Tonsillar origin of deep neck infection as a negative prognostic factor for developing complications.

<b>Aim:</b> The aim of this study was to compare the odontogenic and tonsillar origins of deep neck infection (DNI) as a negative prognostic factor for developing complications. </br></br> <b>Methods:</b> This was a retrospective study of 544 patients with tonsillar and odontogenic origins of DNI treated between 2006 and 2015 at 6 ENT Departments and Departments of Oral and Maxillofacial Surgery. Complications from DNI (descending mediastinitis, sepsis, thrombosis of the internal jugular vein, pneumonia, and pleuritis) were evaluated in both groups and compared. Associated comorbidities (cardiovascular involvement, hepatopathy, diabetes mellitus respiratory involvement, gastroduodenal involvement) were reviewed. </br></br> <b>Results:</b> Five hundred and forty-four patients were analyzed; 350/544 males (64.3%) and 19/544 females (35.7%). There were 505/544 cases (92.8%) with an odontogenic origin and 39/544 cases (7.2%) with a tonsillar origin of DNI. Complications occurred more frequently in the group with tonsillar origin of DNI (P < 0.001). There was no difference in diabetes mellitus between the two groups. </br></br> <b>Conclusions:</b> Currently, the tonsillar origin of DNI occurs much less frequently; nevertheless, it carries a much higher risk of developing complications than cases with an odontogenic origin. We recommend that these potentially high-risk patients with a tonsillar origin of deep neck infections should be more closely monitored.

Prevalence of impaired upper extremity neural mobility among smart device users during the COVID-19 pandemic.

BACKGROUND: Both the development of various countries and people's health were impacted by the unforeseen global COVID-19 outbreak. Many countries prefer to do their daily business online. Although it was incredibly useful at the time, it still had a problem that was not properly addressed, especially among the student population. OBJECTIVE: The objective of this study was to examine the prevalence of upper extremity neural mobility among students who were using smart devices during the COVID-19 pandemic. METHODS: 458 students who had previously taken home-based online classes during the COVID-19 pandemic and used a smart device for more than six hours were included in this study. The study was conducted in three phases. After being examined in the first two stages of the study, a total of 72 people were chosen for the final phase. Peripheral nerve mobility tests were performed on these 72 subjects. RESULTS: This study observed that 15.72% of smart device users have been affected by forward neck posture and impaired peripheral nerve mobility in the cervical spine. CONCLUSION: The study concludes that forward neck posture is associated with impaired peripheral nerve mobility among smart device users who were in home-based online classes during the COVID-19 pandemic lockdown. Hence, we suggest an appropriate treatment strategy focusing on preventing the forward neck posture through timely analysis and self-care therapies.

Magnetic resonance imaging organ at risk delineation for nasopharyngeal radiotherapy: Measuring the effectiveness of an educational intervention.

INTRODUCTION: Magnetic resonance imaging (MRI) demonstrates superior soft tissue contrast and is increasingly being used in radiotherapy planning. This study evaluated the impact of an education workshop in minimising inter-observer variation (IOV) for nasopharyngeal organs at risk (OAR) delineation on MRI. METHODS: Ten observers delineated 14 OARs on 4 retrospective nasopharyngeal MRI data sets. Standard contouring guidelines were provided pre-workshop. Following an education workshop on MRI OAR delineation, observers blinded to their original contours repeated the 14 OAR delineations. For comparison, reference volumes were delineated by two head and neck radiation oncologists. IOV was evaluated using dice similarity coefficient (DSC), Hausdorff distance (HD) and relative volume. Location of largest deviations was evaluated with centroid values. Observer confidence pre- and post-workshop was also recorded using a 6-point Likert scale. The workshop was deemed beneficial for an OAR if ≥50% of observers mean scores improved in any metric and ≥50% of observers' confidence improved. RESULTS: All OARs had ≥50% of observers improve in at least one metric. Base of tongue, larynx, spinal cord and right temporal lobe were the only OARs achieving a mean DSC score of ≥0.7. Base of tongue, left and right lacrimal glands, larynx, left optic nerve and right parotid gland all exhibited statistically significant HD improvements post-workshop (P < 0.05). Brainstem and left and right temporal lobes all had statistically significant relative volume improvements post-workshop (P < 0.05). Post-workshop observer confidence improvement was observed for all OARs (P < 0.001). CONCLUSIONS: The educational workshop reduced IOV and improved observers' confidence when delineating nasopharyngeal OARs on MRI.

Assessment of Forward Head Posture and Ergonomics in Young IT Professionals - Reasons to Worry?

BACKGROUND:  Prolonged computer use and poor ergonomics among IT professionals are considered risk factors for musculoskeletal disorders. This research aims to analyze the degree of forward head posture and workplace ergonomics in young IT professionals to assess the risk for a neck disability. Methods: A prospective study was carried out by assessing the sitting posture at work, neck disability in the cervical region, quality of life, physical activity, and ergonomics of the workspace in 73 young IT professionals (32.56±5.46 years). Results: The score for the cervical functional disability index (NDI) showed a mild neck disability (8.19±7.51). The craniovertebral angle has an average value of 32.01±11.46, corresponding to a light forward head posture, and it positively correlated with age and work experience and negatively correlated with ROSA (r=0.24, p<0.05). The NDI positively correlated with physical activity (r =00.32 p<0.05) and with ROSA (r= 0.24, p<0.05). Conclusions: In IT professionals, neck disability is associated with the lack of workspace ergonomics and the amount of physical activity. Forward head posture correlated with age, work experience, and poor workspace ergonomics. According to our findings, there are real concerns about the influence of head posture and workplace ergonomics on health among IT professionals. We consider that it is necessary to adopt preventive measures to address neck disability and improve workspace ergonomics.

Isolated thyroid abscess in early childhood.

Isolated thyroid abscess is a rare entity in early childhood. Among thyroid disorders, thyroid abscess or acute suppurative thyroiditis constitutes about 0.7%-1% of all cases. The thyroid gland is normally resistant to infections due to its well-enveloped capsule, rich blood supply, and high iodine content.A child presented with tender neck swelling accompanied by fever for 3 days. Ultrasound of the neck showed features suggestive of left parapharyngeal abscess. Laboratory parameters including thyroid function test were within normal limits. Contrast-enhanced CT of the neck was done and showed an isolated thyroid abscess with no other abnormalities. The patient was started on intravenous antibiotics followed by incision and drainage of the abscess. The child improved symptomatically. This report discusses the differential diagnosis and management of this rare entity.

[Surgical treatment of a patient with stage v multinodular toxic goiter, severe thyrotoxicosis, strangulation syndrome and severe comorbidities]. / Khirurgicheskoe lechenie patsientki s mnogouzlovym toksicheskim zobom V stepeni, tireotoksikozom tyazheloi stepeni, kompressionnym sindromom i tyazhelymi soputstvuyushchimi zabolevaniyami.

The authors describe thyroidectomy in a patient with multinodular toxic goiter stage V, severe thyrotoxicosis complicated by thyro-cardiac disease, strangulation syndrome and severe comorbidities. Nodular euthyroid goiter was first diagnosed in 1992, and resection of the right thyroid lobe was performed. Progressive enlargement of thyroid gland and thyrotoxicosis occurred after coronavirus infection in February, 2020. Along with progression of thyrotoxicosis and strangulation of cervical organs, the patient suffered from portal vein thrombosis, pulmonary embolism. Myeloproliferative disease with essential thrombocythemia was also diagnosed. Volume of the right and left thyroid lobes was 69 and 101.3 cm3, respectively. X-ray examination of the esophagus revealed narrowing at C6 level up to 5-8 mm. Surgery time was 2 hours, dimension of removed right thyroid lobe - 10.0×7.5×6.5 cm, left thyroid lobe - 11.0×6.5×5.5 cm, total weight - 348 g. The patient was discharged in 6 days after surgery.

Pediatric Cystic Deep Neck Mass Presenting With Stridor and Dysphagia.

A 6-month-old girl presented to the emergency department for evaluation of fever and was noted to have mild inspiratory stridor, which began acutely at 4 months of age without any inciting illness or event. What is your diagnosis?

Deep neck space infection extending to the mediastinum that was treated conservatively.

Deep neck space infections (DNSIs) are challenging to diagnose and manage. A female ex-smoker presented with difficulty breathing and chest pain. She was initially treated for exacerbation of emphysema with intravenous antibiotics. The ear, nose and throat team were later asked to review the patient for left submandibular swelling and odynophagia. CT of the neck was performed 10 days later, due to limited availability during COVID-19. It showed an extensive retropharyngeal collection from the level of the vallecula to just above the carina. Normally, a DNSI extending to the mediastinum would require prompt surgical management. However, the patient was clinically well once imaged, so the abscess was managed conservatively with intravenous antibiotics.

The Effect of the FIFA 11 + with Added Neck Exercises on Maximal Isometric Neck Strength and Peak Head Impact Magnitude During Heading: A Pilot Study.

BACKGROUND: Higher neck strength has been postulated to reduce head impact magnitude during purposeful heading in football. OBJECTIVES: This pilot trial explored the effect of a neck exercise programme on (1) neck strength and (2) head impact magnitude during heading in male and female adolescent football players. METHODS: Boys and girls (aged 12-17 years) were randomised by team to the intervention (5 weeks of supervised neuromuscular neck exercises integrated into part 2 of the FIFA 11 + , completed three times per week) or the control group (usual part 2 of the FIFA 11 + , no neck exercises). Outcomes included isometric neck strength and head impact magnitude (peak linear acceleration and peak angular velocity) during standardised heading from a throw-in (at baseline and 6 weeks) plus completion of an evaluation survey by intervention players and coaches. RESULTS: In total, 52 players (n = 31 intervention; n = 21 control) completed the study. Mixed-model analysis of variance (ANOVA) revealed significant differences in neck strength variables (p < 0.001), peak linear acceleration (p = 0.04) and peak angular velocity (p = 0.04) between the intervention and control groups over time. Intervention players demonstrated increases in mean composite neck strength (53.8% intervention vs 15.6% control) as well as decreases in mean peak linear head acceleration during heading (- 11.8% vs - 5.0%) from baseline to follow-up. Reduction in peak angular velocity was more pronounced in girls (- 27.7%) than boys (- 11.5%) in the intervention group. The addition of neck exercises into part 2 of the FIFA 11 + was feasible and accepted by players and coaches. CONCLUSION: On average, players who completed neck exercises demonstrated an increase in isometric neck strength and a decrease in head impact magnitude during heading. These exercises were easily incorporated into usual training. Australian New Zealand Clinical Trials Registry (no: ACTRN12619001375145).

Repetitive trauma-induced extra-nuchal-type fibroma.

A nuchal-type fibroma is a rare, benign fibrous tumour that typically occurs in the posterior neck along the midline, but can occur in extra-nuchal locations, most commonly in the back, shoulder and face. We present a biopsy-proven case that arose as a result of heavy gym-related activities. In particular, a heavy barbell was rested on his vertebral prominence at the level of C7/T1 during leg squatting. Repetitive trauma as a cause for extra-nuchal-type fibromas has been sparsely reported, but we suggest that sustained high pressure is an additional required feature. Although this lesion was in the posterior neck, it was contained entirely within the subcutaneous tissues without involvement of the nuchal ligament. Hence, it was considered an extra-nuchal fibroma. A description of key ultrasound and MRI imaging characteristics are provided to assist in making the diagnosis, along with a review of the current literature and a discussion of differential diagnoses.

Cervical lymphadenopathy following coronavirus disease 2019 vaccine: clinical characteristics and implications for head and neck cancer services.

OBJECTIVE: Patients with coronavirus disease vaccine associated lymphadenopathy are increasingly being referred to healthcare services. This work is the first to report on the incidence, clinical course and imaging features of coronavirus disease vaccine associated cervical lymphadenopathy, with special emphasis on the implications for head and neck cancer services. METHODS: This was a retrospective cohort study of all patients referred to our head and neck cancer clinics between 16 December 2020 and 12 March 2021. The main outcomes measured were the proportion of patients with vaccine-associated cervical lymphadenopathy, and the clinical and imaging characteristics. RESULTS: The incidence of vaccine-associated cervical lymphadenopathy referrals was 14.8 per cent (n = 13). Five patients (38.5 per cent) had abnormal-looking enlarged and rounded nodes with increased vascularity. Only seven patients (53.9 per cent) reported full resolution within an average of 3.1 ± 2.3 weeks. CONCLUSION: Coronavirus disease vaccine associated cervical lymphadenopathy can mimic malignant lymphadenopathy and therefore might prove challenging to diagnose and manage correctly. Healthcare services may encounter a significant increase in referrals.

Multisystem inflammatory syndrome in children associated with SARS-CoV-2: extracardiac radiological findings.

OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) is seen as a serious delayed complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to describe the most common imaging features of MIS-C associated with SARS-CoV-2. METHODS: A retrospective review was made of the medical records and radiological imaging studies of 47 children (26 male, 21 female) in the age range of 25 months-15 years who were diagnosed with MIS-C between August 2020 and March 2021. Chest radiographs were available for all 47 patients, thorax ultrasound for 6, chest CT for 4, abdominal ultrasound for 42, abdomen CT for 9, neck ultrasound for 4, neck CT for 2, brain CT for 1, and brain MRI for 3. RESULTS: The most common finding on chest radiographs was perihilar-peribronchial thickening (46%). The most common findings on abdominal ultrasonography were mesenteric inflammation (42%), and hepatosplenomegaly (38%, 28%). Lymphadenopathy was determined in four patients who underwent neck ultrasound, one of whom had deep neck infection on CT. One patient had restricted diffusion and T2 hyperintensity involving the corpus callosum splenium on brain MRI, and one patient had epididymitis related with MIS-C. CONCLUSION: Pulmonary manifestations are uncommon in MIS-C. In the abdominal imaging, mesenteric inflammation, hepatosplenomegaly, periportal edema, ascites and bowel wall thickening are the most common findings. ADVANCES IN KNOWLEDGE: The imaging findings of MIS-C are non-specific and can mimic many other pathologies. Radiologists should be aware that these findings may indicate the correct diagnosis of MIS-C.

Primary thyroid squamous cell carcinoma presenting as a left-sided neck lump.

The elderly patient presenting with a neck lump often raises concerns regarding a malignancy. Thyroid gland malignancies are well recognised and subtype characteristics thoroughly researched, whereas rarer types of thyroid carcinoma are reported infrequently and often behave more aggressively. An 83-year-old woman was referred from the general practitioner (GP) to otolaryngology due to a 7-month history of an unexplained enlarging left-sided neck swelling. A fine-needle aspiration revealed cytology consistent with squamous cell carcinoma (SCC). Staging imaging failed to reveal evidence of a primary foci elsewhere. The definitive diagnosis was that of a primary thyroid SCC: a rare entity with limited citations in the literature. Surgical resection has been found to comprise the optimal treatment for this disease. Recognition of the possibility of primary thyroid SCC in elderly patients presenting with a neck lump, with prompt referral to a head and neck specialist permits a timely progression to potentially curative surgical management, a more promising prognosis and reduced mortality rates.