"Puffed-cheek" CT improves evaluation of the oral cavity

BACKGROUND AND PURPOSE: Maneuvers that distend a lumen facilitate radiographic examinations. In evaluation of the upper aerodigestive tract, Valsalva and phonation maneuvers complement barium fluoroscopy. The current work investigates "puffed-cheek" CT to improve visualization of oral cavity tumors. METHODS: Seven patients (ages 17 to 86 years) underwent conventional and puffed-cheek CT. Five had squamous cell carcinoma, one had benign verrucous hyperplasia of the buccal mucosa, one had "cheek swelling," and one had a pulsatile cheek mass. Conventional contrast-enhanced axial CT scans (3-mm thick, no interslice gap) were obtained through the oral cavity and neck. Each patient then pursed the lips and puffed out the cheeks, and axial images were obtained through the oral cavity (puffed-cheek scans). RESULTS: Three patients had normal conventional CT scans whereas puffed-cheek scans clearly showed the mass. Conventional CT in three patients showed a mass inseparable from two mucosal surfaces whereas puffed-cheek images clearly showed which surface the tumor involved. Two patients had normal conventional and puffed-cheek CT studies; in one, the physical examination was also normal. The other patient was a teenager with orthodontic appliances that created artifacts on both conventional and puffed-cheek images. Conventional angiography in this patient revealed a facial artery aneurysm. CONCLUSION: The puffed-cheek CT maneuver is easily taught, and patients comply readily. Puffed-cheek CT scans provide a clearer and more detailed evaluation of mucosal surfaces of the oral cavity than do conventional scans. In selected patients, the puffed-cheek technique can supplement conventional CT studies.