PMC6898894_01
Progress in Patient. (A) Patient before BoNT. (B) Patient at 4 weeks after BoNT injection with only slight improvement regarding retrocaput. (C) Patient at 4 weeks after the injection.
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We diagnosed ASS (Figure 1A). She had an approximately 20% reduction in pain, with only slight improvement regarding the head position (retrocaput) (Figure 1B). After 4 weeks, the patient presented significant improvement (Figure 1C).
Ways of Approaching Used in US-guided LCo Injections. (A) Medial approach of the injection of LCo via the thyroid gland. (B) Arrows show the path of the needle via the thyroid gland. (C) Lateral approach of the injection of LCo via SCM and the anterior scalene muscle.
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We decided to use the medial approach via the thyroid gland (Figure 2A and B).
Simultaneous Use of Both Methods. Longus colli activation in EMG while the patient flexed the neck.
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Using US guidance and an EMG injection needle (26 G x 50 mm), onabotulinumtoxin A was injected 15 U per side (Figure 3).