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G. M. Fatterpekar, MD; B. N. Delman, MD; M. M. Shroff, MD; T. P. Naidich, MD; M. S. Sacher, MD; P. M. Som, MD

Arch Otolaryngol Head Neck Surg. 2003;129:229-232.

Background  The apposing mucosa of the oral cavity makes the computed tomographic identification of a clinically obvious mass difficult. Contrast distension techniques have been used in radiology to evaluate for presence of a "hidden" mass.

Objective  To illustrate the utility of distending the oral cavity with air, water, or contrast to display otherwise obscure oral cavity lesions.

Patients and Methods  In 3 normal subjects and 5 patients with biopsy-proved oral cavity lesions, serial contiguous 3-mm axial and coronal computed tomographic scans were obtained before and after distension of the oral cavity using intraoral air or water. Air distension was achieved by having the subjects perform a modified Valsalva maneuver during the scan acquisitions. Fluid distension was obtained using approximately 40 mL of water.

Results  In each case, the contrast successfully distended the oral cavity, separating the mucosal surfaces. Gingivobuccal lesions that were obscured by apposition of the lips and cheeks to the gums and teeth, or by apposition of the tongue to the inner margins of the gums and teeth, were clearly demonstrated. Lesions involving or extending into the retromolar trigone were also well demonstrated using this distension technique.

Conclusions  Computed tomographic display of the anatomy and pathology of the oral cavity can be improved simply by distending the oral cavity using air or water as a contrast medium. This technique successfully shows lesions that are obscured by the apposing surfaces of the vestibule and the oral cavity proper, improving computed tomographic diagnosis.

From the Departments of Radiology, Mount Sinai Medical Center, New York, NY (Drs Fatterpekar, Delman, Naidich, Sacher, and Som), and P. D. Hinduja National Hospital, Mumbai, India (Dr Shroff).

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