INTRODUCTION:
Ultrasound (US) has become an integral part of the practice of medicine
due in part to its soft tissue resolution, cost effectiveness, ability
to measure vessel flow and, perhaps most relevant to head and neck
surgeons, ease of use in the clinical setting in conjunction with fine
needle aspiration (FNA). Thus, it is no surprise that US has gained
significant traction in head and neck surgery in both the clinical and
operative setting for imaging and biopsies of soft tissue lesions of the
lateral and central neck(2). The development of US probes attached to or
passed through endoscopes has allowed for the development of endoscopic
US. For instance, endobronchial ultrasound (EBUS) is a bronchoscopic
technique that utilizes US to visualize structures in the trachea and
paratracheal soft tissues and has become the modality of choice for
mediastinal lymph node biopsy. In EBUS, the endoscope is equipped with
an US at the tip, allowing for image guided endoscopic FNA. The EBUS
system was first introduced in the 1990’s as a minimally invasive option
compared to mediastinoscopy and open biopsy. Large series have
demonstrated the safety and cost effectiveness of EBUS with a major
complication rate of well under 1%(3).
Transcutaneous central and lateral neck US, in both the outpatient
clinic and operating room, is commonplace in head and neck surgery.
However, for the upper aerodigestive track, flexible endoscope-based US
techniques and approaches have not yet been well developed or described.
Adapting existing endoscopic based US techniques, here, we describe
flexible endopharyngeal ultrasound (EPhUS) and the EPhUS guided FNA.