Approach to ultrasound of the neck

Start with submental region:
Structures to be identified: anterior belly of digastric, myelohyoid, geniohyoid, genioglossue from superfical to deep. Sublingual glands are more deep and lateral.
Lesions superficial to digastric will be submental space
Lesions superficial to myelohypoid will be submandibular space
Lesions deep to myelohypid will be sublingual space
There might be defect in the myelohyoid - from which sublingual lesions may plunge into submandibular space

Midline sagittal scan of the submental space:
Probe netween mandible and hyoid will show myelohyoid and anterior belly of digastric
Evaluate submental region

Then move laterally to submandibular space:
Trace the myelohyoid muscle laterally to its free border to come to submandibular gland and space
Myelohyoid is superficial and hyoglossus is deep. Between them is submandibular duct and lingual vein. The lingual artery lies deep to hyoglossus.
Evaluate submandibular gland and fat anterior to it for lymphnodes

Then image parotid glands:
Identify retrmandibular vein and extrenal carotid artery. Retromandibular vein is landmark for facial nerve.
parotid duct is seen as then echogenic line, pierces buccinator
Messeter is a landmark anteriorly and mandible posteriorly
Common to find accessory partotid along the cheek

Then scan cervical chain:
Identify IJV in cross section, follow it from superior to inferior to look for level 2, 3 and 4 nodes.
Look for thrombosis of IJV

Then scan posterior triangle:
Look for nodes in the superficial fat between trapezius and sternomastoid, superficial to scalene and splenius muscles

Then scan supraclavicular region:
Along the superior border of the clavicle
Identify sternomastoid, trepezius and omohyoid
Identify scalene muscles and brachail plexus

Then scan laryngeal region:
Identify thyroid lamina, strap muscles

Then do not scan thyroid and carotid:
Unless asked, do not ultrasound thyroid and carotids!

(images will be uploaded shortly...)