The neck is the part of the body on many limbed vertebrates that distinguishes the head from the torso or trunk.

Anatomy of the human neck

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Bony anatomy: The cervical spine

The cervical portion of the human spine comprises seven bony segments, typically referred to as C-1 to C-7, with cartilaginous disks between each vertebral body. The neck supports the weight of the head and protects the nerves that travel from the brain down to the rest of the body. In addition, the neck is highly flexible and allows the head to turn and flex in all directions. From top to bottom the cervical spine is gently curved in convex-forward fashion. It is the least marked of all the curves of the column.

Soft tissue anatomy

In the middle line below the chin can be felt the body of the hyoid bone, just below which is the prominence of the thyroid cartilage called "Adam's apple," better marked in men than in women. Still lower the cricoid cartilage is easily felt, while between this and the suprasternal notch the trachea and isthmus of the thyroid gland may be made out. At the side the outline of the sternomastoid muscle is the most striking mark; it divides the anterior triangle of the neck from the posterior. The upper part of the former contains the submaxillary gland, which lies just below the posterior half of the body of the jaw. The line of the common and the external carotid arteries may be marked by joining the sterno-clavicular articulation to the angle of the jaw.

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Head & Neck

Modern management and pathophysiology of ranula: Literature review
John D. Harrison Wed, 06 Jan 2010 13:29:00 -0000
There is a lack of consensus about the appropriate treatment of ranula. The objective of the present investigation was to produce a scientific basis for treatment.A review of the relevant literature is interpreted in the light of improved knowledge about the local anatomy and the pathophysiology of the salivary glands.The oral and plunging ranulas are cystic extravasation mucoceles that arise from the sublingual gland and usually from a torn duct of Rivinus. The sublingual gland is a spontaneous secretor and the salivary flow is resistant to obstruction, which is caused by fibrosis induced by the extravasation. The submandibular gland is not a spontaneous secretor, is less resistant, and does not give rise to ranulas.Effective treatment is removal of the involved unit of the sublingual gland or inducing sufficient fibrosis to seal the leak through which the mucus extravasates. © 2010 Wiley Periodicals, Inc. Head Neck, 2010
Immunotherapy using allogeneic squamous cell tumor-dendritic cell fusion hybrids
Walter T. Lee, Chunrui Tan, Gary Koski, Suyu Shu, Peter Cohen Wed, 06 Jan 2010 13:29:00 -0000
Tumor-associated antigens (TAAs) are known to be immunotherapy targets; thus tumor-sharing TAA may be used as a fusion hybrid partner to confer protection against subsequent tumor challenge.The squamous cell carcinomas (SCCs), SCCVII and B4B8, were used in C3H/HEN mice: SCCVII (H-2k) is syngeneic, B4B8 (H-2d) is allogeneic. Experiments using tumor alone included hyperimmunization schedule, subdermal and intranodal routes. Mice were challenged 2 weeks later. Fusion hybrids were created from both SCC tumor cell lines and syngeneic dendritic cells (DCs). These were delivered intranodally for immunization, and mice were challenged with tumor 2 weeks later.Only syngeneic tumor given subdermally was able to protect after tumor challenge 2 weeks later. Hyperimmunization schedule did not alter these findings. However, fusion hybrid immunization from both allogeneic and syngeneic SCCs conferred protection after tumor challenge.Allogeneic tumor-DC fusion hybrids targeting TAA can protect against subsequent tumor challenge. © 2010 Wiley Periodicals, Inc. Head Neck, 2010
Predictors of functional decline in locally advanced head and neck cancer patients from South Brazil
Heidi J. Silver, Christine de Campos Graf Guimaraes, Paola Pedruzzi, Maraisa Badia, Adriana Spuldaro de Carvalho, Benedito V. Oliveira, Gyl H. A. Ramos, Mary S. Dietrich, Ricardo Pietrobon Wed, 06 Jan 2010 13:29:00 -0000
Functional decline in Brazilian patients with head and neck squamous cell carcinoma (HNSCC) is associated with impaired recovery, quality of life, and health care costs.Sixty patients enrolled at the regional oncology center in Curitiba, Brazil, were assessed over 6 months for toxicities, nutritional status, anthropometry, fatigue, stress, and functionality.Severe mid-arm and mid-calf circumference depletion accompanied weight loss. Total fatigue score increased 64% (p < .001), as did perceived stress and serum cortisol (p = .01). Instrumental activities of daily living (IADL) dependence doubled, and activities of daily living (ADL) dependence quadrupled (p < .001). Difficulty chewing or swallowing, weight loss, fatigue, perceived stress, and IADL dependence accounted for 48.2% of ADL dependence.The physical and psychological impact of HNSCC and its treatment are universally experienced; yet, screening and intervention for symptoms such as fatigue and stress are not typical clinical practice. Moreover, assessment of functional status is usually limited to chewing and swallowing. This study identified symptoms that require systematic intervention and randomized trials with functional independence as the outcome. © 2010 Wiley Periodicals, Inc. Head Neck, 2010
Role of pretreatment 18FDG-PET/CT in surgical decision-making for head and neck cancers
N. Gopalakrishna Iyer, Jonathan R. Clark, Shahlini Singham, Jacqui Zhu Wed, 06 Jan 2010 13:29:00 -0000
Despite widespread use, the utility of pretreatment positron emission tomography/computed tomography (PET/CT) remains undefined. In this study, we aim to determine its accuracy in nodal disease.In all, 111 patients managed between 2003 and 2007 were analyzed.For squamous cell cancers (SCCs) with any increased nodal uptake (mild to high), sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were 75%, 95%, 85%, and 90%. However, if PET was deemed positive for only moderate to high uptake, sensitivity, specificity, PPV, and NPV were 71%, 95%, 85%, and 89%. In patients undergoing elective neck dissection, the accuracy was lower: for any increased uptake, sensitivity, specificity, PPV, and NPV were 66%, 96%, 83%, and 92%, whereas for moderate to high uptake, these were 52%, 97%, 79%, and 89%.Despite advances in PET/CT technology, these statistics suggest that PET/CT is not sufficiently accurate to direct superselective neck dissections, or to guide therapeutic decisions in the N0 neck. © 2010 Wiley Periodicals, Inc. Head Neck, 2010
Intrinsic differences in cisplatin sensitivity of head and neck cancer cell lines: Correlation to lysosomal pH
Cathrine Nilsson, Karin Roberg, Roland C. Grafström, Karin Öllinger Tue, 22 Dec 2009 14:24:00 -0000
Cisplatin treatment is beneficial for approximately 20% of patients with head and neck squamous cell carcinoma (HNSCC). Tools to predict the clinical outcome and evaluate intrinsic cisplatin sensitivity are, therefore, required.Cisplatin sensitivity, lysosomal pH, and cell death pathway was studied in 5 HNSCC lines and compared with normal oral keratinocytes.We identified a linear relationship between lysosomal pH and cisplatin sensitivity. Reduced lysosomal acidification was correlated to decreased expression of the V0V1-ATPase B2 subunit, which is part of the lysosomal acidifying complex. Cisplatin caused apoptosis accompanied by lysosomal membrane permeabilization, and inhibition of lysosomal proteases (cathepsins) partly prevented cell death.Cisplatin-induced apoptosis of HNSCC is more efficient in cell lines with low lysosomal pH and is mediated by the release of lysosomal content. Lysosomal pH and expression of V0V1-ATPase subunits are possible future markers of intrinsic cisplatin sensitivity. © 2009 Wiley Periodicals, Inc. Head Neck, 2010
Prognostic value of MAGE-A and NY-ESO-1 expression in pharyngeal cancer
Marija Pastorcic-Grgic, Bozena Sarcevic, Danijel Dosen, Antonio Juretic, Giulio C. Spagnoli, Marko Grgic Tue, 22 Dec 2009 14:24:00 -0000
The prognostic value of cancer testis antigens in pharyngeal cancer is understudied.We recruited 90 patients who were treated for pharyngeal cancer. Monoclonal antibodies 57B and B9.8.1.1 were used for detection of MAGE-A and NY-ESO-1 genes.MAGE-A and NY-ESO-1 gene products were detectable in 70.0% and 33.3% of pharyngeal tumors, respectively. No correlation was established between MAGE-A and NY-ESO-1 expression and TNM staging at presentation. Survival analysis showed a trend toward a shorter 5-year disease-free survival in the group of patients with MAGE-A-positive tumors (log-rank test, p = .122). In contrast, a trend toward a prolonged 5-year disease-free survival was observed in the group of patients with NY-ESO-1-positive tumors (log-rank test, p = .219).In a large population of patients with pharyngeal cancer and available 5-year survival data, prognosis tended to be poorer with MAGE-A expression and better with NY-ESO-1 expression, but the correlations did not reach statistical significance. © 2009 Wiley Periodicals, Inc. Head Neck, 2010

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