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SUMMARY: This study aimed to classify and investigate anatomical variations of the sternocleidomastoid (SCM) muscle, which is commonly used as an anatomical landmark to indicate the correct position for central venous catheterization, in a Thai population. Thirty- five embalmed cadavers from the Northeast Thailand (19 females and 16 males) were systemically dissected to reveal the SCM muscles in both sides for gross human anatomy teaching. Variations in the SCM origin and insertion were observed and recorded. The prevalence of anatomical variations was approximately 11.4 % (4 of 35 cadavers) and was not different by sex. Such variations were classified into 5 types based on origin, insertion, and presence of additional heads, as follows: type I (n=31; 88.6 %), type II (n=1; 2.85 %), type III (n=1; 2.85 %), type IV (n=1; 2.85 %), and type V (n=1; 2.85 %). Clinical considerations and prevalence of variant SCM muscle have also been discussed. Since the incidence of this anatomical variations was more than 10 %, the cervical surgeons should seriously consider this issue before insertion of a central venous catheter to avoid complications.

El estudio tuvo como objetivo clasificar e investigar las variaciones anatómicas del músculo esternocleidomastoideo (MEM), que se usa comúnmente como un punto de referencia anatómico para indicar la posición correcta para el cateterismo venoso central, en una población tailandesa. Se diseccionaron sistemáticamente 35 cadáveres embalsamados del noreste de Tailandia (19 mujeres y 16 hombres) para observar los músculos MEM en ambos lados para la enseñanza de la anatomía humana macroscópica. Se observaron y registraron variaciones en el origen y la inserción de MEM. La prevalencia de la variación fue de aproximadamente 11,4 % (4 de 35 cadáveres) y no fue diferente por sexo. Dichas variaciones se clasificaron en 5 tipos según el origen, la inserción y la presencia de cabezas adicionales, de la siguiente manera: tipo I (n=31; 88,6 %), tipo II (n=1; 2,85 %), tipo III (n=1; 2,85 %), tipo IV (n=1; 2,85 %) y tipo V (n=1; 2,85 %). También se discutieron las consideraciones clínicas y la prevalencia de la variante del músculo MEM. Dado que la incidencia de esta variación fue superior al 10 %, los cirujanos de cabeza y cuello deben considerar este tema antes de la inserción de un catéter venoso central para evitar complicaciones.

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Resumen Introducción: La Fibromatosis Colli es un tumor fibroso congénito benigno que se desarrolla en el músculo esternocleidomastoideo. Se manifiesta clínicamente por hinchazón del cuello y restricción de movimiento del cuello (tortícolis). Objetivo: Describir los aspectos diagnósticos y terapéuticos fundamentales de la Fibromatosis de Colli o Tortícolis Muscular Congénita. Caso Clínico: Se presenta un caso de neonato de sexo femenino de 21 días de nacida mediante parto en presentación podálica. Al examen físico se encuentra masa en cuello de 1,5*2 cm indolora e inclinación de la cabeza hacia la derecha, diagnosticado con ultrasonografía y tomografía de cuello contrastado, sin otros hallazgos. Conclusiones: La Fibromatosis de Colli es una patología que pasa desapercibida en el examen posparto del recién nacido. Es importante que el personal médico la identifique, evitando así complicaciones futuras, como asimetría craneofacial, escoliosis cervical y torácica o alteraciones oculares importantes.

Abstract Introduction: Fibromatosis Colli is a benign congenital fibrous tumor, which develops in the sternocleidomastoid muscle. Its clinical manifestations encompass neck swelling and torticollis (restriction of neck movements). Objective: The aim of this report is to describe the fundamental diagnostic and therapeutic aspects of Fibromatosis Colli or Congenital Muscular Torticollis. Clinical Case: A case of a 21-day-old female neonate is presented, with the presence of a right cervical mass (1.5*2 cm) and the head tilted to the right without other associated symptoms found in the physical examination. A relevant antecedent is breech presentation during the birth. The diagnosis is obtained through ultrasonography and contrasted neck tomography. Conclusions: Fibromatosis Colli is a pathology that could be unnoticed in the postpartum examination of the newborn. It is important that medical personnel identify it in order to avoid future complications, such as craniofacial asymmetry, cervical and thoracic scoliosis, or important ocular alterations.

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Resumen Introducción: La perforación esofágica es una complicación poco frecuente en la cirugía de columna cervical por vía anterior, sin embargo, puede tener graves consecuencias cuando hay demoras en diagnóstico y tratamiento. Casos Clínicos: Presentamos dos casos clínicos de pacientes con perforación esofágica secundaria a cirugía de columna cervical por vía anterior. Se usaron para su reparación colgajo muscular de esternocleidomastoideo (ECM). Conclusión: La perforación esofágica secundaria a cirugía de columna cervical es poco frecuente, variable desde el punto de vista clínico, el TC y estudio radiológico contrastado son fundamentales en el diagnóstico de esta patología. El colgajo muscular ECM en estos casos es una herramienta fiable y extremadamente útil debido a sus características anatómicas, fácil disección quirúrgica y baja morbilidad asociada.

Introduction: Esophageal perforation is a rare complication in cervical spine surgery by anterior way, however it can have serious consequences when there are delays in diagnosis and treatment. Cases Report: We present two clinical cases of patients with esophageal perforation secondary to cervical spine surgery by anterior way. Sternocleido-mastoid muscle flaps were used for repair. Conclusion: Esophageal perforation secondary to cervical spine surgery is rare, clinically variable, CT and radiologic study are fundamental in the diagnosis of this pathology. The Sternocleidomastoid muscle flap in these cases is a reliable and extremely useful tool due to its anatomical characteristics, easy surgical dissection and low associated morbidity.

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BACKGROUND: Parkinson's disease is a neurological disorder that promotes motor changes in the body. OBJECTIVE: The aim of this study was to investigate the impairment of the stomatognathic function regarding molar bite force, electromyographic activity and thickness of the craniocervical muscles in patients with Parkinson's disease in comparison with those in asymptomatic controls. METHODS: Twenty-four subjects were divided into two groups, a Parkinson's disease group (n = 12) and a control group (n = 12). The subjects were evaluated on the basis of molar bite force, electromyographic activity (rest, right and left laterality, protrusion, maximum voluntary contraction) and thickness (rest and maximum voluntary contraction) of the right and left temporal (anterior portion), masseter and sternocleidomastoid muscles. The results were submitted to a multivariate analysis of variance (MANOVA) to compare the means of the two independent groups, considering diagnosis of Parkinson's disease and craniocervical muscles as independent variables. For the post hoc comparisons, Bonferroni correction was used (P < 0.05). RESULTS: Parkinson's disease group presented lower mean values both sides for maximal molar bite force, significant increases in the electromyographic activities during mandibular tasks, lower mean thickness values of the masseter and sternocleidomastoid muscles, and higher mean thickness values of the temporalis muscles (anterior portion). CONCLUSION: The results suggest that patients with Parkinson's disease may present functional changes of the stomatognathic system, related to bite force, electromyographic activity and thickness of the craniocervical muscles. The greater temporal muscle thickness in Parkinson's disease patients may compromise their daily life activities, especially with respect to chewing and nutrition.

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BACKGROUND: When it comes to autogenous nerve grafting, the sural and great auricular nerve (GAN) are the 2 nerves predominately used for trigeminal and facial nerve repair. Arising from the second and third cervical ventral rami, the GAN emerges from the posterior border of the sternocleidomastoid coursing superiorly and anteriorly toward the ear. METHODS: Eleven sides from 5 Caucasian and 1 Asian cadaveric heads (all fresh-frozen) were used. One man and 5 women were used with an age at death ranging from 57 to 91 years, with a mean of 80.3 years. Measurements were made from the inferior border of the ear to the GAN, the GAN to the external jugular vein, and the inferior border of the mastoid process to the GAN; the proximal, medial, and distal diameters of the GAN and the length of the GAN that was obtained from this exposure were also measured. RESULTS: The mean distance from the inferior border of the mastoid process to the GAN, inferior border of the ear to the GAN, and GAN to the external jugular vein was 27.71, 31.03, and 13.28 mm, respectively. The mean length of the GAN was 74.86 mm. The mean diameter of its distal, middle, and proximal portions was 1.51, 1.38, and 1.58 mm, respectively. CONCLUSIONS: The GAN is an excellent option for use in nerve grafting for repair of, for example, facial dysfunction. In this study, we review our measurements, techniques for identification, and dissecting techniques for the GAN. The proximity to the operative area and minimal complications associated with GAN grafting might contribute to improved patient satisfaction and better outcomes regarding functional restoration.

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INTRODUCTION: The eleventh cranial nerve, the accessory nerve, has a complex and unique anatomy and has been the subject of much debate. Herein, we review the morphology, embryology, surgical anatomy, and clinical manifestations of the accessory nerve. Included in this review, we mention variant anatomy, molecular development, histology, and imaging of the accessory nerve. CONCLUSIONS: The accessory nerve continues to be a topic of much discussion regarding its exact function and in particular to its cranial roots. Recently, various surgical procedures have been devised that repurpose the accessory nerve (e.g., lengthening procedures, contralateral neurotization procedures). Currently, we continue to learn and have much to learn about this lower cranial nerve. Anat Rec, 302:620-629, 2019. © 2018 Wiley Periodicals, Inc.

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RESUMEN La piomiositis es una infección bacteriana del músculo estriado, siendo extremadamente rara la afectación de la musculatura cervical. Se ha asociado en nuestro medio a enfermedades crónicas como la diabetes y a la inmunodepresión. Presentamos a un paciente de 67 años que acude al servicio de urgencias por tumoración laterocervical de rápido crecimiento, negando antecedentes de interés a excepción de diabetes mellitus tipo II. Se le realizó estudio de imagen con tomografía computarizada con contraste, observándose aumento de volumen del músculo esternocleidomastoideo izquierdo y se empezó tratamiento empírico con antibióticos endovenosos. Dada la evolución tórpida finalmente se realizó drenaje quirúrgico bajo anestesia general con mejoría de los parámetros clínicos y analíticos. La piomiositis de los músculos cervicales es muy rara (0,4%-1% de todos los casos) siendo el esternocleidomastoideo el músculo del cuello más frecuentemente afectado. La tomografía computarizada representa la prueba de imagen de elección, permitiendo un rápido diagnóstico llegando a poder diferenciar este cuadro de otros similares. Considerando que muchos de estos pacientes presentan comorbilidades asociadas y/o inmunosupresión, es de extrema importancia diagnosticarlos precozmente y empezar un tratamiento adecuado que dependerá del grado y extensión de la infección. A pesar de ser una entidad poco frecuente, su incidencia está en aumento en nuestro medio asociada a la infección por VIH y otras condiciones de inmunodepresión. Hay que tenerla en mente en el diagnóstico diferencial de las tumoraciones laterocervicales porque solo con una alta sospecha clínica se podrá llevar al cabo un diagnóstico precoz y un tratamiento adecuado.

ABSTRACT Pyomyositis is a bacterial infection of the striated muscle that may affect the cervical musculature in very few cases. In the occidental world it has been associated with chronic diseases as diabetes and immunosuppression. We present a 67 years old patient attended to the Emergency Department because of a laterocervical fast growth tumor, without an interesting clinical history with the exception of type II diabetes mellitus. A CT scan with contrast showed an increased volume in the left sternocleidomastoid muscle, so an empiric treatment with intravenous antibiotics was started. Because of a bad evolution we finally performed a surgical drainage of the abscess under general anesthesia with an improvement of symptoms and laboratory markers. The pyomyositis of cervical muscles is very rare (0.4-1% of all cases) and the sternocleidomastoid muscle is the most commonly affected cervical muscle. CT scan is the gold standard imaging technique, because it allows to diagnose this disease and rule out other similar entities. If we consider that many patients present with associated comorbidities and/ or immunosuppression, it's very important to perform a rapid diagnosis and to begin a correct treatment that depends on the grade and extension of the infection. Although polymyositis of the sternocleidomastoid muscle is rare, its incidence is increasing associated to HIV infection and other immunosuppressive conditions. We have to keep in mind this pathology in the differential diagnosis of laterocervical tumors because high clinical suspicion is necessary to make a rapid diagnosis and a correct treatment.

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La fístula faringocutánea se define como una dehiscencia del cierre de la mucosa faríngea, que produce fuga de saliva y comunicación de la luz faríngea con la piel. Puede clasificarse en fístula propiamente dicha, en el que un trayecto fistuloso comunica luz del tubo digestivo con el exterior y en faringostoma en el que la luz de la faringe se abre directamente al exterior con pérdida importante de tejidos blandos. Es una complicación frecuente tras cirugías abiertas de laringe, pudiendo también aparecer tras cirugías de faringe, de columna espinal, reconstrucciones mandibulares así como en cirugías del piso de boca. Si bien pueden cerrar espontáneamente o con tratamiento conservador, muchas de ellas, sobre todo cuando existe una comunicación amplia entre la faringe y la piel, requieren de cirugía. Existen varias técnicas quirúrgicas para cerrar dichas fístulas. Se presenta un caso en el que se realizó la excéresis de un tumor de base de lengua sangrante, incontrolable, con una faringotomía suprahioidea como vía de abordaje, que presentó como complicación postoperatoria una fístula faringocutánea seguida de la formación de un faringostoma amplio. Fue tratado quirúrgicamente con una síntesis del defecto y refuerzo con colgajo muscular en collar con el fascículo esternal bilateral de esternocleidomastoideo. El paciente presentó buena evolución con cierre de la fístula.

Pharyngocutaneous fistula is defined as a dehiscence of the closing of the pharyngeal mucosa, which produces leakage of saliva and communication of pharyngeal light with the skin. It can be classified as a fistula proper, in which a fistulous tract communicates light from the digestive tract with the outside and in a pharyngostoma in which the pharyngeal lumen opens directly to the outside with significant loss of soft tissues. It is a frequent complication after open surgeries of the larynx, and may also appear after surgery of the pharynx, spinal column, mandibular reconstructions as well as surgeries of the floor of the mouth. Although they can close spontaneously or with conservative treatment, many of them, especially when there is a wide communication between the pharynx and the skin, require surgery. There are several surgical techniques to close these fistulas. We present a case in which the excresis of a tongue-based tumor was performed, due to uncontrollable bleeding, with a suprahyoid pharyngotomy as the approach, presenting as a postoperative complication a pharyngocutaneous fistula followed by the formation of a broad pharyngostoma. He was treated surgically with a synthesis of the defect and reinforcement with a muscular flap in a collar with the bilateral sternocleidomastoid sternal fascicle. The patient presented good evolution with closure of the fistula.

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We describe the surgery and reconstruction employed with a sternocleidomastoid myocutaneous flap for the treatment of a heterotopic glioma in a 2-year-old boy with incomplete palatal fissure who presented with dysphagia and snoring, in whom a lateral pharyngeal wall mass obstructing 60% of the airway was noted. Heterotopic gliomas are uncommonly reported in the parapharyngeal space and should be included in the differential diagnosis at this location in children. Parapharyngeal tumors present difficult diagnostic and management challenges; head and neck surgeons must be prepared not only for the resection but also for the reconstruction of these rare lesions.

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OBJECTIVE: The aim of this study was to evaluate the maximal bite force (MBF), electromyographic (EMG) activity and thickness of the masseter, anterior part of the temporalis and sternocleidomastoid (SCM) muscles in a group of young adults with and without temporomandibular disorders (TMDs). DESIGN: Nineteen individuals comprised the TMD group (6 males/13 females, aged 25.4±3.8 years), classified based on the Research Diagnostic Criteria for TMD (RDC/TMD), and 19 comprised the control group (6 males/13 females, aged 24.1±3.6 years). The MBF was determined with a transducer placed between the dental arches at the first molars level (N). The muscles were evaluated bilaterally at rest and during maximal voluntary clenching (MVC) by assessing EMG activity and performing ultrasonography (USG). The mean values of these measures for both sides of the mouth were used. The normality of the distributions was assessed by the Shapiro-Wilks test. Variables between groups and genders were compared using two-way factorial ANOVA test and correlated using the Spearman coefficient (α=0.05). Unpaired t test was used to compare variables between TMD subgroups. Logistic regression analysis was used to identify the variables associated with the presence of TMD. RESULTS: MBF, EMG and USG data were similar among clinical groups and among TMD subgroups. The thickness of masseter and SCM muscles in the relaxed and clenching states were significantly higher in males than females. On the other hand, the EMG of the temporalis muscle in the rest state was significantly higher in females than males. Additionally, the MBF was positively correlated with the USG characteristics of masseter and SCM muscles, as well as with the EMG activity of masseter and temporalis muscles in the TMD group. In this group, there was also a positive correlation between the thickness of the masseter muscle and its activity. On the other hand, the thickness of the SCM muscle was negatively correlated with its activity. A lower MBF was independently associated with the presence of TMD. CONCLUSIONS: Subjects with TMD exhibited similar values of MBF, thickness and electrical activity of masticatory and cervical muscles when compared with controls; positive correlations observed between these variables may suggest a muscular alteration in TMD patients and a co-activation of masticatory and cervical muscles during mandibular movement. This fact may also be confirmed by the negative association between bite forces and presence of TMD.

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The abnormal origin, presence of additional head and layered arrangement of fibers are the reported variations of sternocleidomastoid muscle in the past. In the present case we report a rare unusual origin of third head of the sternocleidomastoid muscle in a 60 year-old male cadaver. This additional head originated from the investing layer of cervical fascia in the roof of the subclavian triangle close to the clavicle and traversed obliquely upward, forward and fused with clavicular head. The insertion and nerve supply of the muscle was found to be normal...

El origen anormal, presencia de una cabeza adicional y disposición en capas de fibras son las variaciones reportadas del músculo esternocleidomastoideo. En el presente estudio, se presenta un origen poco habitual de la tercera cabeza del músculo esternocleidomastoideo en un cadáver de sexo masculino de 60 años. La cabeza supernumeraria se originaba en la lámina superficial de la fascia cervical en el techo del triángulo subclavio próximo de la clavícula y cruzaba oblicuamente hacia arriba y adelante para fusionarse con la cabeza clavicular. La inserción e inervación del músculo eran normales...

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Anatomical variations of the sternocleidomastoid muscle are rare and concern its origin, insertion, and the number of heads. We report on a rare bilateral variant of the sternocleidomastoid muscle with aberrant and supernumerary muscular heads, observed in a cadaveric subject. On the right side of the neck, a typical sternomastoid head of the sternocleidomastoid muscle, and three aberrant clavicular heads of variable thickness, origin, and termination were noticed. On the left side, two sternomastoid heads were present; the medial one was of typical pattern, while the lateral was supernumerary. The cleidomastoid portion of the left sternocleidomastoid muscle was fused with the double sternomastoid segment. A strap-like muscle originating from the middle third of the clavicle and inserting onto the transverse process of the C3 vertebra was noticed. This is known as the cleidocervical muscle. On the right side of the neck, the posterior cervical triangle was diminished, the minor supraclavicular fossa was considerably narrow, whereas on the left, it was diminished in addition to a bilateral shortening of the major supraclavicular fossa minimizing space needed for potential surgical access. These findings are of prominent significance for anesthetists in ultrasound guided needle positioning in brachial plexus block, as well as in subclavian or external jugular vein catheterization, and in surgical interventions involving structures lying under the sternocleidomastoid muscle...

Las variaciones anatómicas del músculo esternocleidomastoideo son poco frecuentes y se refieren a su origen, inserción, y número de cabezas. Se presenta una rara variante del músculo esternocleidomastoideo con cabezas musculares aberrantes y supernumerarias bilateralmente en un cadáver. En el lado derecho del cuello, se observaron la cabeza esternomastoidea típica del músculo esternocleidomastoideo, y tres cabezas claviculares aberrantes de origen, espesor y terminación variable. En el lado izquierdo, se observaron dos cabezas esternomastoídeas, la medial con su patrón típico, mientras que el lateral fue supernumeraria. La porción cleidomastoídea del músculo esternocleidomastoideo izquierdo se fusionó con el segmento esternocleidomastoideo doble. Un músculo acintado similar procedentes del tercio medio de la clavícula e inserción en el proceso transverso de la vértebra C3 fue observado. Éste se conoce como el músculo cleidocervical. En el lado derecho del cuello, el triángulo cervical posterior fue disminuido, la fosa supraclavicular menor fue considerablemente estrecha, mientras que en el lado izquierdo, se disminuyó además a un acortamiento bilateral del espacio fosa supraclavicular importante reducir al mínimo necesario para el acceso quirúrgico potencial. Estos hallazgos tienen una importancia destacada para los anestesistas en el posicionamiento de aguja guiada por ecografía en el bloqueo del plexo braquial, así como en la cateterización de la vena subclavia o yugular externa, y en las intervenciones quirúrgicas que afecta las estructuras situadas debajo del músculo esternocleidomastoideo...

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En los últimos años, debido al auge que ha tenido la cirugía espinal por vía cervical anterior, se ha observado un incremento en los traumatismos esofágicos después de estos procederes. Existen 2 escenarios clínicos diferentes: la lesión directa transoperatoria, y la presentación tardía por mecanismos de tracción fricción causado por el material de osteosíntesis empleado. A partir del paciente descrito, se exponen las conductas a seguir para cada caso, y se destacan las singularidades del tratamiento quirúrgico, con rafia esofágica y reforzamiento de la sutura con colgajos musculares. El objetivo inicial de la intervención, que es la estabilización espinal, tampoco debe ser descuidado. Se concluye que, por la presentación tardía de lesiones después de cirugía espinal, se necesita de un seguimiento cuidadoso a largo plazo para la detección y tratamiento precoz de estas complicaciones, además de la necesidad del concurso de varias especialidades para la solución exitosa de estas contingencias(AU)

In past years, due to the boom of spinal surgery by an anterior cervical route, there has been an increment of esophageal traumata after these procedures. There are two different clinical scenarios: the transoperative direct injury and the late presentation by friction traction mechanisms caused by the osteosynthesis used. From the described patient the behaviors to be followed for each case are exposed emphasizing the peculiarities of surgical treatment using esophageal raphe and reinforcement of suture with tissue flaps. The intervention's initial objective, the spinal stabilization, must to take into account. We conclude that due to late presentation of the injuries after spinal surgery, it is necessary to be long-term careful for a early detection and treatment of these complications in addition to the need of the involvement of some specialties to achieve a successful solution of these eventualities(AU)

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A rare case of unilateral third head of sternocleidomastoid and an extra muscle levator claviculae were determined unilaterally in a 70-year-old male cadaver during the routine dissections. In the left neck side, it was observed that the sternocleidomastoid muscle also had a third part in addition to known sternal and clavicular heads and levator claviculae muscle which arose from the posterior tubercle of the transverse process of the 3rd cervical vertebra and attached to the posterior margin of the clavicle. An awareness of this variations may be important because of its close relationship with neurovascular structures during neck operations.

Durante una disección de rutina, se observó en un cadáver de sexo masculino de 70 años de edad, la presencia de una tercera cabeza unilateral del músculo esternocleidomastoideo y de un músculo elevador clavicular accesorio. En el lado izquierdo del cuello, se observó que el músculo esternocleidomastoideo poseía una tercera cabeza, además de las cabezas esternal y clavicular. El músculo elevador de la clavícula, tenía su origen en el tubérculo posterior del proceso transverso de la tercera vértebra cervical y se insertaba en el margen posterior de la clavícula. El conocimiento de estas variaciones pueden ser importantes debido a su estrecha relación con las estructuras neurovasculares del cuello durante las operaciones.

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The sternocleidomastoid is a muscle with a great extension that occupies the cervical region and is extended obliquely from the head to the trunk. Its morphology is not uniform, once its ends are wide and slim while its medial edge is thick and narrow. The aim of our work was to relate a case of variation in clavicular origin of this muscle that was extended beyond the half of clavicle laterally, in both sides of the neck.

El esternocleidomastóideo es un músculo de gran extensión en la región cervical con trayecto oblicuo desde la cabeza hasta el tronco. Su morfología no es uniforme, debido a que sus extremos son anchos y finos, mientras que él es grueso y estrecho en su borde medial. El objetivo de este trabajo fue relatar un caso de la variación en el origen clavicular de este músculo que se extendí mas allá de la mitad de la clavícula en dirección lateral, en ambos lados del cuello.

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This study evaluated the electromyographic characteristics of masticatory and neck muscles in subjects with vestibular lesions. Surface electromyography of the masseter, temporalis and sternocleidomastoid muscles was performed in 19 patients with Ménière's disease, 12 patients with an acute peripheral vestibular lesion, and 19 control subjects matched for sex and age. During maximum voluntary clenching, patients with peripheral vestibular lesions had the highest co-contraction of the sternocleidomastoid muscle (analysis of covariance, p=0.02), the control subjects had the smallest values, and the patients with Ménière's disease had intermediate values. The control subjects had larger standardized muscle activities than the other patient groups (p=0.001). In conclusion, during maximum voluntary tooth clenching, patients with vestibular alterations have both more active neck muscles, and less active masticatory muscles than normal controls. Results underline the importance of a more inclusive craniocervical assessment of patients with vestibular lesions.

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A rare case of unilateral third head of sternocleidomastoid muscle was noted during routine dissections for undergraduate medical students. The additional third head originated from the middle third of the clavicle and joined the normal two heads (sternal and clavicular) of the muscle in the middle of the neck. The insertion and nerve supply of the muscle was normal. This case may be important for head and neck surgeons and for plastic surgeons doing muscle graft surgeries.

Un caso raro de una tercera cabeza unilateral del músculo esternocleido-mastoideo se observó durante disecciones de rutina para los estudiantes de medicina de pregrado. La tercera cabeza adicional se originó en el tercio medio de la clavícula y se unió a las dos cabezas normales (esternal y clavicular) del músculo en el medio del cuello. La inserción y e inervación del músculo fue normal. Este caso puede ser importante para los cirujanos de cabeza y cuello y para cirujanos plásticos que realizan cirugías de injerto muscular.

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A rare case of additional slip in the origin of the clavicular head of sternocleidomastoid muscle was found during our routine dissection, on both sides of the neck in an elderly male cadaver. However, on both side of the same muscle no such additional slip of origin was found at the sternal head of the sternocleidomastoid near its origin nor at its insertion of the muscle.

Durante una disección de rutina, fue encontrado un raro caso de un fascículo adicional en el origen de la cabeza clavicular del músculo esternocleidomastoideo, en ambos lados del cuello, en un cadáver de un anciano de sexo masculino. Sin embargo, en ambos lados, no se encontró un fascículo adicional en el origen de la cabeza esternal ni en la inserción del músculo esternocleidomastoideo.

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