Posterior Border Reverse “L” Osteotomy and Condylar Head as free graft for correction of Ramal height in cases of High Condylar Extra Capsular Fractures

The inca bone in the human skull is usually regarded as the homologue of the interparietal of some other mammals. The commonest or best-known form of the interparietal occurs in the rabbit as a single somewhat oval bone, its long axis being transverse, filling up a space between the parietals just in front of the line or curve of the occipital.Carl Vogt (Lectures on Man, London Anthropological Society, 1864) makes frequent and detailed reference to a Helvetian skull. From the woodcuts, p. 52, fig. 15; p. 66, fig. 22; p. 70, fig. 26; p. 389, fig. 124; and p. 390, fig. 125, it is clear that a small round undivided bone occurred in this skull in a situation roughly corresponding with the position of the interparietal in the rabbit. I say “roughly,” because the posterior border of the bone in the Helvetian skull just touches the occipital at the lambdoid suture, while in the rabbit the interparietal for about half the extent of its perimeter is in contact with the occipital.

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Revision of Vagal Nerve Stimulator Electrodes Through a Posterior Cervical Triangle Approach: Technical Note

Operative Neurosurgery ◽

10.1227/neu.0b013e3181f825a3 ◽

2010 ◽

Vol 67 (suppl_2) ◽

pp. ons457-ons460

Author(s):

Brent R. O'Neill ◽

James E. Wilberger

Keyword(s):

Skin Incision ◽

Electrode Site ◽

Technical Note ◽

Vagal Nerve ◽

Electrode Placement ◽

Lead Wire ◽

Posterior Border ◽

Nerve Stimulator ◽

Vagal Nerve Stimulator ◽

Back Ground

ABSTRACT BACK GROUND: We describe an approach to vagal nerve stimulator (VNS) lead replacement through the posterior cervical triangle. Scar around the structures of the carotid sheath is avoided and new leads are placed on a pristine section of the vagus nerve proximal to the original site. CLINICAL PRESENTATION: Skin incision from the implantation surgery is incorporated and extended to allow access to the posterior border of the sternocleidomastoid muscle (SCM). Dissection proceeds along the posterior border of the SCM. The SCM and jugular vein are retracted anterior to expose a fresh segment of the vagal nerve immediately superficial to the carotid artery and proximal to the original electrode site. Once the nerve is adequately exposed, electrode placement proceeds in the standard fashion. Dysfunctional electrodes are left in place, and the lead wire is cut as near the electrodes as can be easily accessed. Three patients have undergone lead revision with this approach. Lead placement was successful and free from complications in all cases. CONCLUSION: The posterior cervical triangle approach provides a virgin dissection plane for VNS revision.

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