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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • The puffed cheek technique is standard for CT neck imaging in oral cancer detection.
  • Air insufflation improves visualization of buccal mucosal lesions and their characteristics.
  • However, this technique has underrecognized pitfalls that can mimic or obscure actual pathology.

Purpose of the Study:

  • To review the puffed cheek technique in CT neck studies.
  • To identify and explain common pitfalls associated with this imaging method.
  • To provide guidance on avoiding these pitfalls for accurate diagnosis.

Main Methods:

  • Review of the puffed cheek technique in CT neck imaging.
  • Analysis of potential artifacts and misinterpretations.
  • Discussion of the underlying mechanism (Valsalva maneuver) and preventive strategies.

Main Results:

  • Common pitfalls include pneumoparotid, soft palate elevation, tongue distortion, sublingual gland herniation, apparent airway edema, vocal cord adduction, and false osteochondronecrosis signs.
  • These artifacts often result from an unintentional Valsalva maneuver during the puffed cheek technique.
  • The primary mechanism involves positive pressure from a closed air column causing soft-tissue displacement.

Conclusions:

  • The puffed cheek technique is valuable but prone to artifacts that can lead to misdiagnosis.
  • Understanding the mechanism, primarily the Valsalva maneuver, is key to recognizing these pitfalls.
  • Instructing patients to maintain continuous nasal breathing during the technique can prevent these artifacts and ensure diagnostic accuracy.