Ultrasound of the airway

Pankaj Kundra, Sandeep Kumar Mishra, Anathakrishnan Ramesh, Pankaj Kundra, Sandeep Kumar Mishra, Anathakrishnan Ramesh

Abstract

Currently, the role of ultrasound (US) in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice.

Keywords: Airway; ultrasonography; upper respiratory tract.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Transverse view at thyrohyoid membrane (THM). E = Epiglottis, A–M = Air–mucosal interface, PES = Pre-epiglottic space, SM = Strap muscles
Figure 2
Figure 2
Left parasagittal view at thyrohyoid membrane (THM). H = Hyoid bone, SM = Strap muscles, THM = Thyrohyoid membrane, TC = Thyroid cartilage, PES = Pre-epiglottic space, E = Epiglottis, A–M = Air mucosal interface
Figure 3
Figure 3
Extended submandibular sagittal view using a curved transducer. T = Tongue, H = Hyoid bone, E = Epiglottis, GG = Genioglossus, GH = Geniohyoid, MH = Mylohyoid, PES = Pre-epiglottic space, P = Palate, TC = Thyroid cartilage
Figure 4
Figure 4
Transverse views at the submandibular position. GG = Genioglossus, GH = Geniohyoid, MH = Mylohyoid, HG = Hyoglossus, T = Tongue, P = Palate
Figure 5
Figure 5
(a) Midline transverse view at hyoid. (b) Transverse view at cricoid cartilage. SM = Strap muscles, CC = Cricoid cartilage, A–M = Air mucosal interface, CTA = Comet tail artefacts, PAS = Posterior acoustic shadow
Figure 6
Figure 6
Vocal cords view with 3D probe with fluid interface (water bath) between probe and skin. V = Vocal cord
Figure 7
Figure 7
(a) Left parasagittal view at trachea. (b) Left parasagittal view at cricothyroid membrane. CC = Cricoid cartilage, T1–T3 = Tracheal cartilages, A–M = Air-mucosal interface, CTA = Comet tail artefact
Figure 8
Figure 8
Transverse view at thyroid cartilage. AC = Arytenoid cartilage, TC = Thyroid cartilage, SM = Strap muscles, VL = Vocal ligaments, V = Vocalis muscle, FC = False cord
Figure 9
Figure 9
Transverse view of US image at thyroid cartilage (TC) in a child with colloid goitre. TG = Thyroid gland (colloid), FC = False cord, T = Trachea
Figure 10
Figure 10
Transverse (a) and oblique transverse view (b) at the level of the suprasternal notch (SSN) showing trachea, thyroid gland, and oesophagus. TG = Thyroid gland, Tr = Trachea, Trc = Tracheal cartilage, A–M = Air–mucosal interface, CTA = Comet tail artefact, ICA = Internal carotid artery, Eo = Oesophagus, SCM = Sternocleidomastoid muscle, SM = Strap muscle, VB = Vertebral body

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