Approaches for percutaneous needle placement for various head and neck procedures.

Use of image-guidance allows safe and precise percutaneous placement of needles for various diagnostic and therapeutic procedures in the head and neck region. This review describes the anatomy relevant to safe-access route planning and the techniques, advantages, and limitations associated with various approaches used for percutaneous needle placement in different head and neck regions. Subzygomatic, retromandibular, paramaxillary, submastoid, transoral, and posterior approaches can be used for percutaneous access in the suprahyoid head and neck region, including skull base and upper cervical vertebrae. In the infrahyoid portion of the neck and for lower cervical vertebrae, access can be achieved via the anterolateral (between the airways and the carotid sheath), posterolateral (posterior to the carotid sheath), and direct posterior approaches.