Forward Head Posture Fix

Forward Head Posture Fix

This ebook guide teaches you the muscles that you need to work to make sure that you have excellent posture all day long, and that you will have the benefits that go along with good posture. You will be able to get rid of many headaches, brain fog, and aching neck muscles by using this workout. There is no need to look old! Stooping is the sign of old age Even if you are an older person you too can work out this muscle group to give you the powerful posture of a much younger person! This bad posture that we are correcting is called texting neck. It comes when you look down at something (like a book or your phone) too often, which puts a huge strain on your neck. You will learn how to fix this problem and help your neck to be in better shape today. Your neck is supposed to remain vertical; we can help put it back where it goes to make sure that you stay healthy for years to come. Read more...

Forward Head Posture Fix Overview


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I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

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Respiratory consequences

The diaphragm is flattened or even everted in the abdominal cavity. During inspiration, this leads to a paradoxical inward movement of the base of the thoracic cage associated with a tracheal tug concomitant with contractions of the sternocleidomastoid and intercostal muscles. The flattened and elongated diaphragm loses its efficacy. Muscle fatigue can develop, with the appearance of alternating abdominothoracic respiration, abdominal paradox, and a progressive decrease in respiratory rate.

Deep Tissue Manipulation

Ida Rolf compared the body to a stack of bricks, each one squarely and firmly on top of one another. If just one of the bricks was out of alignment, the entire structure would be unstable and under duress. When the body is properly aligned, the muscles use little tension in maintaining any given position however, improper posture puts such stress on the muscles, especially of the back, neck, and legs, that the muscles become over-contracted. After months or years in this condition, the movement of fascial tissues, because they have to hold everything in an out-of-balance state, become shortened and inflexible, and eventually lose their pliability. The muscles

Evaluation And Planning

In 1896, Tansini (27) was the first to describe the use of a pedicled myocuta-neous flap to repair a surgical defect. He employed the latissimus dorsi muscle with overlying skin for the reconstruction of a mastectomy defect. Owens (28) in 1955 first described this approach using the sternocleidomastoid myocutaneous flap for reconstruction in the head and neck region. This technique gained wide popularity in 1979 when Ariyan first described the pectoralis major myocutaneous flap in the reconstruction of the oral cavity (29). It subsequently became the work horse in head and neck reconstruction replacing the deltopectoral flap, and continues to be a viable alternative to date. Other pedicled musculocutaneous options include the sternoclei-domastoid, the trapezius, the latissimus dorsi, and the temporalis muscle (30). Further variations of immediate mandibular reconstruction with regional osteomus-culocutaneous flaps comprising the pectoralis major muscle, overlying skin, and a segment...

The First Puzzle Behavior As Inputs And Outputs Of Mindreading

Watching facial expressions, head and eye direction, body posture, and movements allows the perceiver to figure out a great deal about what others believe, want, feel, or intend. On the other hand, perceptions of behavior can also be an output of mindreading. Plenty of research shows that people explain behavior to a considerable extent by ascribing mental states to the agent (e.g., Buss, 1978 Heider, 1958 Malle, 1999 McClure, 2002 Read, 1987 Wellman, Hickling, & Schult, 1997). In the case of intentional behavior, it is primarily beliefs and desires that are seen as reasons that make the agent's action intelligible. But even in the case of unintentional behavior, mental states such as emotions, perceptions, and thoughts serve to explain why the person behaved in the observed way. Thus, mental state inferences are inputs to explaining behavior.

Respiratory rate may be respiratory compensation for metabolic

Assess for nuchal rigidity, including Brudzinski and Kernig signs. Note that these signs become progressively less reliable in children younger than 15 months of age. Tilted head due to torticollis may indicate an inflamed node in contact with the sternocleidomastoid (eg, peritonsillar abscess).

Cerebellopontine Angle Tumors

Not paralyzed with neuromuscular agents when assessing facial nerve responses. A bipolar stimulating electrode provides a spatially precise means of stimulating the facial nerve, enabling EMG potentials to be recorded using needle electrodes in facial muscles (e.g. orbicularis oculi and oris). The signals are amplified and made audible to the surgeon. Although a randomized study of this technique has not been performed, few surgeons now operate without such monitoring. For large CPA lesions and other skull base tumors, the technique can be adapted to monitor the motor components of other cranial nerves. The trigeminal nerve can be assessed by inserting electrodes into the mas-seter and or temporalis muscles. The lower motor cranial nerves can be monitored by inserting electrodes into the soft palate (IX), taping electrodes to the endotracheal tube to assess laryngeal muscle function (X), or inserting electrodes in the sternocleidomastoid and trapezius muscles (XI) or the tongue (XII)....

Adverse Events Waiting To Happen

The surgeon does not have the tactile feedback of open surgery due to the length of the shaft of the surgical instruments. In addition, the freedom of movement of the video camera and the long-shafted instruments is limited because they are fixed in the abdominal wall. This forces the surgeon into unnatural and uncomfortable body postures that can affect the outcome of the operation. The problems caused by the posture the surgeon must assume in actually performing laparoscopic surgery become apparent when the ideal body posture for laparoscopic surgery is considered. Ideal Body Posture in Laparoscopic Surgery. The person is standing upright. The head is bent forward at the angle of a slight nod (Berguer, 1999) or preferably in varying positions. Increased angling of the head and neck over a long period of time should be avoided because that results in tension and pain of the neck muscles. The most favorable angle of the elbow is that for industrial...

Acromioclavicular Joint Anatomy

The acromioclavicular joint is a diarthrodial joint. Both articular surfaces have an ovoid shape. The clavicular surface lies on the acromial one, with the joint space oriented ventrally and medially. Articular surfaces are covered with fibrocartilage, which suggests a poor range of movement between them. A meniscus may arise from the superior part of the capsule (Fig. 2). In some cases, it separates the joint into two compartments, but communications between them may be found that are related to aging (1). Joint stability mainly relies on the coracoclavicular ligaments and the trapezius, deltoid, and sternocleidomastoid muscles. During abduction-adduction movements of the shoulder, the acromioclavicular joint allows the scapula to rotate around the distal end of the clavicle. Maximal tension on the coracoclavicular ligaments is obtained in forced adduction of the arm, such as in tennis backhand preparation.

Radiographic and Other Studies

Can be useful for soft, fluctuant masses (to differentiate lymphangiomas, hemangiomas, and lipomas) and suspected thyroglossal duct cyst (to identify presence or absence of normal thyroid tissue). Color-flow Doppler imaging is helpful to assess blood flow through certain lesions (eg, increased blood flow may be seen in tumoral lymphadenopathy). In fibromatosis coli, ultrasound will demonstrate an oval echogenic mass within the body of the sternocleidomastoid muscle.

Clinical diagnosis of neuromuscular respiratory failure

The danger of respiratory failure should be considered in every patient with progressive weakness, especially if the upper limbs and bulbar muscles are involved. The patient complains of weakness and fatigue but, unlike a patient with parenchymal lung disease or airway obstruction, does not appear wheezy or cyanosed. Instead, the patient prefers to sit or lie still in bed, becomes breathless on talking or swallowing, and uses the accessory muscles of respiration (pectoral, scalene, sternocleidomastoid, and levators of the nostrils). Diaphragm weakness may be detected by indrawing of the abdominal wall during inspiration, that is, paradoxical abdominal movement. Although the respiratory rate may be rapid and shallow, and the observation chart may show an increase in heart and respiratory rate over the previous few hours, this is not invariable and some patients present with ventilatory failure and a normal or reduced respiratory rate. All such patients should be monitored from the...

Combined Eye Head Movements

Combined eye-head movements occur when the head is passively perturbed and the eyes compensate by the VOR. However, under natural circumstances saccadic gaze shifts and smooth pursuit consist of a combination of eye and head movements, especially when the target eccentricity is too large to be reached with the eye alone. Active combined eye-head movements raise several questions 104 , for example whether the VOR is active during the gaze shift, or whether the local feedback loops in the saccadic system operate on gaze (eye plus head) or eye-in-head signals. While it is usually accepted that the VOR is shut off during the gaze shift, models on combined eye-head gaze shifts reached different conclusions concerning the feedback loops while most models assume that gaze is the controlled variable 105-107 , others propose that eye and head movements are controlled separately with the head controller influencing the saccadic burst generator for the eye 108 . The 3-D behavior of eye and head...

The Posterior Limit of the NCDerived Skeleton in Mammals

Thus in mouse, the post-otic NC extends to the anterior lining of the shoulder girdle at the sites where the trapezius muscle is fixed, whose connective component is of NC origin. The post-otic NCCs undergo dermal ossification of the anterior clavicle and form endochondral bone at the insertion of branchial muscles (i.e., sternocleidomastoid and the fascia of omohyoid).10 Generally speaking, the branchial muscles that have a NC connective component extend their attachment site to NC-derived bone in all skeletal structures of the neck and shoulder regions. However, in the cervical vertebra whose body and neural arches are somitic in origin 3 the NC contribution is cryptic since it is limited to spots in the spinal process, which correspond to muscle attachment sites.

Shaken Baby Syndrome 33351 Introduction

An infant is more likely to suffer from intracranial and intraocular bleeding as a result of shaking 7 because the head is proportionately larger and heavier relative to the body than that of an older child or adult, and the still weak neck muscles provide less stability and protection.

Conventional operative tracheostomy

Most surgeons prefer to perform standard elective tracheostomy in an operating room where sterility is more easily maintained and specialized lighting is readily available. Most also prefer to use general anesthesia, although local anesthesia is sometimes used. The patient is positioned supine, usually with a roll beneath the shoulders to extend the neck. After the anterior neck has been cleaned and painted with antiseptic, a 4-cm transverse incision is made over the second, third, or fourth tracheal ring. The subcutaneous tissues are divided, and the anterior neck muscles and vessels are retracted. If the thyroid isthmus overlies the region selected for tracheostomy, it is ligated and transected. After the trachea has been exposed, one or more cartilages are incised to create an opening into which to place the tube. In some cases, a plug of cartilage is excised from one or more rings. The tracheostomy tube is inserted into the opening, and the incision is closed with sutures or...

Control of breathing during mechanical ventilation

If patients can perform significant levels of work despite apparently adequate mechanical ventilation, how is rest achieved and which parameters should be adjusted to achieve rest It may be possible to elicit a history of discomfort and discoordination. Clinical examination may yield several signs of inadequate ventilation. Inspiratory activity may be present (diaphragmatic, sternocleidomastoid, and alae nasa activity) this is particularly significant when it occurs without mechanical assistance. During constant-flow ventilation, inspiratory muscle activity can be detected from irregular asymmetric pressure tracings when these are displayed continuously. If intrathoracic pressure is not measured, an estimate can be made by observing the changes in central venous pressure. During a positive pressure breath, intrathoracic pressure should rise. Conversely, if the central venous pressure falls markedly during a mechanical breath, respiratory muscle activity is likely.

Work of breathing and breathing pattern

Typical modifications in the breathing pattern induced by pressure support ventilation include an increase in tidal volume, a decrease in respiratory rate, and no major change in minute ventilation. Pressure support ventilation also induces a diminution in transdiaphragmatic pressure swings and in the pressure-time index of the diaphragm when compared with spontaneous breathing. Moreover, in patients who are difficult to wean, progressive increments of pressure support lead to parallel decreases in the work of breathing and oxygen consumption of the respiratory muscles, with disappearance of the electromyographic signs of impending diaphragmatic fatigue. These levels of support also allow accessory respiratory muscles (e.g. the sternocleidomastoid) to rest ( Biochard,,etM 1989).

Endpoint Force Field Types

Joint throughout the duration of the experiments. Stimulation through 30 of the electrodes generated whole limb synergies (involving hip, ankle and knee) with torques large enough to lift the animals' hindquarters. The final 10 of the implanted electrodes elicited cocontraction of multiple muscles resulting in stiffening of one or two joints without producing any net movement. Figure 4.8 gives examples of the single-joint and whole limb synergistic movements generated with SCjuStim in awake animals. In (A) and (B), knee extension and ankle dorsiflexion were generated primarily due to the activation of quadriceps and tibialis anterior, respectively. In some cats, quadriceps contractions generated knee torques up to 1 Nm (an estimated torque of about 0.6 Nm is required to support the hindquarters in stance). In (C), stimulation through a single electrode produced a powerful hip-knee-ankle extensor synergy capable of bearing the weight of the animal's hindquarters. These whole limb...

Larynx Cancer Relative Risk Cigarettes

Triangular Space Larynx

Hyoid bone, and the stylohyoid muscle. Thus, the triangle of soft tissue enclosed anteriorly and laterally by the mandible and dorsally by the hyoid is subdivided into one median compartment, the submental area and 2 lateral compartments, the submandibular areas. Level II represents the upper jugular (cervical) group of lymph nodes. This area extends from the base of the skull superiorly to the level of the inferior border of the hyoid bone inferiorly. The lymph nodes in this area mainly cluster in the vicinity of the internal jugular vein and are laterally covered by the body of the sternocleidomastoid muscle. Level III represents the middle jugular (cervical) group of lymph nodes. These lymph nodes are located around the middle third of the internal jugular vein that superiorly begins where the upper jugular compartment ends the lower border lies at the inferior border of the cricoid cartilage. Four different types of neck dissections are recognized 2183 . A radical neck dissection...

Reconstructive Options

Figure 15 Lip chin split, cheek rotation and segmental mandibulectomy for T4N2B of ret-romolar trigone and adjacent FOM note metal bridging plate for attachment of fibular free flap, and radical neck dissection (spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle all involved with extracapsular extension of metastases). Abbreviation FOM, anterior floor of mouth. Figure 15 Lip chin split, cheek rotation and segmental mandibulectomy for T4N2B of ret-romolar trigone and adjacent FOM note metal bridging plate for attachment of fibular free flap, and radical neck dissection (spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle all involved with extracapsular extension of metastases). Abbreviation FOM, anterior floor of mouth.

Gracilis muscle dissection and muscle insertion

Gracilis Myocutaneous Flap

The XI nerve is the most commonly used nerve for FFMT neurotization in BPI reconstruction. The XI nerve is located at the midpoint of the lateral margin of the sternocleidomastoid muscle, or one finger breadth above the transverse branch of the external jugular vein, passing laterally and obliquely down to the clavicle-acromion junction. Dissection of the XI nerve can be performed in two ways (1) from proximal to distal, the XI nerve can be found within one finger breadth above the emergence of the greater auricular nerve or (2) from distal to proximal, the attachment of the

The Interpersonal Perspective

As the tension mounts, their speech may become slow and constrained, with noticeable fragments of confused or irrelevant digressions. They may stutter through their lack of confidence, as with the case of Sean (Case 6.2). Because avoidants often feel that others are watching for their gaffes, their body posture may seem stiff and highly controlled, though with periodic bursts of fidgety movements. Overt expressions of emotion are kept in check for fear that others might detect their anxiety, much to their own shame. Inevitably, the feeling of being awkward contributes to their awkwardness. This is especially true of avoidants, for whom every miskeyed movement is scrutinized and judged, or so they believe.

Right Internal Jugular Vein Approach

Identification of the triangle formed by the clavicle and the medial and lateral heads of the sternocleidomastoid muscle is essential. This may be facilitated by palpating and visualizing the neck while the patient slightly lifts the head from the table, resulting in activation of the appropriate muscles.

Primary and Neck Resection

Communication among surgeons during the neck dissection is also important. For anticipated microvascular cases, gentle dissection and sparing of arterial and venous vessels and lengthy stumps is important for maintaining anastomosis options. Although this requires extra effort and time, sparing extra vessels such as the transverse cervical pedicle and external jugular vein should usually not compromise oncologic resection. The appropriate recipient vessel size needed can be estimated from the anticipated donor site. In addition, inter-surgeon communication of anticipated defect location and microvascular pedicle length, can guide the extirpative surgeon to save potential recipient vessels in a given area of the neck, while allowing faster dissection in non-essential areas. Similarly, anticipated resection of the proximal external carotid arterial system due to neck disease should be communicated to the reconstructive surgeon so alternative recipient arterial supplies can be prepared...

Trochlear nerve palsy

Effects The superior oblique is primarily an intorter and a depressor in adduction. This results in upward vertical deviation of the paralyzed eye in adduction and vertical strabismus (see Fig. 17.16). Patients experience vertical diplopia the images are farthest apart in depression and intorsion. Compensatory head posture is discussed in the section on symptoms. Diplopia is absent in elevation.

Gas exchange consequences

The patient experiencing a severe asthma attack remains seated, avoids speaking, and is dyspneic with profuse diaphoresis and cyanosis. The respiratory rate is increased (above 30 breaths min). Prolonged and active expiration is covered by musical wheezes. The patient breathes with effort, using accessory muscles. Contraction of the sternocleidomastoid muscle, tracheal tug, and inward movement of the thoracic cage during inspiration may be noted. With fatigue, there may appear a paradoxical respiration, bradypnea, and respiratory pauses. These signs or the appearance of a silent chest indicate imminent respiratory arrest. Complications such as pneumothorax or pneumomediastinum may occur any time.

Cerebral Blood Volume

Elevation of the head to 30 degrees above the heart, in order to improve venous outflow and reduce intracerebral hydrostatic pressure, is traditionally advocated in severe head injury. This measure is now also controversial and some centers evaluate head position by its effects on ICP in each individual patient. This measure should be avoided in hypovolemic patients.

Ischemic Stroke And Carotid Endarterectomy

Images Carotid Endarterectomy

Under the sternocleidomastoid, the internal jugular vein and the common facial vein, a branch of the internal jugular, are identified, double-ligated and divided. Care should be taken not to injure the spinal accessory nerve, which is at risk for transection and stretching. Gentle lateral retraction of the internal jugular exposes the carotid artery. Opening the carotid sheath then proceeds, starting inferiorly by the anterior surface of the artery to the level of the omohyoid muscle. Dissection of the CCA, ECA and ICA is gently carried out and vessel loops Fig. 38.3. Illustration of the maneuver used to expose the upper margin of the internal carotid artery by mobilizing the hypoglossal nerve. Normally, the hypoglossal nerve is tethered against the external and internal carotid artery by either the occipital artery or the first branch from the occipital artery after it emerges from the external carotid artery, the sternomastoid artery (upper). This small artery is usually associated...

Pharmacological Actions

It does not affect nerve or muscle excitability or conduction of action potentials. Because it is charged, it penetrates cells poorly and does not enter the CNS. However, if applied directly to brain or spinal cord, it will block nicotinic AChR in those tissues. In humans, d-tubocurarine has a moderate onset of action (34 minutes) followed by progressive flaccid paralysis. The head and neck muscles are affected initially, then the limb muscles, and finally the muscles of respiration. Recovery from paralysis is in the reverse order.

Thyroglossal Duct Cyst and Ectopic Thyroid

Cervical thymic cysts are uncommon approximately 120 cases in children were reported through 2001 51, 89 . Males are affected more commonly than females. According to Guba et al., 70 of CTC are on the left side of the neck, 23 on the right and the remainder in the mid-line 47 . They can be found anywhere from the angle of the mandible to the sternum, paralleling the sternocleidomastoid muscle and normal descent of the thymus. Sixty-seven percent occur in the first decade of life. The remainder occur in the second and third decades 51 .


Proper setup of a stereo-dissecting-type microscope is important for good microsurgery. In addition to to good posture, eyepiece height, and working height of the bench, it is very important to adjust the eyepieces according to the manufactuer's instructions, such that both eyes focus at the same level and have stereoptic vision. We work on a large, flat, cooled surface, rather than on

Cervical Lesions

Extension of the tumor into the thoracic inlet must be determined prior to surgery as the exposure is much different for these tumors. Most pure cervical lesions have favorable histologic characteristics, a good pseudocapsule, and occur in patients < 1 year of age at diagnosis.Very large lesions may require partial or complete division of the sternocleidomastoid muscle. Grossly involved jugulodigastric lymph nodes should be removed in a systematic way using a modified neck-dissection technique. Parents should be forewarned that removal of cervical lesions almost always results in Horner's syndrome.

Tornwaldts Cyst

A Tornwaldt's cyst (or pharyngeal bursitis named after Gustav Ludwig Tornwaldt, 1843-1910) is a dilatation of a persistent pharyngeal bursa in the posterior median wall of the nasopharynx above the superior pharyngeal constrictor muscles and at the lower end of the pharyngeal tonsil caudally and posteriorly to where Rathke's cleft cysts arise 128 . The cysts arise at the site of embryonic communication between the notochord and the roof of the pharynx and can be detected in up to 7 of adults at routine autopsies 86 . Tornwaldt's cysts are typically less than 1 cm in size and asymptomatic 92 . Obstruction of the bursal orifice results in a cystic dilatation. The cysts may become infected and inflamed with subsequent abscess formation. Symptomatic disease, termed Tornwaldt's disease, may present with nasal obstruction and nasopharyngeal drainage, dull occipital headaches, pain in the ears and neck muscles and occasionally neck muscle stiffness 130 . Tornwaldt's cysts are lined with...


To accurately deliver treatments to the intended target, the patient must be immobilized in a comfortable and reproducible position. Immobilization of the trunk and extremities is often accomplished with the aid of vacuum-molded bags of polystyrene beads or polyurethane foam molds which can be customized to each patient. Masks of thermal plastic materials, which become compliant when heated can be applied to the head and neck, and secured to the treatment couch or head holder to ensure reproducibility of neck flexion and head position.

Binocular Adaptation

When short-term phoria adaptation is performed with a vertical disparity at a single location, phoria becomes uniform for all gaze directions. Upon two vertical disparities at opposite gaze directions and with opposite sign, adapted phoria shows a gradient along the line between the two stimuli 91, 92 . Phoria adaptation to opposite vertical disparities is also effective along the depth axis 93 or to multiple vertical disparities at different near and far locations 94 . Human subjects are also able to adapt vertical phoria to different prism-induced vertical disparities that vary with head position 95 or with head and gaze


This female patient of Asian descent was born in 1970 in Korea, but moved as a child to a foster family in Europe. Of her family nothing is known. At the age of 16 tics started to appear. These consisted initially of jerks of her head to the left, but gradually over the years more involuntary movements appeared, such as contractions of eyes, mouth and lips accompanied by vocalisations. In 1993 a diagnosis of Gilles de la Tourette syndrome was made, despite the findings of areflexia and a CPK of 700 U L (normal < 170 U L for females). As the symptoms worsened over the years psychiatric interventions became necessary. There was loss of concentration and increasingly chaotic behaviour. Haloperidol, tetrabenazine and pimozide were prescribed in high doses. These resulted in severe depression and somnolence, and an increase of orofacial dyskinesias was seen which was initially interpreted as tardive dyskinesia. Her situation worsened in that she showed self-mutilation with biting of her...

Needle Approach

The right side is most often chosen for a right-handed physician. After disinfection and local anesthesia in the medial border of the sternocleidomastoid muscle, the needle is inserted between the large vessels laterally and the esophagus and trachea medially, which are pushed away by the fingers (9). Great care must be taken during the procedure to avoid puncturing the carotid. Specific techniques to avoid this problem have been proposed no local anesthesia because of the proximity of cephalic vessels displacing the trachea, the esophagus, and the carotid medially (together) away from the path of the needle more lateral approach and laterally and posteriorly to the jugulocarotid vessels at the posterior border of the sternocleidomastoid muscle. As at the lumbar level, proper placement of the needle tip is to be checked with biplanar fluoroscopy and AP and lateral radiographs.

Other Views

First, my asymmetry hypothesis is that, helped by visual evidence, young children first apply the concepts of attitudes to others, and need more time, more cognitive effort, different evidence, and new abilities to figure out how to apply the (alleged) same concepts to themselves. Same concepts notwithstanding, it is still the case that self-ascriptions can be harder and develop later than other-ascriptions. A second argument points to evolution. The asymmetry is not just a matter of evidence and cognitive resources. It is also a matter of the function of a theory of mind. A good case can be made that in humans and possibly other primates a naive theory of mind first evolved to deal with conspecifics, not with selves. The most pressing challenges posed by conspecifics are in ongoing contexts of social interaction and involve observable features of conspecifics, such as facial expression, gaze, bodily posture, behavior, communication, and the like (Bogdan, 1997 Tomasello, 1999 Whiten,...


Also known as fibromatosis coli or fibroma of the sternocleidomastoid muscle. May present as a fibrous mass in a 2- to 8 week-old infant with a head tilt occurs as a result of collagen and fibrous tissue deposition around atrophied muscle fibers of the sternocleidomastoid muscle.


A less common form of the disease is that of infant botulism, which follows the ingestion of spores of neurotoxigenic Clostridium that germinate and multiply within the intestinal tract. Rather than a primary intoxication, this disease is an intoxication following a previous infection of the infant's intestinal tract, which lacks the protective bacterial flora of the adult, allowing colonization by Clostridium. It has been estimated that fewer than 100 spores are sufficient to cause such disease (Arnon 1980). The affected infants present constipation, weak sucking, hypotonia, and ptosis. In the more severe cases, the patient becomes lethargic and loses head posture control. The disease progresses to a flaccid paralysis which may extend to respiratory muscles with arrest. Type A toxin is usually associated with more severe diseases and a higher mortality rate than type B or E toxin, and the recovery time is accordingly longer (Arnon 1980). Wound botulism following spore contamination...

Orbital Examination

Optic Disc Haemorrhage

The proptotic eye should also be examined from the standpoint of ocular motility in cardinal positions and compared with the normal eye. Recordings of deviations should be made whenever applicable. Although accurate recordings of prism values may be useful for the posttreatment follow-up of the patient, detailed diplopia measurements in prism diopters are not always possible or necessary. The amount of deviation can be quickly approximated by a red glass test in the clinic.36 The author's preference is to use a modified Maddox cross engraved on transparent plastic that has a white fixation light in the center (Figure 6.10). When the patient is seated with straight head position at 50 cm, the numbers on the cross indicate the amount of deviation in degrees. A red glass is positioned in front of the fixating eye, and the patient is asked to point at the white light and the red light on the surface of the device (Figure 6.11).


Triple Nerve Transfer

The XI nerve is the motor nerve of the sternocleidomastoid and trapezius muscles, lying behind the sternocleidomastoid muscle at a point within one finger breadth above the emergence of the greater auricular nerve, passing laterally, obliquely, and posteriorly in front of the trapezius muscle. Alternatively, the XI nerve can also be indentified subcutaneously on the anterior and lateral margins of the trapezius muscle after detaching the trapezius muscle from the clavicle. Nerve stimulation can confirm the location of the XI nerve. Dissection should be as distal as possible down to the two or three terminal rami that enter into the muscle, which are then divided for transfer. The proximal stump can be transferred either to the retro- or supraclavicular region to coapt the suprascapular nerve (see Fig. 2 Fig. 4), or to the posterior division of the upper trunk directly, or to the infraclavicular region for free muscle transplantation. In addition to the main distal ramus being coapted...

Of Neck Dissections

Neck dissection is classified primarily by the cervical lymph node groups that are removed, and secondarily on the anatomic structures that may be preserved, such as the spinal accessory nerve, the sternocleidomastoid muscle, and the internal jugular vein 71, 99 . Table 9.5. Updated classification of neck dissection (extracted from 99 ). SCM sternocleidomastoid, IJV internal jugular vein, SAN spinal accessory nerve Radical neck dissection consists of the removal of all five lymph node regions of one side of the neck (levels I-V). This includes removal of the sternocleidomastoid muscle, the internal jugular vein, and the spinal accessory nerve. Modified radical neck dissection refers to excision of all lymph nodes routinely removed by radical neck dissection, with preservation of one or more of the non-lymphatic structures (i.e. spinal accessory nerve, internal jugular vein, and or sternocleidomastoid muscle). After the neck dissection specimen has been oriented as it appears in vivo,...


Preston and de Waal (2002a) propose that at the core of the empathic capacity is a relatively simple mechanism that provides an observer (the subject) with access to the subjective state of another (the object) through the subject's own neural and bodily representations. When the subject attends to the object's state, the subject's neural representations of similar states are automatically activated. The more similar the subject and object, the more the object will activate matching peripheral motor and autonomic responses in the subject (e.g., changes in heart rate, skin conductance, facial expression, body posture). This activation allows the subject to understand that the object also has an extended consciousness, including thoughts, feelings, and needs, which in turn fosters sympathy, compassion, and helping. Preston and de Waal (2002b) and de Waal (2003) propose evolutionary continuity between humans and other mammals in this regard. Their Perception-Action Model (PAM) fits...

Nystagmus Definition

Treatment Where nystagmus can be reduced by convergence, prisms with an outward facing base may be prescribed. In special cases, such as when the patient assumes a compensatory head posture to control the nystagmus, Kestenbaum's operation may be indicated. This procedure involves parallel shifts in the horizontal extraocular muscles so as to weaken the muscles that are contracted in the compensatory posture and strengthen those that are relaxed in this posture.

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