Head and Neck Ultrasound in Otolaryngology Surgical Missions

Surgical mission work in low- and middle-income countries (LMICs) is a growing priority in otolaryngology–head and neck surgery. ^{1 -3} Maintaining the standards of care physicians are accustomed to in their home countries is an important but challenging aspect of global outreach initiatives in resource-limited settings. Careful planning and organization to maximize available clinical resources is critical to the success of these missions. ⁴ The utility in conducting an annual head and neck surgical training camp for otolaryngology residents has been previously described. ⁵ The camp’s organizers continue to seek for new avenues of improvement, and training has recently expanded to include perioperative techniques including the use of head and neck ultrasound.

Mirroring other technological advances, ultrasound equipment has become lighter, compact, and thus more mobile with the introduction of smartphone and tablet-based devices. These adaptations have made point-of-care ultrasound ideally suited for a range of applications in LMICs. ⁶ We have found tablet-based ultrasound in Kenya to be extremely useful not only for the on-site work-up and biopsy of head and neck lesions but also in the perioperative setting. The ultrasound equipment used most recently consisted of the Phillips Lumify portable ultrasound system including the L12-4 transducer (Phillips Healthcare; Amsterdam, the Netherlands) and a Galaxy 10.1 tablet (Samsung; Seoul, South Korea). Otolaryngology residents, fellows, nurse practitioners, and attending physicians performed ultrasound in the inpatient, outpatient, and perioperative setting. Regular use of the ultrasound included diagnostic endocrine and head/neck imaging, image-guided FNA, serial evaluation of cervical lymphadenitis in a child, obtaining difficult intravenous access, and other general clinical tasks. Broader applications included diagnosis of submandibular sialolithiasis, upper extremity DVT detection, and monitoring of vascular flow through a free flap anastomosis.

Ultrasound is a dynamic, cost-effective, and useful diagnostic tool, especially in LMICs, where access to computed tomography and magnetic resonance imaging is unavailable, untimely, and/or unaffordable. ^6,7 Furthermore, it is a readily acquired skill, especially when the learner is already familiar with the anatomic area. ⁸ In otolaryngology–head and neck surgery, ultrasound is already used regularly to assess thyroid and parotid disease as well as to obtain cytology for bedside pathologic analysis. More recently, clinician-performed ultrasonography is being utilized with increasing frequency, expanding the range of diagnostic applications for this imaging technique. ⁶ Surgical mission teams in resource-scarce environments can derive several benefits from familiarization with ultrasound techniques and performing their own real-time imaging diagnostics.

While there are numerous clinician-training programs for performing ultrasound in LMICs, the majority focus on obstetrics and emergency medicine applications. ^6,9,10 To the authors knowledge, there are no published reports on training otolaryngologists to use head and neck ultrasound in resource-scarce settings, yet skills acquisition in head and neck ultrasound would benefit local providers. ¹¹ During our most recent surgical camp, we included the use of head and neck ultrasound in the training course. The effectiveness of this training will soon be reported in a separate feasibility study and represents an area of future opportunity for improving delivery of care during these trips. In summary, ultrasound is a cost-effective, portable, and versatile tool with many uses in caring for otolaryngology patients. Its applications are especially valuable in LMICs, where there are limited alternatives, and we recommend its incorporation into otolaryngology–head and neck surgical missions in these settings.