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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5770_Библиотеки_им_академика_М_И_Перельмана.pdf
3 Ultrasound Anatomy oftheHead andtheNeck
Fig. 3.15 Lateral cervical
compartment. (a) Transverse
plane. (b) Sagittal plane. CCA
common carotid artery, IJV
internal jugular vein, SCM
sternocleidomastoid muscle,
SHM sternohyoid muscle,
STM sternothyroid muscle,
THY thyroid, VN vagal nerve
a
25
b
26
Fig. 3.16 Venous valve
(arrow) in the left internal
jugular vein (IJV)
P. J e ck er
Fig. 3.17 External jugular
vein (EJV)
More cranially, the bifurcation and the jugulofacial vein
angle become obvious (Fig.3.19). The relation of both structures to each other differs. Often it is necessary to differentiate between the large arteries of the neck. A differentiation is
possible using Doppler ultrasound. The color-coded examination and the Doppler examination of the common carotid
artery are easy (Fig.3.20, Video 3.6). In contrast, the detec-
tion of the internal and the external carotid artery is more
difcult, especially if the bifurcation is more cranial.
Depending on the anatomy of the bifurcation, the internal
and external carotid arteries can be seen in a more sagittal
plane or a frontal plane (Fig.3.21). The pulsed-wave (pw)
Doppler allows a distinction between both blood vessels
(Video 3.7). Whereas the end-diastolic pressure is nearly
3 Ultrasound Anatomy oftheHead andtheNeck
Fig. 3.18 The omohyoid
muscle (OHM) can be seen in
an oblique plane under the
sternocleidomastoid muscle
(SCM). CCA common carotid
artery, IJV internal jugular
vein
Fig. 3.19 Carotid bulb,
bifurcation (BIF) and
jugulofacial vein angle
(JVA) in a transverse view
(a, b, different patients) and
a sagittal (c) view. FV facial
vein, IJV internal jugular
vein, SCM
sternocleidomastoid muscle
27
a
b
28
Fig. 3.19 (continued)
Fig. 3.20 Common carotid artery
(CCA). (a) B-scan. (b) Color-coded
sonography. (c) Doppler
sonography
P. J e ck er
c
a
b
3 Ultrasound Anatomy oftheHead andtheNeck
Fig. 3.20 (continued)
Fig. 3.21 Carotid bifurcation
with a calcied plaque
(arrow). (a) B-scan. (b)
Color-coded sonography.
CCA common carotid artery,
ECA external carotid artery,
ICA internal carotid artery
29
c
a
b
30
Fig. 3.22 Doppler
sonography of the external
carotid artery (ECA) (a) and
internal carotid artery (ICA)
(b)
P. J e ck er
a
b
zero in the external carotid artery, it is much higher in the
internal carotid artery (Fig.3.22).
If the probe is moved laterally in a sagittal view, the vertebral artery can be detected (Fig. 3.23). Its lumen is frequently covered by the acoustic shadows of the transverse
processes of the vertebra (Videos 3.8 and 3.9).
3.3.4 The Floor oftheMouth, Including
Submandibular andSublingual Glands
Cranial to the bifurcation and the jugulofacial vein angle, the
submandibular gland can be detected (Fig.3.24). In healthy
persons, the gland is homogeneous, and the echogenicity is
3 Ultrasound Anatomy oftheHead andtheNeck
a
31
b
Fig. 3.23 Vertebral artery (VA) and vertebral vein (VV) in a sagittal section. (a) B-Scan. (b) Color-coded sonography. (c) Doppler sonography.
TP transverse process of the vertebra
32
Fig. 3.23 (continued)
P. J e ck er
c
Fig. 3.24 Oblique section
through the jaw angle. SM
submandibular gland, TO
tongue
similar to that of the thyroid gland (Video 3.10). The submandibular gland has direct contact with the inferior part of
the parotid gland, and the echo of the two glands is somewhat different (Fig.3.25). Within the submandibular gland,
the hilus can sometimes be seen; it should not be confused
with intraglandular vessels (Fig.3.26). The facial artery also
can be detected in this region (Fig.3.27).
From the submandibular gland, the array should be moved
in the direction of the mouth oor (Video 3.11). In the ventral portion of the mouth oor, a gure like the “head of
3 Ultrasound Anatomy oftheHead andtheNeck
Fig. 3.25 Contact between
submandibular gland (SM)
and parotid gland (PAR). LN
lymph node, TO tongue
33
Fig. 3.26 A hilus-like
structure (asterisk) in the
submandibular gland (SM),
diagnosed as an intraglandular
blood vessel by using
color-coded ultrasound
Mickey Mouse” can be seen (Fig.3.28). The single muscles
of the mouth oor can be identied as structures of poor echo
(Figs.3.28 and 3.29). Furthermore, the sublingual glands can
be seen beside the mandible. They are characterized by the
typical echo similar to that of other major salivary glands.
Finally, the sublingual artery can be seen with B-scan and
with color-coded sonography (Fig.3.30).
3.3.5 Tongue, Tongue Base, andTonsils
Although the tongue (Video 3.12) can also be seen in a frontal section, the optimal visualization of its whole body
requires a sagittal view (Fig.3.31). In this view, the caudal
parts of the tongue base can also be identied (Video 3.13).
Within the tongue base, a small area is always covered by the
34
Fig. 3.27 The facial artery
(FA) can be detected upon the
mandible (MA) and next to
the posterior end of the
submandibular gland (SM).
PAR parotid gland
Fig. 3.28 Frontal section
through the anterior mouth
oor (a) and posterior mouth
oor (b). DIG digastric
muscle, GHM geniohyoid
muscle, MA mandible, MHM
mylohyoid muscle, SL
sublingual gland
P. J e ck er
a
b