The Case of Asymmetry of the Omohyoid Muscle

The asymmetry of omohyoid muscles was found during topographic anatomical preparation of female cadaver (using methods: anatomical preparation and morphometry) which was use in medical student’s training. The detected deviations in structure of this muscle, accordingly to many articles, have not only anatomic value but also a significant importance for clinical surgeons of different fields. The described anatomical variation of omohyoid muscle structure (the asymmetry) has some very important clinical aspects, concerning front neck region surgery. Omohyoid muscle is a reliable landmark for endoscopic examination of brachial plexus and searching for metastases in neck lymphatic nodes. In some cases, hypertrophy of omohyoid muscle can cause development of functional dysphagia and spastic torticollis.

Effect of Chloroethane Spray in the Treatment of Spastic Torticollis in Children and Adolescents

Objective. A study to determine the efficacy of chloroethane spray compared to normal saline in the treatment of spastic torticollis in children and adolescents. Hypothesis. Chloroethane spray is more superior to normal saline for the treatment of spastic torticollis in children and adolescents in the pediatric emergency room. Design. Prospective randomized study. Setting. Urban inner-city hospital pediatric emergency department. Methods and Results. All children and adolescents (between the ages of 1 and 16 years) presenting to the author with the complaint of stiff neck were enrolled in the study. A total of 132 patients were enrolled. After complete evaluation to rule out cervical spine injury, a central neurological cause, patients were enrolled in the study. Sixty-six patients were treated with chloroethane spray to the neck and the other 66 were given normal saline as placebo. Sixty-three out of 66 patients treated with chloroethane spray achieved relief in 5 minutes as demonstrated by painless and free movement of the head and neck. No adverse effects were observed. The patients treated with placebo have no relief in 5 minutes. To test the null hypothesis that the percentages improved in the 2 groups equally, we calculated the Z statistic. The Z statistic of 24 corresponded to a P value of <.0001, whether the test is 1-sided or 2-sided. Chloroethane spray treatment was superior to placebo with a high statistical significance. Conclusion. For children and adolescents with spastic torticollis chloroethane spray was more superior to normal saline in the pediatric emergency room.

Efficacy of Botulinum toxin type A in treatment of different forms of focal dystonias in the Serbian population: Experience of the Botulinum Toxin Outpatients Department

Background/Aim. Botulinum toxin (BTX) irreversibly inhibits presynaptic acetylcholine release with subsequent relaxation of abnormally contracting muscles. It is an effective and well tolerated treatment with long-term benefit in a variety of movement disorders and other neurological and non-neurological disturbances. The aim of our study was to present our experience with BTX type A in treatment of different forms of focal dystonias. ?ethods. ? hundred of patients with different focal dystonias (spastic torticollis, blepharospasm and graphospasm) from the Botulinum Toxin Outpatients Department, Clinic for Neurology, Clinical Center of Serbia, were included in the study. All the patients were examined and rated at baseline visit prior to BTX application and on the following visit, after 3-4 months, using self-assessment improvement questionnaire and standardized rating scales. Results. The improvement of ? 50% was presented in 68.2% of all (199) the analyzed applications. Independent predictors of good response to the therapy (improvement ? 50%) were male sex (p = 0.011), the presence of sensory trick (p = 0.013) and the total number of BTX applications (p = 0.002). The patients with spastic torticollis and blepharospasm showed a statistically significantly better BTX effect (improvement 57.3 ? 27.5% and 54.1 ? 28.3%), respectively than the graphospasm group (26.7 ? 25.6%). Most of the patients did not have therapy complications (81.4% and 72% in two applications). Side effects in the remaining patients (muscle weakness, dysphagia, ptosis, double vision, neck weakness and lacrimal dysfunction) lasted for 28.3 ? 18.6 days after the first treatment and 32.5 ? 36.2 days after the second one. Conclusion. BTX is safe and highly effective in long-term treatment of patients with different forms of focal dystonia, with only mild and well-tolerated side-effects.