SUMMARY Neck manipulation may uncommonly be associated with serious and even fatal vascular complications. Although well recognised, the nature of the vascular injury has only rarely been directly established by pathological examination. The case is reported of a 43-year-old man who died following neck manipulation, and in whom multiple dissecting aneurysms within both vertebral arteries were demonstrated radiologically and found at necropsy. Bilateral dissecting aneurysms were found both at the level of atlanto-axial articulation and close to the origins of the vertebral arteries. No predisposition was found, other than early atheroma consistent with the patient's age.Alternative medicine, including chiropractic and osteopathy, enjoys an ever-increasing popularity. The Australian Health Survey for [1977][1978] We describe the case of a 43-year-old man who died following neck manipulation and in whom multiple dissecting aneurysms within both vertebral arteries were demonstrated radiographically and found at necropsy. Case reportA 43-year-old truck driver presented with a three-month history of intermittent headache and neck discomfort associated with long-distance driving. He went to a naturopath, since he had had similar symptoms treated successfully by local manipulation 3 years before. Immediately after a therapeutic twisting of the neck he experienced the sudden onset of vertigo, with transient loss of consciousness followed by persistent vertigo, vomiting, and oscillopsia. There was no previous history of similar episodes, hypertension, or other significant illness.Upon examination 6 hours after the onset he was drowsy, but orientated and co-operative. There was no neck stiffness or photophobia. A slurring dysarthria, rotatory nystagmus in the primary position, and mild bilateral upper limb intention tremor were present. The patient was able to sit but was unwilling to stand because of vertigo. There were no cranial or neck bruits. Pulse was 70/minute and regular, blood pressure 130/70mmHg, and heart sounds were normal. Radiographs of the cervical spine showed minimal 349 by copyright.
The thyroid gland is a symmetrical H-shaped endocrine structure in the lower neck. It consists of two lobes, each extending from the oblique line of the thyroid cartilage above to the sixth tracheal ring below – united by a median isthmus covered by the anterior jugular veins. The small, (usually) paired and inconsistent parathyroid glands lie behind the lobes of the thyroid gland. They measure 6mm by 4mm by 2mm and are ordinarily four in number – two superior and two inferior. They are involved in the careful regulation of the body’s calcium levels. Both superior and inferior glands are ordinarily supplied by the inferior thyroid artery. Drainage is into the venous plexus on the anterior surface of the thyroid.
A sound knowledge of anatomy forms the scientific backbone of medicine and surgery – equipping the owner with the tools necessary to understand, remember and ultimately manage the clinical scenarios encountered throughout ones career. The Oxford Handbook of clinical head and neck anatomy is a novel venture for the Oxford Handbook series into the field of anatomy. It tackles the notoriously difficult three-dimensional anatomy of the head and neck and provides clinically relevant correlates, etymology and a brief insight into the people behind the commonly encountered eponymous structures and syndromes. Traditional anatomy texts and atlases can be overwhelming in terms of volume, descriptions and accompanying images. The Oxford Handbook of clinical Head and neck anatomy offers a succinct yet comprehensive, portable and quick reference guide with over 400 colour and grey-scale illustrations. The schematic nature of the illustrations makes them readily reproducible on the operating theatre whiteboard, outpatient clinic or ward, making it a true bedside companion. It is written and illustrated by a trainee in oral and maxillofacial surgery, with an awareness of the needs of those in a similar position, combined with firsthand insight into the difficulties faced by those attempting to learn and link the anatomy taught in pre-clinical years with cases seen in day to day clinical practice thereafter. This book is aimed at medical and dental students, trainees at all levels in Oral and Maxillofacial surgery, ENT surgery and plastic and reconstructive surgery, and radiologists and anaesthetists with an interest in head and neck. Furthermore, it provides an authoritative source for those preparing for the Member of the Royal College of Surgeons and Member of the Faculty of Dental Surgeons exams.
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