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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5770_Библиотеки_им_академика_М_И_Перельмана.pdf
6 Sonography ofOther Neck Masses
137
Fig. 6.72 Sonography of the
oor of the mouth (FM) and
the tongue (TO) after tumor
resection followed by
reconstruction with a radial
forearm ap (arrows), using a
frontal section (a) and sagittal
section (b). The echo of the
ap differs from the echo of
the tongue. DIG digastric
muscle, MA mandible, MMH
mylohyoid muscle
a
b
Fig. 6.73 Cystic lesion (RF)
after lateral pharyngotomy.
ACEexternal carotid artery,
ACIinternal carotid artery,
VJIinternal jugular vein
138
P. J e ck er
References
1. Orloff LA. Head and neck ultrasonography. 2nd ed. San Diego:
Plural Publishing; 2017.
2. Welkoborsky HJ, Jecker P, Maurer J, Mann WJ.Ultraschalldiagnostik
Kopf-Hals. Stuttgart: Thieme; 2013.
3. Jecker P, Maurer J, Mann WJ.Ultrasound characteristics of lateral
cervical space-occupying lesions. Ultraschall Med. 2001;22:130–5.
German.
4. Peer S.The place of sonography in the diagnostic work-up of haemangiomas and vascular malformations. Handchir Mikrochir Plast
Chir. 2009;41:70–7. German.
5. Costache A, Dumitru M, Tweedie D, Sarafoleanu C, Anghel I.Adult
cervical lymphangioma - ultrasonography, surgical removal, and
pathology results. Case report. Med Ultrason. 2015;17:411–3.
6. Choi HI, Choi YH, Cheon JE, Kim WS, Kim IO.Ultrasonographic
features differentiating thyroglossal duct cysts from dermoid cysts.
Ultrasonography. 2018;37:71–7.
7. Inarejos Clemente E, Oyewumi M, Propst EJ, Ngan BY, Greer
ML. Thyroglossal duct cysts in children: Sonographic features
every radiologist should know and their histopathological correlation. Clin Imaging. 2017;46:57–64.
8. Jin ZQ, He W, Wu DF, Lin MY, Jiang HT.Color Doppler ultrasound
in diagnosis and assessment of carotid body tumors: comparison
with computed tomography angiography. Ultrasound Med Biol.
2016;42:2106–13.
9. Tong Y.Role of duplex ultrasound in the diagnosis and assessment
of carotid body tumour: a literature review. Intractable Rare Dis
Res. 2012;1:129–33.
10. Podzimek J, Jecker P, Daliri A. Seltene Ursache für eine Schwellung
im Bereich der Gl. parotis. HNO. 2018;66:702–4.
Sonography oftheOropharynx,
Hypopharynx, Larynx, andCervical
Esophagus
PeterJecker
7
7.1 Tumors oftheOral Vestibule,
theFloor oftheMouth, theTongue,
andtheTonsils
Tumors of the oral vestibule can be detected easily with
ultrasound [1–3]. In this region, we often see benign tumors,
such as cysts of the small salivary glands of the lip. These are
commonly hypoechoic and homogenous with a relative signal enhancement (Figs.7.1 and 7.2). Their margins are regular. In contrast, malignant tumors in this area sometimes
show irregular margins (Fig.7.3).
Alveolar cysts (Fig.7.4) show the typical characteristics
of cysts of other regions. These cysts in the maxillary area
can be detected better by ultrasound than by other imaging
methods.
Another cystic tumor that often can be seen is a ranula
(Fig.7.5). A ranula is located next to the mandible, where the
sublingual gland is normally seen. As with other cysts, the
margin is regular, and the ranula itself is hypoechoic with a
relative signal enhancement. The same pattern can be seen
with other cystic lesions of the mouth oor (Fig.7.6).
In contrast to benign lesions, malignant tumors of the
mouth oor often show irregular margins (Fig.7.7). With
ultrasound, inltration of the tongue or other surrounding
structures can be seen early in the diagnostic process [1].
Commonly, these tumors are less hypoechoic than cysts and
sometimes are inhomogeneous. They are located next to the
mouth oor muscles. Complications such as tumor extension
toward the contralateral side of the mouth oor can be seen
with ultrasound (Fig.7.8).
Electronic Supplementary Material The online version of this
chapter (https://doi.org/10.1007/978-3-030-12641-4_7) contains supplementary material, which is available to authorized users.
P. Jecker (*)
Department of Otorhinolaryngology and Plastic Head and Neck
Surgery, Klinikum Bad Salzungen GmbH, Bad Salzungen,
Germany
e-mail: peter.jecker@klinikum-badsalzungen.de
Tongue cancer shows a similar ultrasound nding
(Figs.7.9, 7.10, and 7.11). In contrast to mouth oor cancer,
tongue tumors do not necessarily contact the mouth oor
muscles. Their sonographic appearance is similar to cancer
of other neck regions. Because they are sometimes located in
deeper regions of the neck, the use of low frequencies is
advantageous. We sometimes recommend the use of an
abdominal curved array to detect the whole tumor (Fig.7.11).
In contrast to the tongue and the mouth oor, the tonsillar
region is more difcult to examine because ultrasound must be
performed in a more or less oblique plane caudal to the jaw
angle. Therefore, the examiner must be well trained to detect
pathological processes (such as tumors) of the tonsil with ultrasound. There is no reason to perform ultrasound of the tonsils
in patients with tonsillitis or tonsillar abscesses; these diseases
should be diagnosed clinically. Furthermore, in our experience,
small abscesses cannot be excluded with ultrasound alone, so
we prefer to use CT scans in unclear clinical situations.
Normally, the tonsils can be seen lateral to the tongue and
behind the submandibular gland. In younger patients, the
tonsils are characterized by an onion-like pattern (Fig.7.12).
In older patients, they become atrophic and therefore are
more difcult to detect.
Unilateral growth or hyperplasia of the tonsil is frequently
seen clinically. Then, the different size can be documented
with ultrasound. The normal hyperplastic tonsil (Figs.7.13
and 7.14; Video 7.1) and cancer of the tonsil (Figs. 7.15,
7.16, and 7.17; Video 7.2) or malignant lymphoma (Figs.7.18
and 7.19) are characterized by a hypoechoic pattern of the
organ. The differential diagnosis can be conrmed if lymph
nodes are present with patterns typical of cancer or lymphoma. Furthermore, the extent of tumor growth especially
details such as inltration of the tongue or the mouth oor
(Fig. 7.17) or tumor growth along the pharynx (Fig. 7.20)
can be seen well by ultrasound. In some cases, ultrasound
will show tumor growth toward the large vessels of the neck
(Fig.7.21). In these patients, duplex scan should be used to
differentiate between the internal and external carotid artery,
which is essential for the therapeutic strategy.
© Springer Nature Switzerland AG 2019
H. J. Welkoborsky, P. Jecker (eds.), Ultrasonography of the Head and Neck, https://doi.org/10.1007/978-3-030-12641-4_7
139
140
Fig. 7.1 Salivary cyst (TU)
of the lower lip. The cyst is
hypoechoic and the borders
are regular. MA mandible
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Fig. 7.2 Salivary cyst (TU)
of the lower lip. Note the
relative acoustic enhancement
(between arrows). MA
mandible
7 Sonography oftheOropharynx, Hypopharynx, Larynx, andCervical Esophagus
Fig. 7.3 Cancer (TU) of the
lower lip. The tumor is
heterogeneous and the borders
are irregular
141
Fig. 7.4 Alveolar cyst (TU)
of a maxillary tooth (TO)
142
ab
ab
Fig. 7.5 Ranula (RA) of the
left mouth oor. This cyst is
typically located in the area of
the sublingual gland. Note the
relative acoustic enhancement
(between arrows). FL oor of
the mouth, MA mandible,
RSG right sublingual gland
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Fig. 7.6 Large cystic tumor (TU) of the mouth oor, in sagittal (a) and frontal (b) plane. DIG digastric muscle, MA mandible
Fig. 7.7 Cancer (TU) of the left mouth oor, inltrating the tongue (TO), in sagittal (a) and frontal (b) plane. DIG digastric muscle, MHM mylo-
hyoid muscle
7 Sonography oftheOropharynx, Hypopharynx, Larynx, andCervical Esophagus
a
b
143
Fig. 7.8 Cancer (TU) of the right mouth oor (a), which crosses the midline (arrow). The tumor is inltrating Wharton’s duct, resulting in chronic
sialadenitis (asterisk) of the right submandibular gland (b). MHM mylohyoid muscle, TO tongue
144
ab
ab
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ab
Fig. 7.9 Left side tongue cancer (TU) exceeding the midline (arrow), in frontal (a) and sagittal (b) plane. HB hyoid bone, MF mouth oor,
TO tongue
Fig. 7.10 Left side tongue cancer (TU) exceeding the midline (arrow), before (a) and after (b) radiotherapy, in the same patient. The tumor seems
to be larger after therapy. Note that different arrays were used. MF mouth oor, TO tongue
Fig. 7.11 Cancer (TU) in the midline of the tongue after radiotherapy, in frontal (a) and sagittal (b) plane. A 5-MHz curved array was used for
better tumor detection. MA mandible, MF mouth oor, TO tongue
7 Sonography oftheOropharynx, Hypopharynx, Larynx, andCervical Esophagus
Fig. 7.12 Hyperplastic
tonsils (TO, right greater than
left) in a child. Note the
typical onion-like pattern of
childhood. SM submandibular
gland
145
Fig. 7.13 Massive
hyperplasia of the right tonsil
(tonsille) in an adult patient.
SM submandibular gland
146
Fig. 7.14 Moderate
hyperplasia of the left tonsil
(TO) in an adult patient. SM
submandibular gland
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Fig. 7.15 T2 cancer of the
left tonsil (TO). SM
submandibular gland