<p>Modern food manufacturing necessitates technologies that couple real-time monitoring with precise processing to ensure product quality and safety. Conventional approaches rely on separate single-function techniques, whereas ultrasonic technology integrates both capabilities through controlled intensity-dependent mechanisms. Despite this dual functionality, current literature has predominantly investigated these functions in isolation, overlooking their synergistic potential. To address this gap, this narrative review provides a comprehensive analysis beginning with fundamental acoustic principles. Subsequently, it examines applications across monitoring domains (process tracking, quality assessment, safety screening, and multimodal sensing) and processing operations (cleaning, extraction, mixing, drying, sterilization, and packaging). Detailed analysis reveals that ultrasonic monitoring offers high precision but lacks generalizability, while processing efficiency is constrained by acoustic field non-uniformity. Furthermore, the absence of validated correlation models linking these domains restricts current implementations to static open-loop operations. To address these constraints, interdisciplinary solutions and potential pathways are systematically explored. These strategies underpin integrated closed-loop frameworks, positioning ultrasonic technology as core infrastructure for autonomous and sustainable intelligent food manufacturing.</p>