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Year : 2002  |  Volume : 12  |  Issue : 3  |  Page : 333-334
Puffed cheek Ct technique as an imaging protocol for the evaluation of oral vestibule


Dept of Radiology, Govt. Medical College, Nagpur, Maharashtra, India

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   Abstract 

Computed Tomography with puffed cheek is a new imaging protocol in evaluation of pathologies of the oral vestibule. Puffed cheek CT of the oral vestibule is very useful for defining separate involvement of the buccal and gingival mucosa and other deeper involvement of the oral vestibule. Puffed cheek technique is easy to perform, practicable and of immense diagnostic value and hence should be included as a routine imaging protocol for CT evaluation of the oral vestibule.

Keywords: Puffed cheek oral vestibule, Gingival and buccal mucosa

How to cite this article:
Taori K B, Mitra K, Kimmatkar S V. Puffed cheek Ct technique as an imaging protocol for the evaluation of oral vestibule. Indian J Radiol Imaging 2002;12:333-4

How to cite this URL:
Taori K B, Mitra K, Kimmatkar S V. Puffed cheek Ct technique as an imaging protocol for the evaluation of oral vestibule. Indian J Radiol Imaging [serial online] 2002 [cited 2020 Aug 8];12:333-4. Available from: http://www.ijri.org/text.asp?2002/12/3/333/28473

   Introduction Top


A forty-seven years old man approached the surgery outpatients department with a non-healing ulcer inside the oral cavity and pain on the left side of his face. The patient gave a history of tobacco chewing since fifteen years.

On examination, a whitish growth was seen on the left side extending from the left lateral incisor to the last molar in the gingivobuccal region involving the labial sulcus. Scrape biopsy was taken and a histopathological diagnosis of verrucous carcinoma was given.

The Computed Tomography of the oral vestibule was done with conventional and puffed cheek technique and the imaging details were compared.

The conventional CT showed [Figure - 1]

  1. Mildly enhancing growth along the alveolar aspect of the left cheek extending up to the premolar.
  2. Erosion of the mandibular ramus.
  3. Submandibular lymphadenopathy.


The puffed cheek CT in addition to the above showed [Figure - 2],[Figure - 3],[Figure - 4]

  1. Involvement of the gingival and buccal mucosa separately
  2. Distensibility of the buccal mucosa
  3. Involvement of the retromolar trigone
  4. Mandibular involvement in the region of the pterygoid plates.



   Discussion Top


The oral vestibule separates the teeth and gingival mucosa from the lip and cheek. On conventional CT images, the buccal and gingival mucosa is not separated and hence separate involvement is difficult to opine and define [1],[2]. Also lesions involving the gingival mucosa can involve the buccal mucosa and vice versa. This imaging protocol is supported by various studies mentioned in literature [3],[4]. Images taken with puffed cheek technique are useful as

  1. Air acts as a negative contrast medium and separates the buccal and gingival mucosa and the extent of the tumor is better defined
  2. Separate involvement of the buccal and gingival mucosa can be commented.
  3. Distensibility of both the cheeks as well as buccal mucosa can be assessed
  4. Retromolar trigone involvement can be better assessed.


Success of the puffed cheek technique depends on co-operation of the patient, distensibility of the cheeks and buccal mucosa and the extent of submucosal oral fibrosis which commonly coexists in these cases. This maneuver is easily taught and patients' compliance is not a problem.

Puffed cheek CT scans provide a clearer and more detail evaluation of the gingival and buccal mucosa of the oral cavity. It can be used as a routine protocol in the pathologies of the oral vestibule. For evaluation of lesions involving the oral vestibule puffed cheek technique is recommended.


   Conclusion Top


Simple applications in CT techniques can go a long way for better management. Puffed cheek technique is a simple, useful CT technique with precise information about the buccogingival region and should be included in the routine protocol to define the lesions of the oral vestibule.

 
   References Top

1.Schaefer SD, Merkel M, Diehl J, Maravilla K anderson R. Computed tomographic assessment of squamous cell carcinoma of oral and pharyngeal cavities. Arch Otolaryngol. 1982 Nov;108(11):688-92.  Back to cited text no. 1    
2.Fonts EA, Greenlaw RH, Rush BF, Rovin S. Verrucous squamous cell carcinoma of the oral cavity. Cancer. 1969 Jan;23(1):152-60.  Back to cited text no. 2    
3.Bredesen K, Aalokken TM, Kolbenstvedt A. CT of the oral vestibule with distended cheeks. Acta Radiol. 2001 Jan;42 (1):84-7.  Back to cited text no. 3    
4.Weissman JL, Carrau RL Puffed-cheek" CT improves evaluation of the oral cavity. AJNR Am J Neuroradiol. 2001 Apr;22 (4):741-4.  Back to cited text no. 4    

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Correspondence Address:
K B Taori
Dept of Radiology, Govt. Medical College, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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    Abstract
    Introduction
    Discussion
    Conclusion
    References
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