Level VII in the American Head and Neck Society classification refers to pretracheal, paratracheal, and esophageal groove lymph nodes, extending from the level of suprasternal notch cephalad and up to the innominate artery caudad
. These are considered superior mediastinal lymph nodes and are essentially an extension of the paratracheal nodes below the suprasternal notch.
Perpendicular Perpendicul 15[degrees] to IR (c) ar to IR to caudad
, and exit at and center centered acanthion.
From the needle injection point described, the needle was directed caudad
and laterally to perform the sciatic nerve block; and then directed cephalad and medially to locate the femoral nerve.
The alignment manoeuvre by moving the transducer slightly cephalad or caudad
can be used to place the transducer between the spinous processes to view deeper structures.
After cleaning the skin with an antiseptic solution, a hypodermic needle is inserted along the posterior border of the sternocleidomastoid muscle, landmark was identified as the midline between the mastoid process and clavicular head of the sternocleidomastoid muscle, and three injections of 5mL of local anesthetic were done behind the posterior border of the sternocleidomastoid muscle subcutaneously, perpendicularly, cephalad, and caudad
in a fan fashion.
A single injection of 15 mL of 0.5% bupivacaine with 1: 200,000 epinephrine and 25 mcg of dexmedetomidine was administered, evaluating for a U-shaped spread, defined as local anesthetic distribution in a cephalad, posterior, and caudad
position to the axillary artery, as described by Dingemans et al.
These are, respectively, located from the cephalic to the caudad
A minor caudad
adjustment was then made to obtain the SF image [Figure 1].
Transit of material through the gastrointestinal tract relies on a balanced release of contractile neuromodulators orad of the food bolus and the release of relaxative neuromodulators caudad
of the bolus, thus propelling the food in a forward direction (proximal to distal).
A slight cephalad-caudad tilt (image intensifier caudad
) was used to maximize the fluoroscopic anatomy opening of the neuroforamen in the AP view (Figure 2).
Based on ultrasound/MRI visualization of the intertransverse ligament (posteriorly) and the lumbosacral ligament (anteriorly) marking out the osteofibrotic tunnel, the tip of the block needle was placed in the anticipated position for needle insertion caudad
to the intercristal line.
The tubing was positioned to traverse from just proximal to the enterotomy site caudad
to the cloacal opening.