Rare intramuscular haemangioma of the sternocleidomastoid muscle

Intramuscular tumours of the head and neck often represent a differential diagnostic challenge. We report the rare case of an intramuscular haemangioma arising from the sternocleidomastoid muscle in the 6th decade. Pre-operative diagnosis was difficult, as these tumours are extremely uncommon in the head and neck region, with only very few cases reported in the literature. Due to the marked tendency of intramuscular hemangiomas to recur, accurate preoperative diagnosis forms the basis of adequate surgical therapy with sufficient safety margins.     

Seltenes intramuskul?res H?mangiom des M.?sternocleidomastoideus

Intramuscular tumours of the head and neck often represent a differential diagnostic challenge. We report the rare case of an intramuscular haemangioma arising from the sternocleidomastoid muscle in the 6^th decade. Pre-operative diagnosis was difficult, as these tumours are extremely uncommon in the head and neck region, with only very few cases reported in the literature. Due to the marked tendency of intramuscular hemangiomas to recur, accurate preoperative diagnosis forms the basis of adequate surgical therapy with sufficient safety margins.     

Well-circumscribed intramuscular lipoma of the sternocleidomastoid muscle

Intramuscular lipomas are unusual benign mesenchymal tumours, which infiltrate the skeletal muscle, and are exceedingly rare in the head and neck region. They commonly infiltrate the skeletal muscle fibres from which they arise and are rarely well circumscribed. We present the only documented case of well-circumscribed intramuscular lipoma arising from the sternocleidomastoid muscle. Although the recurrence is commoner in the infiltrative variety the surgeon should be aware that differentiation between infiltrative and well circumscribed is based on histological diagnosis, and hence wide excision in all cases of intramuscular lipomas is essential.     

Intramuscular hemangiomas of the mylohyoid and sternocleidomastoid muscle

Intramuscular hemangiomas of the head and neck are uncommon benign vascular tumors. They arise frequently in the masseter and trapezius muscle. However, intramuscular hemangiomas arising from the mylohyoid and sternocleidomastoid muscle are extremely rare. We, herein, report additional two cases with intramuscular hemangioma of the mylohyoid and sternocleidomastoid muscle, and review the literatures pertaining to this condition. Imaging studies such as magnetic resonance image (MRI) were diagnostic and the tumors were resected completely with the cuff of normal surrounding muscle. At follow-up examination the patients have been well, without evidence of tumor recurrence after surgery. Intramuscular hemangioma of the head and neck, despite its rarity, should be considered in the differential diagnosis of the head and neck masses.     

Complete branchial fistula. Case report and review of the literature.

Branchial anomalies, a result of aberrant embryonic development, are rarely seen in clinical practice. Lesions of the second branchial pouch commonly present as a neck lump or discharging sinus that may be complicated by infection. Clinical examination often reveals the lesion to be related to the junction of the upper two thirds and the lower one third of the sternocleidomastoid muscle. Branchial fistulas often present as a discharging sinus in the neck with the fistula tract extending upward within the deep neck tissue for a variable distance. A complete branchial fistula is one that has a defined internal opening in the tonsillar area and an external opening at the skin overlying the sternocleidomastoid muscle at the junction of the upper two thirds and the lower one third of the muscle. The incidence of such lesions is extremely rare. Surgical excision is the treatment of choice for branchial anomalies. We present the case of a patient who presented with a complete branchial fistula and discuss the clinical presentation and surgical management of such lesions, with a review of the relevant literature.     

Myositis of the sternocleidomastoid muscle as a result of arthritis of the sternoclavicular joint

This article describes a rare case of a myositis of the sternocleidomastoid muscle due to an acute septic arthritis of the sternoclavicular joint. A 51-year-old male in reduced condition was admitted to the Department of Otorhinolaryngology with a one-week history of a painless swelling of the sternocleidomastoid muscle associated with recurrent fever. Physical examination was otherwise unremarkable. An intravenous antibiotic therapy was initiated without improvement of the process, accordingly a specific infection or a malignancy was ruled out by biopsy. The positron emission tomography and magnetic resonance imaging finally revealed the diagnosis of a septic arthritis of the sternoclavicular joint as the causal focus of the infection. After an extensive surgical debridement and under continued antibiotic therapy the patient made an uneventful recovery. The acute septic arthritis of the sternoclavicular joint is an uncommon infection with an insidious onset and is often unrecognized until it spreads to adjacent structures leading to serious complications. This case emphasizes that a myositis of sternocleidomastoid muscle can be caused by an ascending infection due to an acute septic arthritis of the sternoclavicular joint. Clinical course, diagnosis and treatment of this uncommon disease are reviewed in this article.     

Bilateral sternocleidomastoid tumors of infancy

The sternocleidomastoid tumor of infancy (STOI) is a relatively uncommon condition. Typically, it presents as a firm, well circumscribed mass within the sternocleidomastoid muscle (SCM) in infants 1-8 weeks of age and may be associated with torticollis. This condition must be considered in any infant with a lateral neck mass. The diagnosis can often be made clinically, but unusual presentations may present diagnostic challenges. Although bilateral involvement is rare, it does occur. The second reported case, a 2-week old female with bilateral STOIs and torticollis, is reported. Although many of the characteristics of the masses suggested the condition, the bilateral nature added uncertainty to the clinical impression, and magnetic resonance imaging (MRI) was used to confirm the diagnosis. The clinical presentation and management of the STOI are reviewed, and the unusual features of this case are discussed.     

Infiltrating lipoma of the sternocleidomastoid muscle

Infiltrating lipomata are unusual benign tumors that have been rarely associated with the head and neck areas. We present the only known documented case of an infiltrating lipoma of the sternocleidomastoid muscle. The literature is reviewed and the characteristics of these lesions are discussed. The head and neck surgeon should include these interesting tumors in the differential diagnosis of head and neck masses and be aware that, because of a known propensity for recurrence, total surgical excision is the treatment of choice.     

Third branchial cleft anomaly presenting as a retropharyngeal abscess

Branchial cleft anomalies are congenital developmental defects that typically present as a soft fluctuant mass or fistulous tract along the anterior border of the sternocleidomastoid muscle. However, branchial anomalies can manifest atypically, presenting diagnostic and therapeutic challenges. Error or delay in diagnosis can lead to complications, recurrences, and even life-threatening emergencies. We describe a case of an infected branchial cleft cyst that progressed to a retropharyngeal abscess in a 5-week-old female patient. The clinical, radiographic, and histologic findings of this rare presentation of branchial cleft cyst are discussed.     

Focal myositis. A new cause for the pediatric neck mass

Focal myositis is an inflammatory pseudotumor of skeletal muscle that may involve the head and neck. It can closely mimic either a neoplastic or infectious process. We present the case of a 7-year-old boy with a 2-week history of a painful, unilateral neck swelling, fever, and torticollis. He failed to respond to antibiotic therapy and required an open neck exploration. An incisional biopsy of the indurated, inflammatory tissue adherent to his sternocleidomastoid muscle showed focal myositis. Focal myositis is an unusual, but important possibility in the differential diagnosis of any neck mass and especially one in a child. Although its cause is unknown, it is a self-limited disease and neither excisional biopsy nor radical resection is justified.     

Intramuscular hemangioma of the posterior belly of the digastric muscle failing to highlight on magnetic resonance imaging

Intramuscular hemangiomas of the digastric muscle are rare. We present the fifth case reported and the second to be imaged in vivo with magnetic resonance imaging. Accurate preoperative diagnosis of these lesions is difficult, but may be facilitated by a high degree of clinical suspicion and imaging. Magnetic resonance imaging using T2-weighted sequencing has been reported to effectively highlight these lesions. We present a case in which magnetic resonance imaging failed to highlight an intramuscular hemangioma of the posterior belly of the digastric muscle. Possible reasons for this failure are discussed.     

Lipoma in the deep lobe of the parotid gland: a case report

We report here on a rare case of lipoma in the deep lobe of the parotid gland. MRI revealed that the tumour was situated mainly in the deep lobe and it extended posteromedially into the space between the sternocleidomastoid muscle and the posterior belly of the digastric muscle, with slight extension into the parapharyngeal space. This tumour produced strong signals on T1- and T2-weighted MR images and weak signals on fat suppression images. In addition, MRI clearly showed the margin of the tumour, which enabled us to readily distinguish the tumour from the surrounding adipose tissue. The images suggested a diagnosis of deep lobe parotid lipoma with posteromedial extension to the sternocleidomastoid muscle, which proved true at surgery. We thus believe that MRI is highly useful, perhaps even necessary, in diagnosing tumours of the head and neck.     

Intramuscular haemangioma of head and neck region

Intramuscular haemangiomas are rare benign haemangiomas occurring within the skeletal muscle. These are uncommon tumours in the head and neck region and occur most frequently on the trunk and extremities. Fewer than 80 cases of intra-muscular haemangioma in the head and neck region have been reported in the literature. A case of intramuscular haemangioma of the sternocleidomastoid muscle is presented. The review of occurrence and natural history of such tumours is described and clinical and radiological presentation, histological classifications and treatment modalities are discussed.     

Congenital muscular torticollis. A spectrum of disease

Sternocleidomastoid muscle fibrosis has been recognized for centuries, but its pathogenesis and treatment remains controversial. Pseudotumor of infancy is a firm fibrous mass in the sternocleidomastoid muscle appearing at 2 to 3 weeks of age. Congenital muscular torticollis is less common and appears later in life. Pseudotumor and congenital muscular torticollis probably represent different manifestations of sternocleidomastoid muscle fibrosis. Pseudotumor will usually resolve with conservative therapy; however, some patients will subsequently develop torticollis. Congenital muscular torticollis usually requires surgical release of the sternocleidomastoid muscle to achieve a good cosmetic result and to prevent plagiocephaly, facial asymmetry, and scoliosis. This report provides guidelines for the management of congenital muscular torticollis and pseudotumor of infancy based on the authors' experience and review of the medical literature. Representative case histories from the neonate through the adult are presented, and the pathogenesis, diagnosis, treatment, and prognosis are discussed.     

Intramuscular hemangioma in the head and neck.

Intramuscular hemangioma is a distinct type of hemangioma occurring within skeletal muscle and making up less than one per cent of all hemangiomas. They occur most often in the trunk and extremities, perhaps beacuse of the larger muscle volume in thos areas. 13.5 per cent of intramuscular hemangiomas do occur in the head and neck region and for this reason they should be considered in the differential diagnosis of head and neck masses. The first case of an intramuscular hemangioma of the digastric muscle is presented and confirmed by electron microscopic sections. An interesting finding in this tumor is the proliferation of both endothelial cells and pericytes. Hemangiomas are classified according to vessel size; "large vessel" cavernous, "small vessel" capillary, and "mixed". Various etiologies and modalities of treatment are discussed, and total excision with ligation of the feeding vessels is advocated to prevent the high incidence of later recurrence.     

Intramuscular hemangioma of the head and neck

Intramuscular hemangiomas are unusual tumors in the head and neck region that occur most frequently in the masseter muscle and are often confused with parotid neoplasms. Four cases are described and the literature reviewed. The diagnosis and management of these tumors are discussed in view of the fact that accurate preoperative diagnosis is unusual and tumor recurrence rates high. Increased awareness of the clinical presentation of intramuscular hemangiomas should enhance diagnostic accuracy and facilitate optimal treatment planning.     

A neck mass with brachial plexus injury: Pott's disease

Tuberculous osteomyelitis of the spine is most commonly seen in lower thoracic and lumbar vertebrae. Cervical spine tuberculosis is a very rare condition, and it represents a very small part of all patients with Pott's disease. We present a case with thoraco-cervical Pott's disease, with left-sided neck mass and left arm and hand weakness and numbness. The patient had a paraspinal abscess under the sternocleidomastoid muscle that was compressing the brachial plexus.     

Reconstruction of the tongue

Subtotal or total glossectomies performed for malignancies or other afflictions of the tongue are fraught with great disabling problems postoperatively. Recently the introduction of myocutaneous flaps has aroused new interest in surgical procedures to reconstruct the tongue following major resections. A new approach to functional reconstruction of the tongue is presented utilizing the sternocleidomastoid myocutaneous flap based superiorly. Neurorrhaphy between the hypoglossal nerve on the resected side of the tongue and the nerve to the sternocleidomastoid muscle is easily achieved without under tension as these nerves are in close proximity. In addition, the sternocleidomastoid myocutaneous flap is an ideal flap in tongue reconstruction as there is no fat between the skin and muscle and it resembles the bulkiness of the tongue muscle itself. A patient with a carcinoma of the tongue treated with subtotal resection and reconstruction using the above principles demonstrated full tongue movements 11 months postoperatively.     

Aberrantes Speicheldrüsengewebe in der Differentialdiagnose branchiogener Halszysten Eine Falldarstellung

A neck fistula next to the sternocleidomastoid muscle is suspicious of a branchial origin. Here we report on a 29-year-old patient with a discharging cutaneous orifice caused by an ectopic salivary gland. The clinical and histological findings are demonstrated and discussed with reference to the literature. Surgical removal of ectopic salivary gland tissue is the treatment of choice. However, surgery is limited in extent compared to surgical removal of a branchial fistula. Our case demonstrates that an ectopic salivary gland should be considered in the differential diagnosis of a branchial fistula.     

Experience with the sternocleidomastoid myoperiosteal flap for reconstruction of subglottic and tracheal defects: modification of technique and report of long-term results

Subglottic or tracheal reconstruction may be required in cases of subglottic stenosis, invasive thyroid carcinoma, or trauma. The sternocleidomastoid myoperiosteal flap uses clavicular periosteum on a muscle pedicle to provide vascularity. Clavicular periosteum is fibrous, durable, and will conform to the shape of the trachea, forming bone to provide stability to the airway. The procedure is relatively simple and involves single-staged reconstruction. After 4 years' experience with this flap, we present the results from a series of 11 patients who underwent subglottic or tracheal reconstruction with the sternocleidomastoid myoperiosteal flap. Ten of 11 patients were successfully decannulated. The average time from reconstruction to decannulation was 50.3 days. Follow-up ranged from 12 to 40 months. We also describe modifications of the initial technique that have been introduced to improve the flap's versatility and effectiveness.