Sternalis muscle: an underestimated anterior chest wall anatomical variant

Over the recent years, an increased alertness for thorough knowledge of anatomical variants with clinical significance has been recorded in order to minimize the risks of surgical complications. We report a rare case of bilateral strap-like sternalis muscle of the anterior chest wall in a female cadaver. Its presence may evoke alterations in the electrocardiogram or confuse a routine mammography. The incidental finding of a sternalis muscle in mammography, CT, and MRI studies must be documented in a patient's medical records as it can be used as a pedicle flap or flap microvascular anastomosis during reconstructive surgery of the anterior chest wall, head and neck, and breast. Moreover, its presence may be misdiagnosed as a wide range of benign and malignant anterior chest wall lesions and tumors

Functional Endoscopic Evaluation of Swallowing (FEES) in the education of patients and family members for the effective management of oropharyngeal dysphagia and recognition of aspiration

Introduction: The aim of this study is to examine the contribution of Functional Endoscopic Evaluation of Swallowing (FEES) to the education of patients and family members - caring professionals for the effective management of oropharyngeal dysphagia and recognition of aspiration. Methods: Prospective study of 87 patients and families treated at the swallowing disorders clinic. Primary outcome: recognition of aspiration symptoms (cough, voice change, "secretions" from tracheostomy). Secondary outcome: compensatory positions and swallowing maneuvers performance (patients) recognition of correct application of positions and maneuvers (family members). The clinical treatment protocol involves intensive training during the FEES examination of patients and family members with visual feed-back until they were confident they could follow guidelines or the patient was tired. The study group included hospitalized patients and out patients, patients unable to be mouth fed, patients applying compensatory positions and swallowing maneuvers to eliminate aspiration and patients with swallowing disorders without aspiration.Results: Out of 87 patients 42 experienced aspiration if they would swallow without compensatory positions and swallowing maneuvers. In these subgroup, 40 patients' family members successfully recognized aspiration cough and 37 recognized voice change. Family members overdiagnosed "secretions" from tracheostomy and 79% of them recognized correct application of compensatory positions and swallowing maneuvers. Sixty per cent of the patients were applying correctly the positions and maneuvers after the intensive training.Conclusions: FEES is effective in educating patients and family members in dysphagia management and aspiration recognition