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Regional approach of the neck anatomy by threedimensional ultrasonography: Description using five
voluminal acquisitions
Poster No.:
C-1686
Congress:
ECR 2010
Type:
Educational Exhibit
Topic:
Head and Neck
Authors:
A. Iannessi, P. Y. Marcy, N. Amoretti, M. Maillard; Nice/FR
Keywords:
neck, anatomy, ultrasonography
DOI:
10.1594/ecr2010/C-1686
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Page 1 of 58
Learning objectives
To have a three-dimensional ultrasound approach of the neck anatomy.
To identify muscles of the neck and the buccal floor.
To know the surgical "triangle" division of the neck and the international nodes levels
classification used for terminology of neck dissection.
To have a logical progression space by space during ultrasound examination.
To locate key structures of each space studied and their anatomic relations.
Background
The understanding of the regional anatomy is the key of any radiological approach
Unfortunately, the complexity of the area of the neck is an obstacle with its good
knowledge.
The cross-sectional imaging not being the examination of first intention of this region, its
anatomy is less familiar to us.
Cervical echography being however a first-line examination for any pathology of this
region it appears essential to us to perfect its knowledge.
Imaging findings OR Procedure details
INTRODUCTION:
Three dimensional ultrasound approach is used to describe neck anatomy. We've based
on a surgeon's practical division making five volumal ultrasound acquisitions:
anterior cervical region (suprahyoid and infrahyoid) postero-lateral cervical region
(Parotid, Vascular axis, Supra clavicular).
After reformatting them we labelled the slices and for each acquisition, a key slice tried
to outline structures not to miss.
We illustrated anatomic relations of salivary glands and in particular the parotid one with
facial nerve.
Page 2 of 58
We detailed the hyoid muscles with buccal floor and nodes levels, knowing good the
digastric and omohyoid muscle.
We mentioned nerves (X, XI, VII) and explored the brachial plexus.
ABREVIATIONS on page 16
CONTENTS
on page
A) CLINICAL ANATOMY:
1) Boundaries of the neck (figure) on page 16
Definition : Region of the body that links the trunk with the head.
The surface limits of the neck are recognized easily during the inspection and palpation :
•
Top , anterior to posterior :
- Lower border of the mandible and the posterior ramus
- Horizontal line through the ATM and the lower edge of the base of the skull (mastoid of
the temporal bone and external occipital protuberance)
•
Low, anterior to posterior :
- Jugular notch of sternum
- Upper edge of the clavicle
- Horizontal line joining the spine process of C7 with acromioclavicular articulatio
2)The skin and the platysma (figure) on page 17
The platysma is a cutaneous muscle located over the surface of the superficial cervical
fascia. It is part of the muscles for facial expression and thus does not have his own fascia.
It is innervated by the facial nerve.
• Termination: mandible (m), muscles around the angle of the mouth, skin of the cheek.
Page 3 of 58
• Variable Origin: superficial fascia of deltoid muscle (D) and pectoralis major (PM).
• Function: Pull down and back external part of the lower lip, lowers the mandible.
3) Systematization: Triangles of the neck and superficial muscles
Anatomists and surgeons divide the neck into triangles defined by the relief of
superficial muscles and their attachments.
This practice is based on the dissection and not suitable for cross-sectional imaging but
his knowledge is essential to enable a mutual understanding with surgeon (figure )
An anatomical knowledge of 3 muscles allows this regionalization:
- Sternocleidomastoid = SCM
- Digastric = DG
- Omohyoid = OH
a) Sternocleidomastoid muscle (figure) on page 18
It divides the neck into two triangles anterior and posterior
•
•
Insertion: mastoid and posterior nuchal line
Origin = 2 heads:
Sternal = manubrium sterni
Clavicular = superior surface of the medial third of the clavicle
•
Actions :
Acting alone : tilts head to its own side and rotates it so the face is turned towards the
opposite side.
Acting together: flexes the neck, raises the sternum and assists in forced inspiration.
•
Nerve : Accessory Nerve (XI) and Plexus brachial (C1 C2)
b) Anterior triangle of the neck (figure) on page 20
It is divided by the hyoid bone in supra and infrahyoid level:
Page 4 of 58
•
SupraHyoid level is separated into two trigone by the anterior belly of
digastric muscle:
- Submental trigone(1)
- Submandibular trigone(2)
•
InfraHyoïd level is separated into two trigone by the superior belly of
omohyoid muscle:
- Carotid trigone (3)
- Muscular trigone (4)
c) Posterior triangle of the neck Also known as lateral neck or supra clavicular
region (figure) on page 20
It is subdivided by the posterior belly of the omohyoid muscle into:
- Occipital triangle superiorely (5)
- Supraclavicular inferiorely (6)
B) CROSS SECTIONAL ANATOMY:
1) Cervical fascia and compartmental anatomy notion
Connective tissue found the compartmental anatomy by dividing the neck spaces into
cellular fatty area in witch can be found lymphatics.
These spaces are closed transversely and can be resected carcinologic if it take off the
fascia from structures that surrounds. This is the principle of functional dissection.
Some are open cranio-caudally as the space of vascular pedicles explaining the
spread of infectious or neoplastic process in the mediastinum.
it differentiates : (Figure) on page 22
A Muscular Fascia formed by 3 layers :
Page 5 of 58
Superficial (yellow): envelopes neck. Only the external jugular vein and the platysma
(brown) are outside it.
Pretracheal (red) : encloses minfrahyoid muscles.
Prevertebral (purple) : encloses the scalene muscles, the prevertebral muscles and
intrinsic muscles of the back.
A neurovascular fascia (blu) to enclose carotid pedicle
A visceral fascia (green) encloses larynx, trachea, pharynx, œsophagus and thyroïd.
2) Systematization of the neck:
•
Axes of the neck
From the compartmental anatomy emerges another possible systematization in 3 axes.
(Figure) on page 23
The center line = visceral
The anterolateral axis = vascular
The posterolateral axis = muscle
•
International nomenclature:
* The systematization of Robbins
In oncology practice, it is necessary to know the international systematization introduced
in 1991 and revised in 2002 by K. Thomas Robbins. Its purpose is to standardize the
nomenclature of the different procedures of lymphadenectomy in classifying the different
regions involved in lymph node dissection and anatomical structures sacrificed.
The subdivision is based on the "triangles" neck and 3 additional markers
(Figure) on page 23
* The lymph node dissection
The neck dissection is a necessary complement to the treatment of cervical tumors:
At the beginning of the century, The American surgeon G. Crile introduced the radical
neck dissection in the treatment of head and neck tumors. All lymph node I to V, the
Page 6 of 58
lymphatic vessels and vital structures are resected so this technique is associated with
high morbidity and mortality.
In 1960, E. Bocca brought on functional neck dissection (modified radical) based
on the compartmental anatomy of the neck. It is not envisaged in case of lymph node
capsular rupture. It preserves at least one of the 3 vital structures (SCM, IJV, accessory
nerve) with a recess I to V.
More recently, selective neck dissection applies to N0 patients and relies on a recess
prophylactic sites statistically higher risk of occult metastases ccording to the original
neoplasm. Ex: Selective Neck Dissection supraomohyoid, SND III II I
3) Voluminal Ultrasonographic Anatomy:
5 volumes to acquire :
Scan medial suprahyoid level = IA, IB Video 1 on page 40 2 on page 41 3 on page
42 4 on page 43
Scan the parotid Video 1 on page 45
Scan medial infrahyoid level = VI Video 1 on page 44
Scan lateral neck carotid-jugular = II, III, IV Video 1 on page 47 2 on page 48
Scan posterolateral neck and sus clavicular hollow = V Video 1 on page 49
TWO MEDIAL ACQUISITIONS
1) Supra hyoid level, site I of Robbins classification
The supra hyoid region is part of the anterior triangle of the neck. It is divided into two
triangles separated by the anterior belly of digastric easily identified on ultrasound.
•
Median scan = Ia (Video 1) on page 40 (Video 2) on page 41 (Figure)
on page 27
Le submental triangle (odd) is concerned by this acquisition and includes two overlapping
regions :
* the floor of the mouth (surperficial)
* the lingual region (deep)
Keys structures:
Page 7 of 58
-Lymph nodes of the group Ia
-Muscles of the tongue
-Lingual artery
-Artère linguale
-Glande sublinguale
$ Supra Hyoid Muscles (group)
All have their origin on the hyoid bone
•
•
•
•
Digastric (DG)
Mylohyoid (MH)
Geniohyoid (GH)
Stylohyoid (SH)
Digastric muscle ends in a tendon inside a flange conjunctiva by cleaving the stylohyoid
muscle
$ Mouth Floor (Figure) on page 24
Is formed by DG, MH, GH
Mylohyoid (MH)
Geniohyoid (GH)
Termination
inner surface of the mental spine
horizontal branch of the
mandible
and
behind
the mandibular symphysis
under the insertion of
geniohyoid muscles.
Action
Raises oral cavity floor and deglutition
elevates hyoid,
mastication
deglutition
Mastication (laterally)
$ Tongue (Figure) on page 26
Page 8 of 58
The tongue is a very mobile sensory and muscular organ essential for chewing,
swallowing and tasting as well as speeching.
Suspended by extensions muscle to the mandible, the hyoid bone and styloid process
of the hyoid bone thus facilitating mobility
We distinguish:
- Intrinsic muscles of the tongue witch have their origin and their termination in the
organ.
- Extrinsic muscles that end in it but have an external origin are called « X- glossus ».
They are peers, the tongue is separated into two by fibrous septa.
During ultrasonography exam we can see the two extrinsic tongue's depressor
muscles:
Genioglossus
Hyoglossus
The mylohyoid muscle is to seek to differentiate a lesion submandibular a
sublingual lesion: A lesion superficial to this muscle is a submandibular lesion.
$ Arteries (Figure) on page 27 (Figure) on page 28
on page 27
The lingual artery (4) arises from the external carotid artery (5).
It runs in the floor of the mouth to the deep muscle hyoglossus and divides into deep
artery of tongue and sublingual artery.
The facial artery (3) is a branch of the external carotid artery above the lingual artery. It
emerges under the horizontal branch of the mandible and runs deep to the submandibular
gland. Then she leaves a submental branch before ascending path in the face
•
Paramedian scan = from Ia to Ib (video 3) on page 42
$ Anatomical relations of salivary glands:
Page 9 of 58
Mylohyoid muscle (8) thickens back up to a free edge that's why there is continuity
between the sublingual space (11) and the submandibular space (10) laterally and
the para pharyngeal space medially. (Figure) on page 29
The submandibular gland (sm) in a space located between the digastric (dg) and
mylohoidien muscle (mh).
The free edge of the mylohyoid muscle separates the superficial gland of the deep
extension.
The posterior belly of digastric muscle and tendon are thin. It is immediately posterior
to the gland and can be traced to the hyoid bone.
The submandibular area is limited by the platysma (pt)
The submandibular duct (1) go forward up against the medial surface of the sub lingual
to the ostium near the lingual frenulum. It is undercrossed by the lingual nerve (2).
It passes between the mylohyoid and hyoglossus muscles medial to sublingual
gland. (Figure) on page 29
Anterior to the gland, we identify a cellular fatty space where can be found lymph nodes
of the site Ib.
Two venous anatomical landmarks that join to drain into the IVJ (6) are constant: (Video
4) on page 43
Anterior, Superior, Superficial: Facial vein (3)
Posterior: division of the Retromandibular vein (1) anastomosing also the VJE (7)
They can determine whether a lesion is parotid or submandibular according to
their displacement in case of mass effect. (Figure) on page 30
2) Infra hyoid, this space is the site VIRobbins (Video) on page 44 (Figure) on page
34
Many of us easily analyze the thyroid gland, but most do not examine systematically the
midline of the mandible to the sternum. Focus on neglected areas and key structures
Keys Structures to identify from top to bottom :
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-The suprahyoid level is represented by the triangle in mind already detailed.
-The hyoid bone is easily found under the chin as a structure very attenuating.
-The larynx and the thyroid cartilage is easily recognizable (ultrasound anatomy not
detailed in this paper)
-The thyroid and parathyroid.
-The hyoid muscles in the overlying visceral axis
Infra hyoid muscles (Figure) on page 31 (group)
Visceral axis is covered by muscles called "strap muscles".
It has a proper fascia called pretracheal.
There are two recovery planes:
Superficial plane
Deep plane
SternoHyoid SH
SternoThyroïd ST
OmoHyoïd OH
ThyroHyoïd
The sternothyroid muscle (ST) arises from the posterior surface of the manubrium sterni
below the origin of the Sternohyoideus (SH) witch is a muscle longer. It is inserted into
the oblique line on the lamina of the thyroid cartilage and is the key of thyroidectomy.
(Figure) on page 34
The cricoid cartilage is a good marker on the midline.
It is located below the thyroid isthmus.
It is followed by the cartilaginous rings of the trachea.
The ideal site of tracheostomy is between the first and second ring and an ultrasound
tracking is possible.
Be careful not to confuse the esophagus with a thyroid nodule
THREE LATERAL ACQUISITIONS :
Page 11 of 58
1) Parotid acquisition (Video) on page 45
$ The area: (Figure) on page 32
Location = Retro mandibular fossa
- In front of the ear and sternocleidomastoid muscle
- From the external auditory meatus to the mandibular angle.
Approximately one finger's breadth below the zygoma, the parotid duct emerges and
goes forward.
The parotid gland is located in front of the SCM and posterior belly of digastric (DG).
It has two lobes without stand true anatomical terms, they are separated by a vascular
plane :
•
A superficial lobe with anterior extension covers the back of the masseter
muscle (5).
•
A deep lobe extends to the superficial part of the prestylian space.
Homogeneous as all major salivary glands and Hyper echogenic to muscle. It depends
on his fat charge.
$ In the gland we find neurovascular elements: (Figure) on page 32
From the surface to the depth ...
The facial nerve + + + (4) is attached to the venous level
A venous plane: retromandibular vein (9) et anastomosis to the external jugular vein(10)
An arterial plane with the termination of the external carotid (8) into superficial temporal
and maxillary arteries.
Sometimes it's hard to distinguish vessels in depth and Color Doppler is therefore useful
+++.
•
The facial nerve (Figure) on page 32
The goal of surgery is to resect parotid gland without damaging the facial nerve and its
branches.
The first step is to identify the common trunc (3) of the facial nerve outside the parotid
gland.
In the gland the nerve divides into several branches (5,6,7,8,9).
Page 12 of 58
The facial nerve (3) is not viewed formally.
There is a risk of confusion with an intraparotid duct.
•
The venous plane (1) is an easy landmark to identify by sonography. The
nerve stand immediately lateral to the vein.
$ Anterior extension of the parotid (Figure) on page 33
Approximately one centimeter below the zygoma, the parotid duct leaves the superficial
surface of the gland and passes forward. It becomes medial peforant in the buccinator
muscle and ends in the ostium of the second molar lingual vestibule. Dilated it is difficult
to identify. It appears as a thin echogenic line.
In the parenchyma there are lymph nodes that should not exceed 6 mm in the normal
state.
The presence of a hyperechoic hilum is a criterion of benignity
2) Carotid-jugular acquisition
The vascular axis is divided into upper, middle, inferior, respectively limited by the hyoid
bone and cricoid cartilage. (Figure) on page 35
The region is the area of carotid trigone and SCM. It consists of many neurovascular
structures. The sternocleidomastoid muscle form a cover for the vascular axis (Video)
on page 46
By scanning from top to bottom are detected lymph nodes adjacent to vessels.
We must recognize the key elements:
-The posterior belly of digastric
-The SCM and the carotid-jugular vessels
-The nerve X
-The omohyoid muscle
•
Axial scan Along the carotid trigone = site II (Video) on page 47
Probe on to the mastoid moving toward the hyoid bone. We identify a structure under the
SCM muscle and adjacent to the tail of the parotid in antero-inferior direction:
Page 13 of 58
The posterior belly of digastric marks the division with the submandibular triangle. Only
the mandibular retro vein and external jugular vein is more superficial.
Transverse probe, deep muscle, it identifies forwards 3 vessels :
* Internal jugular vein
* Internal carotid artery
* External carotid artery
In thin people can be seen the process of the atlas
First important surgical landmark : The carotid bifurcation
It is the marker of the transition between the site II and III actually realized by the
path of the accessory nerve.
•
Axial scan Along the vascular axis = site III and IV (Video) on page
48
Second important surgical landmark: omohyoid: (OH)
It is an infrahyoid superficial muscle. It is a digastric muscle with a tendon passing through
in a fascia attached to the clavicle.
Its anterior belly divides the anterior triangle into carotid trigone and muscle triangle.
(figure) on page 20
Its posterior belly divides the posterior triangle occipital triangle and supraclavicular
area. (figure) on page 20
Origin: anterior portion of the body of the hyoid bone
Termination: the top edge of the scapula
Route: slanting down before crossing the common carotid artery and subsequently the
sternocleidomastoid muscle.
Role: Lowering of the hyoid bone.
The OH muscle crosses CCA: This level is usually where cricoid cartilage divides
the sites III and IV.
Page 14 of 58
Vagus X runs with the vascular axis, it is easily identified
3) Posterior triangle and Supraclavicular acquisition (Video) on page 49
It corresponds to the muscular axis or the site of V Robbins (Figure) on page
The region of the posterior triangle is a superficial region of the neck surface full of
muscles. The region is bordered by the SCM anteriorly and the trapeze posteriorly. The
floor is made up of muscles covered by pre vertebral fascia (part of the cervical fascia).
Identify key structures:
The brachial plexus is the challenge of ultrasound in the region.
Recognize the scalene muscles.
Know where the accessory nerve passes
$ The Scalene muscles (Figure) on page 39
Key structure of the region is the anterior scalene (SA) muscle
It extends down and forward of the transverse processes of C3 through C6 to the upper
surface of the first rib (tubercle Lisfranc).
It passes behind the clavicle and between the subclavian artery and subclavian
vein
•
Sagittal scan :
1) Passing over the clavicle in sagittal, we recognized it above the subclavian artery.
2) Once the anterior scalene muscle found in sagittal, we check sweeping upward in axial
sections.
Back in the space between the scalenus anterior and scalenus medius, we identify the
brachial plexus as 3 hypoechogenic nodules corresponding to 3 trunks lateral, medial
and posterior.
•
Axial scan :
In axial section, the key is the identification of muscle scalene deep to the muscle
scm and rear to jugular trunk. The scalenus anterior (SA) has a route between 7am
and 12pm.
Page 15 of 58
$ The brachial plexus:
Origin: C5 to T1
Runs between the scalenus anterior and scalenus medius.
The emergence of roots can be objectified by their common nerve trunk. Then, the nerves
running along the infraclavicular vascular axis.
Nerves : posterior radial nerve, anterior median nerve and anterolateral
musculocutaneous nerve, ulnar nerve between the artery and vein.
Images for this section:
Fig. 1
Page 16 of 58
Fig. 2: Boundaries of the neck
Page 17 of 58
Fig. 3: Platysma
Page 18 of 58
Page 19 of 58
Fig. 4: Sternocleidomastoid muscle
Fig. 5: Anterior triangle of the neck
Page 20 of 58
Fig. 6: Posterior triangle of the neck
Page 21 of 58
Fig. 7: Anatomical dissection
Page 22 of 58
Fig. 8: Cervical fascia
Fig. 9: Axes of the neck
Page 23 of 58
Fig. 10: The systematization of Robbins
Fig. 11: Mouth Floor muscles
Page 24 of 58
Fig. 12: Hyoid Muscles
Page 25 of 58
Fig. 13: Hyoid Muscles
Page 26 of 58
Fig. 14: Tongue
Fig. 15: Key slice : I
Page 27 of 58
Fig. 16: Arteries of the level I : The lingual artery (4), The external carotid artery (5). The
facial artery (3.
Page 28 of 58
Fig. 17: Arteries of the level I
Fig. 18: Mylohyoid muscle (8), The sublingual space (11) and the submandibular space
(10),The submandibular gland (sm) in a space located between the digastric (dg) and
mylohoidien muscle (mh). The submandibular duct (1) is undercrossed by the lingual
nerve (2).
Page 29 of 58
Fig. 19: Anatomical relations of salivary glands:
Page 30 of 58
Fig. 20: Venous landmarks : Facial vein (3, division of the Retromandibular vein (1)
anastomosing also the VJE (7).
Page 31 of 58
Fig. 21: Infrahyoid muscles
Fig. 22: Parotid
Page 32 of 58
Fig. 23: Facial nerve : common trunc (3) divides into several branches (5,6,7,8,9). venous
plane (1).
Page 33 of 58
Fig. 24: Anterior extension of the parotid
Fig. 25: Key slice : VI
Page 34 of 58
Fig. 26: Strap muscles of level VI
Page 35 of 58
Page 36 of 58
Fig. 27: The vascular axis is divided into upper, middle, inferior, respectively limited by
the hyoid bone and cricoid cartilage.
Fig. 28: Muscular axis
Page 37 of 58
Fig. 29: Key slice : II III IV
Page 38 of 58
Fig. 30: Key slice : V
Page 39 of 58
Fig. 31: Find the brachial plexus = V
Page 40 of 58
Fig. 32: Suprahyoid Median scan Ia
Page 41 of 58
Fig. 33: Suprahyoid Median scan Ia
Page 42 of 58
Fig. 34: Suprahyoid Paramedian scan Ia to Ib
Page 43 of 58
Fig. 35: Suprahyoid Paramedian scan
Page 44 of 58
Fig. 36: Infrahyoid scan
Page 45 of 58
Fig. 37: Parotid scan
Page 46 of 58
Fig. 38: Carotid Jugular scan = SCM
Page 47 of 58
Fig. 39: Carotid Jugular = II
Page 48 of 58
Fig. 40: Carotid Jugular = III IV
Page 49 of 58
Fig. 41: Posterior triangle = V
Page 50 of 58
Conclusion
Three dimensional ultrasound allow to illustrate spaces of neck anatomy and to outline the
different key structures often not good explored apart from thyroïd using five acquisitions:
MEDIAN SPACES
The suprahyoid space is the floor of the mouth and called Level I. The muscles that are
recognizable are the digastric, the mylohyoid, the geniohyoid, the genioglossus.
It distinguishes the site Ia anteromedial called submental and the site Ib posterolateral
called separated by the anterior belly of digastric.
(Figure) on page 51
Infrahyoid level is the visceral column. It is covered with infrahyoid muscles : hyo thyroid,
sterno thyroid, sterno hyoid, omo hyoid. This axis includes site VI. (Figure) on page 52
LATERAL SPACES
The parotid gland is separated into superficial and deep parts by the facial nerve witch
is most often invisible. The venous plane is a useful landmark to estimate invasion of
intra parotid lesion to facial nerve. (Figure) on page 53
The jugular carotid vascular axis includes sites II, III, IV respectively separated from
the top down by the carotid bifurcation and the omohyoid muscle. The X easily visualized
running along the vessels.
The sternocleidomastoid muscle superficially covers this vascular axis, its on page
53posterior border is the anterior boundary of the site V. (Figure) on page 53
The brachial plexus is visible laterally in the hollow above the clavicle behind scalenus
anterior. (Figure) on page 54
Images for this section:
Page 51 of 58
Fig. 1: Key slice : I
Page 52 of 58
Fig. 2: Key slice : VI
Fig. 3: Anterior extension of the parotid
Page 53 of 58
Fig. 4: Key slice : II III IV
Page 54 of 58
Fig. 5: Key slice : V
Page 55 of 58
Personal Information
A. Iannessi : Fellow
Head & Neck Imaging and Interventional Radiology
Antoine Lacassagne Anticancer Research Institute
Sophia Antipolis University
06189 Nice cedex1
FRANCE
Office: 00 33 4 92 03 11 81
Personal email: [email protected]
P. Y. Marcy : MD
Head & Neck Imaging and Interventional Radiology
Antoine Lacassagne Anticancer Research Institute
Sophia Antipolis University
06189 Nice cedex1
FRANCE
Office: 00 33 4 92 03 11 81
Personal email: [email protected]
N. Amoretti : MD
University Hospital Archet 2
Radiology unit
B.P. 3079
06202 Nice (Alpes-Maritimes)
Office : 00 33 4 92 03 63 73
Personal email: [email protected]
M. Maillard : Fellow
University Hospital Archet 2
Radiology unit
Page 56 of 58
B.P. 3079
06202 Nice (Alpes-Maritimes)
Office : 00 33 4 92 03 63 73
Personal email: [email protected]
References
Articles :
Robbins KT et al. Neck dissection classification update: revisions proposed by the
American Head and Neck Society and the American Academy of Otolaryngology- Head
and Neck Surgery(AAOHNS). Arch Otolaryngol Head Neck Surg 2002;128:751-758.
Bialek EJ et al. US of the major salivary glands: anatomy and spatial relationships,
pathologic conditions, and pitfalls. Radiographics. 2006 May-Jun;26(3):745-63.
Thoron JF et al. Ultrasonography of the parotid venous plane. J Radiol. 1996
Sep;77(9):667-9.
Books :
Titre
Practical Guide to Neck Dissection
Auteurs
I. Serafini, Marco Lucioni, J.P. Shah, J.
Medina, W. Steiner
Édition
illustrée
Éditeur
Springer, 2007
ISBN
3540716386, 9783540716389
Longueur
105 pages
Titre
Practical head & neck ultrasound
Greenwich Medical Media
Auteurs
Anil T. Ahuja, Rhodri M. Evans
Rédacteurs
Anil T. Ahuja, Rhodri M. Evans
Édition
illustrée
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Éditeur
Cambridge University Press, 2000
ISBN
1900151995, 9781900151993
Longueur
172 pages
Titre
Tête et cou: anatomie topographique
Auteurs
Claude Maillot, Jean-Luc Kahn
Éditeur
Springer, 2003
ISBN
228740208X, 9782287402081
Longueur
222 pages
Titre
Atlas d'anatomie Prométhée: Tome 2,
Cou et organes internes
Auteurs
Michael Schünke, Erik Schulte, Collectif,,
Udo Schumacher, Jürgen Rude
Éditeur
Maloine, 2007
ISBN
2224028474, 9782224028473
Longueur
370 pages
Titre
Anatomie de l'appareil locomoteur: Tome
3 : Tête et cou
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ISBN
2294710487, 9782294710483
Longueur
372 pages
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