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Ebook Diagnostic Ultrasound Head and Neck 2Nd Edition PDF Full Chapter PDF
Ebook Diagnostic Ultrasound Head and Neck 2Nd Edition PDF Full Chapter PDF
SECOND EDITION
Cover image
Title page
Copyright
Dedications
Contributing Authors
Preface
Acknowledgments
Sections
Part I: Anatomy
PAROTID SPACE
SUBMANDIBULAR SPACE
Chapter 60: Submandibular Gland Benign Mixed Tumor
GENERAL LESIONS
SOLID
MISCELLANEOUS
SECTION 6: VASCULAR
SECTION 8: INTERVENTION
INDEX
Copyright
DIAGNOSTIC ULTRASOUND: HEAD AND NECK, SECOND
EDITION
ISBN: 978-0-323-62572-2
Notices
ATA
Additional Contributors
Kunwar S.S. Bhatia, MBBS, FRCR
Simon S.M. Ho, MBBS, FRCR
Stella Sin Yee Ho, RDMS, RVT, PhD
Yolanda Y.P. Lee, MBChB, FRCR
H.Y. Yuen, MBChB, FRCR
Preface
The role of ultrasound in evaluating abnormalities in the head and
neck is well established. In evaluating thyroid diseases, it is the
investigation of choice, whereas for many other abnormalities
(salivary glands, parathyroid, neck lymph nodes, and nonnodal
masses), it plays a complementary role to other imaging modalities.
What started as static grayscale imaging modality (predominantly
differentiating cystic from solid masses) has expanded to Doppler,
elastography, and contrast-enhanced ultrasound. These advances in
technology have allowed ultrasound to characterize tissue and
accurately detect and predict histology/cytology of head and neck
lesions. In addition, its role in guiding safe needle biopsy has
significantly increased its specificity.
Modern ultrasound lends itself as an ideal tool in the hands of
clinicians. It is far more accurate than palpation, and with its current
capabilities, it readily provides diagnoses for patients’ symptoms at
their first visit to the doctor. Its application/use has therefore
expanded outside the confines of the imaging department; it is now
extensively used by endocrinologists, head and neck surgeons, and
oncologists to monitor treatment change, follow-up with patients, and
guide interventional procedures in the head and neck (such as
chemical or thermal ablation of lesions).
This book was written to provide essential information to those
who practice or who are considering taking up head and neck
ultrasound as their specialty. It focuses on ultrasound, but readers will
find images from other imaging modalities so as to highlight the
importance of multimodality imaging in modern clinical practice.
The second edition could not have been possible without the
continuing help and contribution of friends (authors, sonographers,
graphic designers, etc.) with similar interests. It has given us all an
opportunity to enhance our own knowledge, share experience, and
contribute images. Above all, we are grateful to all the authors and
contributors to the first edition who laid the foundation of this book
and without whose efforts none of our current work could have been
possible. We remain indebted for their hard work and generosity in
sharing their invaluable expertise. We thank the Elsevier production
team in Salt Lake City for their immense patience, constant
encouragement, and professionalism in guiding us through a difficult
task.
We hope this book will find a place in your library and help you in
your daily clinical practice.
Anil T. Ahuja, MBBS (Bom), MD (Bom), FRCR, FHKCR,
FHKAM (Radiology), Professor of Diagnostic Radiology & Organ
Imaging, Department of Imaging and Interventional Radiology, Faculty of
Medicine, The Chinese University of Hong Kong, Hong Kong (SAR), China
Eunice Y.L. Dai, MBBS, MRes(Med), FRCR, FHKCR, FHKAM
(Radiology), Honorary Clinical Assistant Professor, Department of
Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese
University of Hong Kong, Hong Kong (SAR), China
Evelyn W.K. Tang, MBBS, MRes(Med), FRCR, Honorary Clinical
Tutor, Department of Imaging and Interventional Radiology, Prince of Wales
Hospital, The Chinese University of Hong Kong, Hong Kong (SAR), China
Acknowledgments
Lead Editor
Megg Morin, BA
Text Editors
Arthur G. Gelsinger, MA
Rebecca L. Bluth, BA
Nina I. Bennett, BA
Terry W. Ferrell, MS
Joshua Reynolds, PhD
Image Editors
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS
Illustrations
Richard Coombs, MS
Lane R. Bennion, MS
Laura C. Wissler, MA
Production Coordinators
Emily C. Fassett, BA
Angela M. G. Terry, BA
Sections
Part I: Anatomy
SECTION 1: HEAD AND NECK
Chapter 1: Neck
Chapter 1: Neck
TERMINOLOGY
Abbreviations
• Suprahyoid neck (SHN)
• Infrahyoid neck (IHN)
Definitions
• SHN: Spaces from skull base to hyoid bone (excluding orbits,
paranasal sinuses, and oral cavity), including parapharyngeal
(PPS), pharyngeal mucosal (PMS), masticator (MS), parotid
(PS), carotid (CS), buccal (BS), retropharyngeal (RPS), and
perivertebral (PVS) spaces
• IHN: Spaces below hyoid bone to thoracic inlet, including
visceral space (VS), posterior cervical space (PCS), anterior
cervical space (ACS), CS, RPS, and PVS
IMAGING ANATOMY
Overview
• Fascial spaces of SHN and IHN are key for cross-sectional
imaging
Concept is difficult to apply with US
• US anatomy is based on division of neck into anterior and
posterior triangles
Anterior triangle: Bounded anteriorly by midline and
posteriorly by posterior margin of sternomastoid
muscle
– Further divided into suprahyoid and
infrahyoid portions
– Suprahyoid portion: Divided by anterior
belly of digastric muscle into submental
and submandibular triangles
– Infrahyoid portion: Divided by superior
belly of omohyoid muscle into muscular
and carotid triangles
Posterior triangle: Bound anteriorly by posterior margin of
sternomastoid muscle and posteriorly by anterior border
of trapezius muscle
– Apex formed by mastoid process, base of
triangle formed by clavicle
– Subdivided by posterior belly of omohyoid
muscle into occipital triangle (superior) and
supraclavicular triangle (inferior)
• Submental region
Key structures include anterior belly of
digastric muscle, mylohyoid, genioglossus
and geniohyoid muscles, sublingual
glands, and lingual artery
• Submandibular region
Key structures include submandibular gland,
mylohyoid muscle, hyoglossus muscle, anterior and
posterior bellies of digastric muscle, facial vein, and
anterior division of retromandibular vein (RMV)
• Parotid region
Key structures include parotid gland, masseter and
buccinator muscles, RMV, and external carotid artery
(ECA)
• Cervical region
Upper cervical region: Skull base to hyoid
bone/carotid bifurcation
– Key structures include internal jugular vein
(IJV), carotid bifurcation, jugulodigastric
node, and posterior belly of digastric
muscle
Midcervical region: Hyoid bone to cricoid cartilage
– Key structures include IJV, common carotid
artery (CCA), vagus nerve, and lymph nodes
Lower cervical region: Cricoid cartilage to clavicle
– Key structures include IJV, CCA, superior belly
of omohyoid, and lymph nodes
• Supraclavicular fossa
Key structures include trapezius,
sternomastoid, omohyoid muscles,
brachial plexus elements, and transverse
cervical nodes
• Posterior triangle
Bordered anteriorly by sternomastoid muscle and
posteriorly by trapezius muscle
Floor formed by scalene muscles, levator scapulae,
and splenius capitis muscles
• Midline
Key structures include hyoid bone, strap muscles,
thyroid, larynx, and tracheal rings
Imaging Approaches
• US imaging protocol
Start in submental region by scanning in transverse
plane
Next, scan submandibular region in transverse and
longitudinal/oblique planes
Then scan parotid region in transverse and
longitudinal planes
Now examine upper cervical, midcervical, and lower
cervical regions in transverse plane
Then examine supraclavicular fossa with transducer
held transversely
Now scan posterior triangle transversely along line
drawn from mastoid process to ipsilateral acromion
Finally, scan midline and thyroid gland in both
transverse and longitudinal planes
• This protocol is robust and can be tailored to suit individual
clinical conditions
• Transverse scans quickly identify normal anatomy and detect
abnormalities
• Any abnormality identified is further examined in
longitudinal/oblique planes (grayscale and Doppler)
• In restless children, it may not be possible to follow above
protocol
It would therefore be best to evaluate primary area of
interest 1st, before child becomes uncooperative
GRAPHICS
GRAPHICS
TRANSVERSE ULTRASOUND
Standard transverse grayscale US shows the submental
region. The mylohyoid muscle is an important landmark for
the division of the sublingual (deep to mylohyoid muscle) and
submandibular (superficial to mylohyoid muscle) spaces. Part
of the extrinsic muscles of the tongue, including the
geniohyoid and genioglossus, are visualized.
Standard transverse grayscale US shows the submandibular
region. The submandibular gland is the key structure with its
homogeneous echotexture. The gland sits astride the
mylohyoid and posterior belly of the digastric muscles.
Standard transverse grayscale US shows the parotid region.
Note that the deep lobe is obscured by shadowing from the
mandible and cannot be evaluated. The retromandibular vein
serves as a landmark for the intraparotid facial nerve.
TRANSVERSE ULTRASOUND
Standard transverse grayscale US shows the upper cervical
level. Key structures include the internal jugular vein, the
proximal internal and external carotid arteries, and the jugular
chain lymph nodes. The jugulodigastric node is the most
prominent and consistently seen on US.
Standard grayscale US shows the midcervical level. Note that
the vagus nerve is clearly seen on US.
Standard grayscale US shows the lower cervical level. The
thyroid gland is related to the common carotid and internal
jugular vein laterally. The anterior strap muscles (including the
sternohyoid and sternothyroid muscles) and the superior belly
of the omohyoid are clearly visualized.
TRANSVERSE ULTRASOUND
Standard grayscale US shows the supraclavicular fossa. Note
that the trunks of the brachial plexus are consistently seen on
high-resolution US at this site.
Standard transverse grayscale US shows the posterior
triangle. Note that the intermuscular fat plane is visible. The
spinal accessory nerve and lymph nodes are important
contents of the posterior triangle.
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