Ultrasound examination of the head and neck region: anatomy, diagnostic algorithms, pathologies, clinical cases

Course curriculum

• Ultrasound examination of the head and neck region. Fundamentals of the method, topography, lymph nodes
• History of the head and neck diagnostic method and its evolution in ultrasound diagnostics
• Analysis of ultrasound physics, important points for use for diagnostic purposes
• Topography of the neck by compartments and ultrasound sections
• Ultrasound examination of the head and neck region – soft tissue masses
• Benign neck masses. Lymph node masses, cystic masses, soft-tissue masses
• Principles of analyzing neck masses with reference to topography. Thyroglossal duct cysts. Branchial (lateral) cyst and neck sinuses. Paragangliomas of the carotid body and vagus nerves, their histological types and structural variants. Laryngeal paragangliomas. Lipomas and nerve tissue tumors. Lymphangiomas and teratomas
• Life cycles of infantile hemangioma on ultrasound. Congenital hemangiomas: rapidly involuting, partially involuting, and non-involuting. Juvenile variants of hemangiomas
• Fibromatosis of the sternocleidomastoid muscle (“muscular torticollis”)
• Zenker hypopharyngeal diverticula
• Typical subcutaneous and skin lesions of the neck and head. Life phases of a cyst (inflammation, partial and complete rupture) using epidermoid cysts as an example. Sebaceous gland cyst – atheroma. Pilomatrixoma. Dermoid cyst
• Incidental findings of vascular origin — jugular vein thrombosis, hematomas
• Malignant neck tumors: sarcomas, chordomas, branchiogenic carcinomas and cystic metastases from Waldeyer's ring
• Ultrasound examination of the lymph nodes of the neck region. Description of the topography of pathological lymph nodes in accordance with the recommendations of the American Joint Committee on Cancer (AJCC). Use of elastography (compression Strain, shear wave SWE) in the assessment of cervical lymph nodes. Assessment in B-mode – malignant and benign signs. The concept of reactive lymph nodes, acute and chronic inflammation. Lymph nodes in lymphomas, tuberculosis and other diseases
• Ultrasound examination of the head and neck region – salivary gland
• Normal and ultrasound anatomy of the salivary glands. Sublingual and submental space. Parotid space. Wharton's and Stensen's ducts
• Features of salivary gland examination. Intraoral palpation maneuver. Provocation of salivation
• Viral and bacterial sialadenitis. Salivary gland abscess
• Mycobacterial diseases of the salivary glands
• Chronic sialadenitis. Sjögren's syndrome. Juvenile recurrent parotitis. Küttner tumor
• Sialolithiasis. A multimodal approach to imaging stones in the salivary gland ducts. Provocation tests for salivary duct obstruction. The role of ultrasound in stone removal, visualization of forceps and drains
• Tumors of the salivary glands. Pleomorphic adenomas and carcinomas. Warthin tumor (papillary cystadenoma). Histologically unrelated tumors in the salivary gland region: lipomas, schwannomas, hemangiomas, and vascular malformations
• Analysis of malignancy signs of tumors. Features of malignancy probability in the parotid and submandibular glands. Mucoepidermoid carcinoma, adenoid cystic carcinoma and others. The relationship between submandibular lymph nodes and skin cancer of the head
• Other salivary gland problems: simple cysts, lymphoepithelial lesions, ranula, sialosis, atrophy and fibrosis
• Tonsil scanning technique. Transoral and transcutaneous scanning
• Ultrasound diagnostics of peritonsillar abscess
• Ultrasound diagnostics of tonsil tumors
• Tongue scanning technique
• Detection of tongue tissue tumors
• Ultrasound of the head and neck region – larynx
• What is the value and advantages of the method? What equipment is needed and are standard ultrasound probes sufficient?
• Analyzing the structures of the larynx on the ultrasound image. We compare the ultrasound and normal anatomy of the larynx. Step-by-step scanning protocol by Timothy J. Beale et al. Principles of compiling the examination report
• In which cases is the method applied and what pathology can be detected on laryngeal ultrasound? Principles of detecting malignant tumors of the larynx. Assessment of growth inside and outside the larynx. Typical pathway of metastasis
• Assessment of benign lesions: benign thyroglossal duct cysts and their malignant variants, vocal cord cysts, laryngeal mucoceles, and assessment of tracheal stent status
• Assessment of vocal cord mobility. Paralysis. Atrophy of the laryngeal muscles
• Inflammatory diseases – stridor and epiglottitis. Post-extubation stridor. Laryngomalacia
• Analysis of the description of laryngeal pathology in the ultrasound examination report
• Ultrasound of the head and neck region – airways
• The role of upper airway ultrasound examination in the intensive care unit and operating room. Ultrasound predictors of difficult airway management
• How to solve the problem of a difficult airway? The Kristensen protocol. Identification of the cricothyroid membrane. Assistance in difficult intubation. A universal probe or a dedicated one for each task depending on the scanning region?
• Scanning algorithm according to Kristensen. Oropharyngeal zone and mandible, hyoid bone, base of the tongue. Subpharyngeal region and hyoid bone, thyrohyoid membrane, epiglottis and thyroid cartilage. Larynx, thyroid cartilage, vocal cords and arytenoid cartilages, cricothyroid membrane and cricoid cartilage
• Choice of endotracheal or tracheostomy tube based on ultrasound data. Technique of marking the cricothyroid membrane and its clinical significance. Technique of tracheal ring identification
• Ultrasound guidance during percutaneous dilatational tracheostomy. Ultrasound assessment of laryngeal mask placement
• Regional block of the laryngeal nerve during intubation of a conscious patient. Blunt trauma of the upper airways – ultrasound diagnosis, Schaefer classification
• Normal pleural sliding and pneumothorax, assessment of airway patency by lung ultrasound scanning
• Ultrasound of the head and neck region – thymus
• Can the thymus enlarge normally? Is this always a sign of pathology, or just a stress reaction? Brief information on physiology and anatomy
• Multidisciplinary approach to thymus assessment. Comparison of radiography, ultrasound, CT, MRI methods
• Ultrasound picture of the normal thymus
• Algorithm for decision-making on management in case of suspected thymic tumor
• Small and large thymus – under what conditions it is detected
• Aplasia and hypoplasia, atrophy and ectopia of the thymus. Accessory thymus
• Differential diagnosis of focal and diffuse thymic changes
• Congenital and acquired thymic cysts
• Lymphatic malformation, germ cell tumors, lymphoma, thymoma, thymolipoma. Thymic carcinoma and carcinoids, infantile hemangioma of the mediastinum, Castleman disease, mediastinitis and tuberculosis
• Thymus measurement — establishing the norm, measurement technique, review of studies, guidelines, and recommendations. Grades of thymomegaly and criteria for thymic hypoplasia
• Clinical significance of detecting thymomegaly
• Ultrasound of the head and neck region – facial injuries, acute vision loss, paranasal sinuses
• Can the paranasal sinuses be reached with ultrasound? Why is ultrasound more sensitive than X-ray?
• Amplitude-modulated ultrasound (A-mode) or two-dimensional scanning (B-mode), which is better to use?
• Assessment of the paranasal sinuses. Ultrasound scanning technique and equipment selection. Sinusitis, sinus mucosal edema and fluid filling. Cysts and polyps. Correlation with radiography, CT and MRI. Generally accepted terminology for describing results
• Face and orbit region. Subcutaneous and orbital abscesses, mucocele, orbital cellulitis. Orbital masses
• Traumatic injury of the face