Briefly review of the radiological anatomy of the oral cavity and consider normal findings in CT scans of the air-distended oral cavity. Provide a detailed guide for the “puffed cheek” CT technique. Demonstrate the spectrum of findings in oral cavity tumors imaging carried out by means of contrast enhanced multi-detector computed tomography (MDCT) that is supplemented with this dynamic maneuver. Mention some difficult situations and pitfalls.

Anatomy of the oral cavity The oral cavity has two main subdivisions – the vestibule, which lies anteriorly and laterally, and the central part - the oral cavity proper (OCP). [ Fig. 1] The borders of the vestibule are: the lips anteriorly, the buccal mucosa laterally, the gingivobuccal sulci (GBS) inferiorly and superiorly, the gingival mucosa medially. The borders of the oral cavity proper are: the gingival mucosa of the upper and lower alveolus laterally, the hard palate superiorly, the mucosa of the mouth floor...

The “puffed-cheek” technique for evaluation of the oral cavity was described by Weissman and Carrau. It is indicated in patients with proven or suspected oral cavity lesions [6]. Instrucions to the patient: The patient is asked to close the lips and blow uniformly until the cheeks are fully puffed out. This can be sufficient if the suspected lesion is located exclusively in the vestibule. The air filling the space provides excellent contrast against the mucosal surfaces and can also help move the buccal mucosa away...

Contrast enhanced MDCT combined with the "puffed-cheek" maneuver is an accurate imaging method for oral cavity tumors. It is important for radiologists to be familiar with the technique details and the essential imaging findings in order to provide quality pretreatment radiological assessment of the disease.

Maria Ivanova Eneva, MD - Resident physician, Assoc. Prof. Maria Nedevska, MD, PhD - Head of Department, Department of Diagnostic Imaging, University Hospital "St. Ekaterina", Medical University - Sofia, 52A Pencho Slaveykov blvd., 1431, Sofia, Bulgaria

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