Interventional Ultrasonography

  • Urban W. Geisthoff
  • Lisa A. OrloffEmail author


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.


Ultrasonography Ultrasound, intervention Fine needle aspiration cytology Core biopsy Sclerotherapy Interstitial laser therapy Catheterization Salivary duct stenosis Sialolithiasis Lithotripsy 

Supplementary material

Video 4.1

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)

Video 4.2

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

Video 4.3

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

Video 4.4

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)

Video 4.4

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)

Video 4.4

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)

Video 4.5

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)

Video 4.6

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

Video 4.7

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)

Video 4.8

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

Video 4.9

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

Video 4.9

(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)

Video 4.10

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)

Video 4.11

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)

Video 4.12

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)

Video 4.13

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

Video 4.14

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)


  1. 1.
    Yuen HY, Lee YY, Bhatia K, Ahuja AT. A short review of basic head and neck interventional procedures in a general radiology department. Cancer Imaging. 2013;13:502–11.CrossRefGoogle Scholar
  2. 2.
    Joshi AS, Sood AJ. Ultrasound-guided needle localization during open parotid sialolithotomy. Otolaryngol Head Neck Surg. 2014;151:59–64.CrossRefGoogle Scholar
  3. 3.
    Kim JH. Ultrasound-guided sclerotherapy for benign non-thyroid cystic mass in the neck. Ultrasonography. 2014;33:83–90.CrossRefGoogle Scholar
  4. 4.
    Berenguer B, Burrows PE, Zurakowski D, Mulliken JB. Sclerotherapy of craniofacial venous malformations: complications and results. Plast Reconstr Surg. 1999;104:1–11; discussion 2–5.CrossRefGoogle Scholar
  5. 5.
    Karp BI, Alter K. Botulinum toxin treatment of blepharospasm, orofacial/oromandibular dystonia, and hemifacial spasm. Semin Neurol. 2016;36:84–91.CrossRefGoogle Scholar
  6. 6.
    Schramm A, Baumer T, Fietzek U, Heitmann S, Walter U, Jost WH. Relevance of sonography for botulinum toxin treatment of cervical dystonia: an expert statement. J Neural Transm (Vienna). 2015;122:1457–63.CrossRefGoogle Scholar
  7. 7.
    Farrugia MK, Nicholls EA. Intradermal botulinum A toxin injection for axillary hyperhydrosis. J Pediatr Surg. 2005;40:1668–9.CrossRefGoogle Scholar
  8. 8.
    Barbero P, Busso M, Artusi CA, De Mercanti S, Tinivella M, Veltri A, et al. Ultrasound-guided botulinum toxin-A injections: a method of treating sialorrhea. J Vis Exp. 2016;(117)
  9. 9.
    Petracca M, Guidubaldi A, Ricciardi L, Ialongo T, Del Grande A, Mulas D, et al. Botulinum toxin A and B in sialorrhea: Long-term data and literature overview. Toxicon. 2015;107(Pt A):129–40.CrossRefGoogle Scholar
  10. 10.
    Porte M, Chaleat-Valayer E, Patte K, D’Anjou MC, Boulay C, Laffont I. Relevance of intraglandular injections of botulinum toxin for the treatment of sialorrhea in children with cerebral palsy: a review. Eur J Paediatr Neurol. 2014;18:649–57.CrossRefGoogle Scholar
  11. 11.
    Shariat-Madar B, Chun RH, Sulman CG, Conley SF. Safety of ultrasound-guided botulinum toxin injections for sialorrhea as performed by pediatric otolaryngologists. Otolaryngol Head Neck Surg. 2016;154:924–7.CrossRefGoogle Scholar
  12. 12.
    Ali MJ, Orloff LA, Lustig LR, Eisele DW. Botulinum toxin in the treatment of first bite syndrome. Otolaryngol Head Neck Surg. 2008;139:742–3.CrossRefGoogle Scholar
  13. 13.
    Ghosh A, Mirza N. First bite syndrome: Our experience with intraparotid injections with botulinum toxin type A. Laryngoscope. 2016;126:104–7.CrossRefGoogle Scholar
  14. 14.
    Capaccio P, Cuccarini V, Benicchio V, Minorati D, Spadari F, Ottaviani F. Treatment of iatrogenic submandibular sialocele with botulinum toxin. Case report. Br J Oral Maxillofac Surg. 2007;45:415–7.CrossRefGoogle Scholar
  15. 15.
    Chow TL, Kwok SP. Use of botulinum toxin type A in a case of persistent parotid sialocele. Hong Kong Med J. 2003;9:293–4.PubMedGoogle Scholar
  16. 16.
    Pantel M, Volk GF, Guntinas-Lichius O, Wittekindt C. Botulinum toxin type B for the treatment of a sialocele after parotidectomy. Head Neck. 2013;35:E11–2.CrossRefGoogle Scholar
  17. 17.
    Austin T, Davis J, Chan T. Sialolithiasis of submandibular gland. J Emerg Med. 2004;26:221–3.CrossRefGoogle Scholar
  18. 18.
    de Bree R, Duyndam JE, Kuik DJ, Leemans CR. Repeated botulinum toxin type A injections to treat patients with Frey syndrome. Arch Otolaryngol Head Neck Surg. 2009;135:287–90.CrossRefGoogle Scholar
  19. 19.
    Drobik C, Laskawi R, Schwab S. Therapy of Frey syndrome with botulinum toxin A. Experiences with a new method of treatment. [Article in German]. HNO. 1995;43:644–8.PubMedGoogle Scholar
  20. 20.
    Yamamoto S, Maeda N, Yoshimura K, Oka M. Intraoperative detection of sentinel lymph nodes in breast cancer patients using ultrasonography-guided direct indocyanine green dye-marking by real-time virtual sonography constructed with three-dimensional computed tomography-lymphography. Breast. 2013;22:933–7.CrossRefGoogle Scholar
  21. 21.
    Eppstein AC, Munshi IA, Sakamoto B, Gwirtz K. Ultrasonography-guided identification with methylene blue tattooing of the ilioinguinal nerve for neurectomy for chronic pain: a case series. JAMA Surg. 2015;150:180–2.CrossRefGoogle Scholar
  22. 22.
    Hiremath R, Reddy H, Ibrahim J, Haritha CH, Shah RS. Soft tissue foreign body: utility of high resolution ultrasonography. J Clin Diagn Res. 2017;11:TC14–6.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Paziana K, Fields JM, Rotte M, Au A, Ku B. Soft tissue foreign body removal technique using portable ultrasonography. Wilderness Environ Med. 2012;23:343–8.CrossRefGoogle Scholar
  24. 24.
    Ahn D, Kim H, Sohn JH, Choi JH, Na KJ. Surgeon-performed ultrasound-guided fine-needle aspiration cytology of head and neck mass lesions: sampling adequacy and diagnostic accuracy. Ann Surg Oncol. 2015;22:1360–5.CrossRefGoogle Scholar
  25. 25.
    Kraft M, Laeng H, Schmuziger N, Arnoux A, Gurtler N. Comparison of ultrasound-guided core-needle biopsy and fine-needle aspiration in the assessment of head and neck lesions. Head Neck. 2008;30:1457–63.CrossRefGoogle Scholar
  26. 26.
    Saha S, Woodhouse NR, Gok G, Ramesar K, Moody A, Howlett DC. Ultrasound guided core biopsy, fine needle aspiration cytology and surgical excision biopsy in the diagnosis of metastatic squamous cell carcinoma in the head and neck: an eleven year experience. Eur J Radiol. 2011;80:792–5.CrossRefGoogle Scholar
  27. 27.
    Werner JA, Lippert BM, Gottschlich S, Folz BJ, Fleiner B, Hoeft S, et al. Ultrasound-guided interstitial Nd: YAG laser treatment of voluminous hemangiomas and vascular malformations in 92 patients. Laryngoscope. 1998;108:463–70.CrossRefGoogle Scholar
  28. 28.
    Geisthoff U, Hoffmanns L, Al-Habib A, Maune S. Sonographisch kontrollierte, minimal-invasive Verfahren zur Behandlung der obstruktiven Sialadenitis aktuelle Ergebnisse und neue Techniken. Abstractband zur 84 Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie eV, 8-1252013 Nürnberg. Mönchengladbach: Rheinware Verlag; 2013.Google Scholar
  29. 29.
    Jecker P, Geisthoff U, Meyer JE, Orloff LA. Salivary gland ultrasonography. In: Orloff LA, editor. Head and neck ultrasonography. 2nd ed. San Diego: Plural Publishing Inc.; 2017.Google Scholar
  30. 30.
    Wacker F, Wolf KJ, Fobbe F. Percutaneous vascular access guided by color duplex sonography. Eur Radiol. 1997;7:1501–4.CrossRefGoogle Scholar
  31. 31.
    Geisthoff U. Techniques for multimodal salivary gland stone therapy. Oper Tech Otolaryngol. 2007;18:332–40.CrossRefGoogle Scholar
  32. 32.
    Geisthoff UW, Lehnert BK, Verse T. Ultrasound-guided mechanical intraductal stone fragmentation and removal for sialolithiasis: a new technique. Surg Endosc. 2006;20:690–4.CrossRefGoogle Scholar
  33. 33.
    Geisthoff UW, Maune S. Ultrasound-guided mechanical fragmentation of sialoliths (sonoguide forceps). Head Neck. 2010;32:1641–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyMarburg University HospitalMarburgGermany
  2. 2.Department of Otolaryngology–Head and Neck SurgeryStanford University School of MedicineStanfordUSA

Personalised recommendations