An unusual neck lump: intramuscular haemangioma of the sternocleidomastoid muscle

Neck lumps can often present a diagnostic dilemma, with a wide pre-operative differential diagnosis. We present an unusual case of an intramuscular haemangioma arising in the sternocleidomastoid muscle. Pre operative diagnosis is often difficult, as these lesions are extremely rare in the head and neck region and only few sporadic cases have been reported in the literature. We report the presentation diagnosis and management of intramuscular haemangiomas of the sternocleidomastoid muscle.     

Plastic surgical treatment of a chronic thoracic duct fistula using a sternocleidomastoid muscle flap — a case report

Thoracic duct fistula is a rare but potentially serious complication of head and neck surgery. Such fistulae may be difficult to treat, and several techniques, both operative and non-operative, have been advocated. A case of successful surgical treatment of a chronic thoracic duct fistula is presented. The fistula occurred in a 51-year-old female following treatment of a solitary supraclavicular breast metastasis by local excision and radiotherapy. The divided duct was ligated and the area was covered with the clavicular head of the sternocleidomastoid muscle.     

胸锁乳突肌部分切除术治疗先天性肌性斜颈

目的 :探讨先天性肌性斜颈松解的方法和效果。方法 :采用胸锁乳突肌部分切除术治疗先天性肌性斜颈45例。结果 :45例均获得良好矫正。结论 :胸锁乳突肌部分切除术疗效优于胸锁乳突肌切断术。术后局部粘连少 ,没有复发。包括颈阔肌、颈深筋膜的彻底松解是手术成功的关键。     

Tracheal window resection and reconstruction via sternocleidomastoid flap for invasive thyroid carcinoma

 Open in a separate windowOBJECTIVESThe aim of this study was to present surgical techniques and evaluate outcomes of a sternocleidomastoid muscle (SCM) myoperiosteal flap used for the reconstruction of tracheal or laryngotracheal defects after the radical resection of invasive thyroid carcinoma.METHODSA retrospective study was performed for patients at Peking Union Medical College Hospital from January 2008 to December 2018 of papillary thyroid carcinoma with tracheal or laryngotracheal invasion. Patients were enrolled only when they received window resection and reconstruction via an SCM myoperiosteal flap. The primary outcome was a stable airway, and the secondary outcome was survival.RESULTSA total of 15 invasive thyroid carcinoma patients were enrolled in this study. Laryngotracheal and tracheal reconstruction were performed in 11 and 4 patients respectively, with a median vertical defect of 3.5 cm (3.0, 4.5). A stable airway was achieved in 14 patients postoperatively. One patient experienced tracheal stenosis and received a second operation of tracheal sleeve resection and end-to-end anastomosis 105 days after the first operation. Tracheostomy was conducted in 5 out of 15 patients in whom the vertical defects were larger than 4 cm, and the tubes were extubated after a median time of 56 days (32, 84). The median observation time was 55 months (48, 86), and all 15 patients achieved a stable airway and showed no evidence of local recurrence at the end of follow-up.CONCLUSIONSFor thyroid carcinoma with tracheal or laryngotracheal invasions, window resection with the SCM myoperiosteal flap reconstruction presented positive results in terms of a stable airway as well as oncological outcomes. The SCM myoperiosteal flap can be an appropriate reconstruction strategy, especially when the defects reach the thyroid cartilage.     

超声半定量评分在小儿肌性斜颈诊治中的应用

评价超声对先天肌性斜颈半定量分级评分诊断的价值。对SCM依据声像图特征进行分型及半定量分级评分。（1）Ⅰ型弥漫型4例;Ⅱ型结节型7例;Ⅲ型瘤样团块型27例。（2）三型在SCM粗细及血流方面存在显著差异。（3）随访观察,血流信号评分显著下降。超声对先天肌性斜颈分型诊断并半定量分级评分诊断,有利于临床有针对性设计治疗方案及客观评价疗效。     

Intramuscular benign lipoma of the sternocleidomastoid muscle: a rare cause of neck mass

Intramuscular benign lipoma commonly is found on the extremities, but is extremely rare in the head and neck region. Intramuscular type lipomas arise between the muscle fibers and pass through the intermuscular septa, infiltrating the surrounding tissue. A 29-year-old male patient presented with the complaint of a painless and slowly growing lateral neck mass on the left side. Physical examination revealed a 4×5-cm mass adjacent to the sternocleidomastoid (SCM) muscle. CT examination revealed a lobulated, well-circumscribed 5.5×2.5-cm diameter mass with adipose tissue signal density inside the SCM muscle. The surgical exploration of the mass was done under general anesthesia, and it was excised totally. Recurrence was not seen in the 3-year follow-up. This rare entity should be considered in the differential diagnosis of intramuscularly located neck masses. Complete removal of the tumor can only succeed if planned and performed after a thorough preoperative clinical and radiological assessment in order to prevent recurrences.     

带蒂胸锁乳突肌移位术修复晚期面瘫

目的　探讨应用带蒂胸锁乳突肌移位术动态修复晚期面瘫畸形的疗效。方法　 1999年 12月以来 ,采用带蒂胸锁乳突肌移位术修复 7例晚期面瘫 ,将胸锁乳突肌的胸骨头及锁骨头移位至患侧口周 ,替代瘫痪的口周肌肉 ,修复因面神经瘫痪所致的口鼻歪斜畸形及活动障碍。保留副神经的其余功能。结果　术后立即矫正静态时口鼻歪斜畸形 ,1周后已能活动患侧口角。术后 1个月 ,经训练能恢复笑容。经 10个月随访 ,所有患者口部活动恢复满意。结论　带蒂胸锁乳突肌移位术能修复晚期面瘫所致的口鼻畸形 ,并能重建口部表情功能     

实时剪切波弹性成像评价先天性肌性斜颈胸锁乳突肌

目的 应用实时剪切波弹性成像（SWE）技术评价先天性肌性斜颈（CMT）患儿胸锁乳突肌（SCM）。方法 对130例初诊CMT患儿进行二维超声检查,根据二维超声表现确定其二维分型（Ⅰ~Ⅳ型）,采用SWE测量患侧、健侧SCM弹性模量平均值（E_mean）;对患侧二维超声表现分型与E_mean进行相关性分析;运用ROC曲线计算各型的E_mean截断值。结果 CMT患儿各二维超声表现分型健侧与患侧SCM的E_mean差异有统计学意义（P<0.05）。各二维超声表现分型与患侧E_mean呈正相关（r_s=0.76,P<0.05）。利用ROC曲线获得Ⅰ~Ⅳ型E_mean截断值分别为15.35 kPa、29.60 kPa、38.05 kPa及47.80 kPa。结论 SWE技术可客观量化显示SCM硬度,评估CMT患儿胸锁乳突肌纤维化严重程度,具有较高临床价值。     

胸锁乳突肌瓣修复改善腮腺术后外观畸形

目的　研究胸锁乳突肌瓣（SCM）填充对腮腺手术并发症及术后外观的影响。 方法　68例腮腺良性肿瘤患者,随机数字表法分为实验组和对照组。对照组34例接受常规腮腺肿物区域切除术,实验组34例在接受腮腺肿物区域切除术后,以SCM填充术区缺损。随访6~12个月,对术后并发症和术区外观进行主观和客观的评价。 结果　实验组在术后面神经麻痹、主观Freys综合征、耳部麻木感、肿瘤复发的发生率和对照组大致相当。实验组术后5例（15%）发生腮腺瘘,对照组9例（27%）发生腮腺瘘,实验组腮腺瘘发生率低于对照组,差异有统计学意义（P?0.05）。实验组外观患者主观评分为(1.25±0.96);第三者的评分(1.11±0.99),对照组外观患者主观评分为(2.45±1.33);第三者的评分(2.26±0.87),两组患者外观的主观和客观评分差异均有统计学意义（P?0.05）。 结论　SCM填塞腮腺术腔可改善患者术后面部畸形,为腮腺术后的重建提供了合理的美容选择。     

经胸锁乳突肌前缘径路行甲状腺切除术的临床体会

目的探讨经胸锁乳突肌前缘入路行甲状腺切除在肿瘤手术中的临床价值。方法2008年8月-2010年6月间行甲状腺切除患者104例,随机分为观察组52例和对照组52例,观察组采用胸锁乳突肌前缘径路行甲状腺切除;对照组传统经颈白线入路切除。比较两组患者的手术时间、术中出血、术后引流量以及并发症等。结果两组病例手术均顺利,无术中大出血及喉返神经损伤。观察组平均住院时间、手术时间、术中出血、术后引流量较对照组减少（P〈0．01）;颈部功能恢复、颈部术口美观情况优于对照组（P〈0．05）。结论行胸锁乳突肌前缘径路甲状腺切除术暴露充分,操作方便,可减少出血及喉返神经损伤,能较好地满足患者对颈部切口的美观要求等优点。值得临床推广应用。