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Interventional Ultrasonography

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Ultrasonography of the Head and Neck

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Abstract

Ultrasound is just one of several techniques that can be used to guide interventions. Others include haptics, CT, MRI, and the use of navigation systems based on these cross-sectional imaging techniques. The advantages of ultrasound are that it offers a combination of diagnostic imaging, no radiation exposure, relatively low equipment cost, and real-time interaction, so that the effect of dynamic tissue changes can be compensated for.

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Marburg University Hospital, Marburg, Germany

    Urban W. Geisthoff

  2. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Lisa A. Orloff

Authors
  1. Urban W. Geisthoff
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  2. Lisa A. Orloff
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Corresponding author

Correspondence to Lisa A. Orloff .

Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, KRH Nordstadt Clinic-Academic Hospital, Hannover, Germany

    Hans J. Welkoborsky

  2. Department of Otorhinolaryngology and Plastic Head and Neck Surgery, Klinikum Bad Salzungen GmbH, Bad Salzungen, Germany

    Peter Jecker

4.1 Electronic Supplementary Material

Testing of tissue consistency: A needle is used to confirm that the hyperechoic structure in the submandibular region of the left side is a solid stone, and not air or an accumulation of smaller hyperechoic structures (WMV 2176 kb)

Aspiration of liquids: The content of a seroma in the right supraclavicular region is drained under sonographic control (MPG 8072 kb)

Injection of botulinum toxin into the right parotid gland (WMV 2105 kb)

Core bore biopsy of a partially necrotic soft tissue metastasis of the right neck using the Spirotome device. Note that the advancement of the device is always under direct manual control. (a) External view (MTS 207990 kb)

Core bore biopsy of a partially necrotic soft tissue metastasis of the right neck using the Spirotome device. Note that the advancement of the device is always under direct manual control. (b) Sonographic view: introduction of the Spirotome (WMV 11466 kb)

Core bore biopsy of a partially necrotic soft tissue metastasis of the right neck using the Spirotome device. Note that the advancement of the device is always under direct manual control. (c) Sonographic view: cutting with the Spirotome (WMV 11551 kb)

Core bore biopsy of a node in the left thyroid using the Magnum device. Note the frequent tissue shifts resulting from heartbeat, breathing, and other movements of the patient. When firing the device (see Fig. 4.7), first the inner needle advances rapidly, followed by the outer shaft. This rapid and automatic advancement must be considered before the release of the spring mechanism. The examiner asks the patient to stop moving and breathing for a second, calculates the trajectory, and makes sure that no dangerous structures are in the way (MPG 11816 kb)

The procedure in Fig. 4.8 and the coagulation effect achieved can be monitored by ultrasound (WMV 11497 kb)

A stenosis of the right Stensen’s duct is first dilated using a metal dilator. Afterward, a flexible drain is pushed over the dilator and placed into the pre-stenotic, dilated part of the duct (MPG 21854 kb)

A cannula is placed in the cephalic vein of the right arm of a drug-addicted patient under ultrasonographic control (MPG 14478 kb)

(a) Flow inside a venous malformation of the right cheek induced by slow pressure of the ultrasound transducer (MP4 1681 kb)

(b) Vascular access to the same venous malformation with a thin needle, which afterward is used to inject contrast material and Histoacryl glue for sclerosis under sonographic control (Fig. 4.11a, b) (MP4 1768 kb)

Mobilization of a small stone inside the right Wharton’s duct by a finger. The stone blocked the papilla; after it was pushed back, saliva flushed out, giving the patient temporary relief. She did not want immediate surgery for personal reasons and performed this maneuver for several days until duct slitting, stone extraction, and marsupialization were performed. (Video from Jecker et al. [29], with permission) (WMV 5423 kb)

During an acute putrid infection of the parotid gland, a stone inside Stensen’s duct is pushed back with a probe to allow the drainage of pus. We attempted this maneuver, as we were hoping to perform stone fragmentation in a noninfected state with local anesthesia. Unfortunately, this did not work, even after placement of a drain, so we finally had to perform stone fragmentation and extraction under general anesthesia (WMV 5201 kb)

A small stone behind a long stricture of the right Stensen’s duct is extracted with a Dormia basket. (See also Fig. 4.12.) (MPG 7516 kb)

Forceps inside right Stensen’s duct fragmenting a stone. (Video from Jecker et al. [29], with permission) (AVI 367317 kb)

About 3000 shock waves per session are applied to fragment the stone. Sometimes several fragments or a widening of the stone reflex can be observed on the ultrasound screen (WMV 6188 kb)

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Geisthoff, U.W., Orloff, L.A. (2019). Interventional Ultrasonography. In: Welkoborsky, H., Jecker, P. (eds) Ultrasonography of the Head and Neck. Springer, Cham. https://doi.org/10.1007/978-3-030-12641-4_4

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  • DOI: https://doi.org/10.1007/978-3-030-12641-4_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12640-7

  • Online ISBN: 978-3-030-12641-4

  • eBook Packages: MedicineMedicine (R0)

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