Revisiting the "Puffed Cheek" Technique: Advantages, Fallacies, and Potential Solutions

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.