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.