic appearance and no recurrences.

In this paper we present the first description of an anastomosis between both hypoglossal nerves during the embryonic period, a very uncommon anatomical variation. This was observed in a 30 mm crown-rump (C-R) length human embryo (Carnegie stage 23) from the Bellaterra Collection (Prof. Doménech Mateu), stained for nerve fibers. The anastomosis consisted of a large diameter trunk (36.7 microns) situated in front of and slightly below the hyoid cartilage, and clearly distinguishable from the anastomosis found in adults, which has a very fine diameter and is located in the suprahyoid region.

The authors propose a technique for the correction of the scar contractures of the neck after burns, where mandibulo-thoracic bridle scars have developed. We perform a bi-mastoid incision on the line between the neck and thorax, withdrawing a skin triangle in the midline of the neck. The undermined skin pedicle flaps fit into the suprahyoid region, whereas the infrahyoid area is covered with a full-thickness skin graft. This technique is based on the anatomical independence of the regions above and below the hyoid. The method eliminates the need for a plastic or leather collar in the postoperative period, which appears to be unnecessary because secondary retraction of the skin graft does not occur.

Platysma muscle was studied in 50 cadavers. The principal anatomic variation concerned the medical fibers. In 75 percent of the cases, the fascicles are separate in the suprahyoid region but interlace with those of the opposite side, 1 to 2 cm below the chin. In 15 percent, the fascicles come together at the level of the thyroid cartilage, like a single muscle in the suprahyoid region. In 10 percent of the cadavers, the fibers were separate, but inserted in the subcutaneous muscles of the chin without decussating. The posterosuperior fibers of the platysma always pass behind the angle of the jaw and over important structures, the most significant being the mandibular branch of the facial nerve.

A case of cervical ranula is presented, which originated from a projection of the sublingual gland into the suprahyoid region. A diagnosis of cervical ranula could not be established preoperatively because there was no intraoral involvement of the ranula. A cervical approach was used, and the correct diagnosis was made during the operation.