Introduction: An otogenic brain abscess is a common ENT problem but an otogenic trapezius abscess can also be experienced in otolaryngological practice, particularly in patients with chronic suppurative otitis media.Case Report: We report a rare case of a trapezius abscess in an eight-year-old girl who presented at the ENT, Head and Neck Surgery Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan on 15th December, 2010, with a presenting complaint of discharge from her right ear that had been occurring for the last five years. An exploration of the patient's right ear was performed, which showed that there was extensive cholesteatoma and tissue granulation tissues the antrum, attic and middle ear. The trapezius abscess had spread down to her back and was repeatedly drained. The patient was discharged on the 14th day following admission after making a complete recovery. After a regular follow-up period the child has remained disease free. The rare nature of this case prompted us to write this report.Conclusion: Chronic suppurative otitis media is a common clinical problem in developing countries. It can result in a number of complications if not treated properly. Although an otogenic trapezius abscess is a rare complication of chronic suppurative otitis media, it must be kept in mind.

Introduction: This study aimed to investigate the effect of carpet weaving at a proposed workstation on Upper Trapezius (UTr) fatigue during a task cycle. Fatigue in the shoulder is one of the most important precursors for upper limb musculoskeletal disorders. One of the most prevalent musculoskeletal disorders between carpet weavers is disorder of the shoulder region.Methods: This cross-sectional study, included eight females and three males. During an 80-minute cycle of carpet weaving, Electromyography (EMG) signals of right and left UTr were recorded by the surface EMG, continuously. After raw signals were processed, MPF and RMS were considered as EMG amplitude and frequency parameters. Time series model and JASA methods were used to assess and classify the EMG parameter changes during the working time.Results: According to the JASA method, 58%, 16%, 8% and 8% of the participants experienced fatigue, force increase, force decrease and recovery, respectively in the right UTr. Also, 50%, 25%, 8% and 16% of the participants experienced fatigue, force increase, force decrease and recovery, respectively in the left UTr.Conclusions: For the major portion of the weavers, dominant status in Left and right UTr was fatigue, at the proposed workstation during a carpet weaving task cycle. The results of the study provide detailed information for optimal design of workstations. Further studies should focus on fatigue in various muscles and time periods for designing an appropriate and ergonomics carpet weaving workstation.

Background and purpose: Middle Trapezius Muscle (MTM) is a key muscle in maintaining postural stability of the shoulder but it has received less attention in research. This study aimed to measure the ultrasonic thickness of the MTM in non-athlete healthy young men. Also, inter-rater repeatability in measuring ultrasonic thickness of this muscle was calculated.Materials and methods: A fundamental applied study was carried out by voluntary participation of 60 healthy young men aged 18-28 years. Demographic characteristics of the participants were recorded and ultrasonic thickness of both left and right MTM was measured by two examiners when the muscle was at rest. The measurements were repeated for three times. Data analysis was conducted in SPSS V18 using Intraclass Correlation Coefficients (ICC) between the first and third measurements to assess intra-rater reliability. In addition, Standard Error Measurement (SEM) with a 95% confidence interval (CI=95%) was estimated.Results: Average ultrasonic thickness of the left and right MTM was 8.03±1.55 and 8.10±1.54 mm, respectively. The ICC between the measurements from the first and second rater was 0.86. Inter tester reliability showed ICC 0.95 and 0.98 for right and left MTM respectively.Conclusion: Measurement of ultrasonic thickness of MTM at rest, showed a high intra reliability. Further studies are recommended to measure MTM ultrasonic thickness in patients suffering from neck and shoulder dysfunctions.

Background: Most dentists complain of musculoskeletal disorders which can be caused by prolonged static posture, lack of suitable rest and other physical and psychological problems.Objective: We evaluated a chair with a new ergonomic design which incorporated forward leaning chest and arm supports.Methods: The chair was evaluated in the laboratory during task simulation and EMG analysis on 12 students and subjectively assessed by 30 professional dentists using an 18-item questionnaire. EMG activity of right and left trapezius muscles for 12 male students with no musculoskeletal disorders was measured while simulating common tasks like working on the teeth of the lower jaw.Results: Normalized EMG data showed significant reduction (p<0.05) in all EMG recordings of the trapezius muscle. Dentists also unanimously preferred the ergonomically designed chair.Conclusion: Such ergonomically designed chairs should be introduced as early as possible in student training before bad postural habits are acquired.

Musculocutaneous pedicled/ free flaps are an essential prerequisite for reconstructive surgery.Amongst the trunk muscles commonly harvested for flaps, the trapezius and rectus abdominis provide satisfactory coverage for cranial and trunk defects. unilateral/ bilateral or partial congenital absence of trapezius muscle is well documented and may result in muscular imbalances compromising posture and limb movements. During routine cadaveric dissection, we encountered a case of bilateral partial absence of occipital part of the trapezius muscle. Concurrently, the ventral abdominal musculature displayed the aponeurosis of transversus abdominis muscle solely forming the posterior wall of the rectus sheath. These conjointly occurring anomalies advocate a compensatory strengthening of the anterior wall of rectus sheath in response to the congenital absence of occipital part of the trapezius, probably to counteract the postural instability. The present study focuses on recognition of compensatory mechanisms resulting from congenital variations as identification of such processes may prevent chronic debilitating conditions.

Introduction & Objective: Elevation of the skin with its deep fascia vascular network is a recent facility for flap design. Longitudinal trapezius fasciocutaneous flap introduced primarily at 1996 but did not receive enough attention, although it has many significant benefits comparing to the other available procedures.Materials & Methods: Sixteen trapezius fasciocutaneous flaps were used in 15 patients for severe scarring of the neck and mid face reconstruction. All flaps were based on the deep branch of the transverse cervical artery and included overlying fascia of trapezius muscle. Delaying was applied for very long flaps. Results: Two flaps developed minimal distal necrosis(less than 5 cm) due to longer pedicle (more than 10 cm below the muscle border).The result indicates that the extra-long, back fascia flap based on descending branch of transverse cervical artery could be formed long enough to reconstruct whole neck and safely transferred to mid face.Conclusions: The vertical trapezius fascio-cutaneous flap with its abundant tissue, excellent blood supply and anatomic proximity with wide arc of rotation and hidden donor site scar, provides a simple and reliable method for primary reconstruction of various mid - face and neck defects.

Introduction: Motor evoked potentials (MEPs) can be elicited in trapezius and other axial muscles by ipsilateral transcranial magnetic stimulation (TMS).The purpose of this study is to compare the relative amplitudes and latencies of ipsilateral versus contralateral responses to TMS from trapezius muscle of normal subjects.Materials and Methods: MEPs were bilaterally recorded during complete relaxation and voluntary contraction from upper trapezius muscle in 40 healthy right handed subjects by TMS in right and left hemispheres. Base-to-peak amplitude and latency of MEP were measured for each muscle on both sides.Results: At rest, a contralateral response was obtained in 45 trapezius muscles. Ipsilateral responses were observed in 11 muscles (latency contra-lateral and ipsilateral 9.8ms and 15.5 ms, respectively, P <0.001). During contraction ipsilateral MEPs could be evoked in 37 muscles. Contralateral MEPs were obtained in 76 experiments on 40 subjects (latency contralateral and ipsilateral 8.5ms and 12.6 ms, respectively, P <0.001).Conclusion: MEPs can be readily evoked by TMS over the ipsilateral motor cortex in a variety of proximal muscles, such as trapezius. Ipsilateral MEPs have a later onset and lower amplitude than contralateral responses. It is considered that oligosynaptic connections may be a common feature of axial muscles, such as trapezius. These patterns of connections are discussed in relation to the contrasting bilateral functional roles of this muscle.

The aim of this study was to assess the activity of scapular muscles in subjects with forward head posture. The statistical population consisted of female students living in University of Tehran dormitories. 14 healthy girls and 18 girls with forward head posture aged between 23 and 30 were selected. The electromyography activity of serratus anterior, upper trapezius and lower trapezius were recorded during arm abduction. To normalize the data, the mean square of level of electromyography of each muscle was divided by the mean square of level of isometric contraction. Independent t test was used to compare the results in the two groups. The results showed that the electric activity of upper trapezius (P=0.002) in subjects with forward head posture was higher than the healthy group while lower trapezius and serratus anterior showed no difference between the groups. The results showed a difference in electromyography activity of upper trapezius during arm abduction between the healthy group and forward head group. Thus, it can be concluded that normal head posture during arm abduction can support the biomechanical head posture to reduce excessive activity of the upper trapezius.