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Ultrasound of the Head and Neck - welcome into the world of shadows!
-a hands-on workshop
XXXIII Congress of the Nordic Association of Otorhinolaryngology
Malin Wendt, Caroline Gahm, Rusana Bark
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Schedule:
• Ultrasound basics (very short)
• Fields of application
• Demonstration
• Hands on! Anatomy, puncture, cytology
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Ultrasound physics
• Ultrasound is produced and detected by a transducer
• Speed of sound is dependent on the density of the tissue
• Differences in density produces echo
• Ultrasound ”beam” is very thin, approx 1 mm
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Ultrasound physics
Sound = waves.
1 Hz = 1 cycle/sec•Audible range 20 Hz – 20 000 Hz
•Freq ≥ 20 K Hz = ultrasonic
•Head and neck ultrasound 7,5-15mHz
High frequency = high resolution but lower depth
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Ultrasound physics
• Many different ways of optimizing image…..
• Important to know your anatomy+ common artefacts
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Fields of application
Diagnostics: • Lymph node mapping + FNAC• Benign cysts in the head and neck
area
• Abscesses, post-operative seromas• Calculi in salivary glands
Dermoid cyst
Lymfatic
malformation
Calculi of the
submandibular
gland
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Treatment:• Sclerosing therapy (lymfatic
malformations, benign cysts)• Botox injection of salivary glands
(hypersalivation)
Fields of application
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Peroperative:• Lymph node extirpation
(supraclavicular fossa, deep nodes)• Foreign body (glass etc.)
Piece of glass in the lower part of the neck
Fields of application
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Hands on - anatomy
Try to identify the following structures:
• Internal jugular vein• Carotid artery incl. bifurcation• Submandibular and parotid gland• Some lymph nodes• Thyroid gland• Vocal cords
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Internal jugular vein and carotid artery
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Lymph nodes
Benign: Preserved hilus with blood-flow. Oval shape
Malignant: Rounded. No hilus. Heterogenous echogenicity. Vessels only in perifer parts.
Lymfomas: Low, homogenous echogenicity. Scattered vessels.
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Hand on – puncture technique
• Remember: it´s a VERY thin ”beam”!
• Place the ultra sound screen in front of you
• Straight line between transducer/needle
• If free-hand puncture plan your angle
• Don´t look at the screen to fast
• Avoid puncturing the muscles if possible – it hurts!
• If the angle is not right – back out and start over again
• If you are out of field try to change angle of the transducer
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Hands on - puncture
• Needle guide
• Free-hand technique
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Cytology
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Now, let’s practice!