Normal CT anatomy of the tongue, floor of mouth and oropharynx

A computed tomography (CT) technique is described which demonstrates the structures and tissue planes in the floor of mouth, tongue and oropharynx. The anatomy, which forms the basis for understanding pathological change, is given in detail and illustrated by axial and coronal images and line drawings.     

MRI of the floor of the mouth, tongue and orohypopharynx

Magnetic resonance is the imaging modality of choice for studies of the orohypopharynx, floor of the mouth, or tongue base. The superiority of MRI soft tissue contrast can demonstrate intra- and extraorgan spread of tumor beyond that of CT. Use of T1- and T2-weighted pulse sequences allows better discrimination of pathologic masses from fat or muscle than does CT. Multiplanar capabilities allow ease of examination in the preferred planes. Various sequences or planes of imaging may be chosen to tailor the examination to the anatomic region of interest. The use of Gd-DTPA with T1-weighted images should further improve diagnostic precision of tumor location and extension and may replace the need for the longer T2-weighted sequences. Gadolinium may help differentiate tumor recurrence from fibrosis in the post-radiation patient. New improvements in surface coil technology, motion and flow compensation imaging strategies, faster scan times, and spatial resolution will further advance MRI as the modality of choice for assessment of oropharyngeal, mouth, and tongue soft tissue masses.     

Sonography of the tongue and floor of mouth. Part II: Neoplasms of the tongue

Frequently, correct evaluation of space-occupying lesions in the tongue is not possible with clinical methods only. In an attempt to assess the value of sonography in the detection of tongue lesions, we used submental sonography to examine 62 patients with suspicious palpatory findings upon physical examination of the tongue. Ultrasound detected 45 out of 47 tumours that were eventually confirmed either by surgery or by biopsy. Inadequate technique was the only factor that affected the detection rate. Sonography appears to be a reasonable guide in determining size and site of a tumour of the tongue. Thus, more precision in therapy planning may be achieved.     

Hemiatrophy of the tongue and floor of the mouth demonstrated by computed tomography

Computed tomography can show hemiatrophy of the tongue and the floor of the mouth. The normal neuroanatomy of this region with regard to its motor supply is reviewed. In theory six variants of motor nerve lesions with hemiatrophy can be encountered, three of which are illustrated in this report. Knowledge of the muscular anatomy and the motor nerve supply to the tongue and floor of the mouth is helpful when evaluating lesions of the base of the skull with CT. This is particularly true for the lesions involving the trigeminal and hypoglossal nerves.     

Masses of the tongue and floor of the mouth: findings on magnetic resonance imaging

The purpose of this study was to determine the value of MR imaging for the demonstration of masses in the tongue and floor of the mouth. Nine patients were prospectively examined with MR imaging after physical examination. Imaging protocol included T2 and contrast-enhanced and non-contrast-enhanced T1-weighted turbo spin-echo sequences, and the findings were compared with surgical and histopathological results. Histopathological examination revealed four squamous cell carcinomas, one adenoid cystic carcinoma, two tongue abscesses, and one chronic inflammatory change. The other case was diagnosed as hemangioma depending on clinical and imaging findings alone. In cases with squamous cell carcinoma, staging was done on the basis of MR imaging findings, and was found to be T4 in two cases, T3 in one case, and T2 in another. The primary role of MR imaging of the tongue and oropharynx is not to make a tissue diagnosis. Multiple deep biopsies are mandatory for the differentiation of other inflammatory and neoplastic lesions. Magnetic resonance imaging produces coronal and sagittal image planes to assess the volume and spread of the lesion and helps the surgeon determine the direction in which the biopsy should be performed. Received: 4 October 1999; Revised: 31 January 2000; Accepted: 6 April 2000     

Sonography of the tongue and floor of mouth. Part I: Anatomy

Normal structures of the tongue and floor of the mouth were studied using anatomic sections cut with a stainless steel band saw. The sections were performed on the same planes as used in US and CT scanning. The ultrasound studies were carried out with 20 young and healthy volunteers. CT images were obtained from head-neck preparations that were subsequently used for anatomic sectioning. On comparing these sections to US and CT images, normal structures including intrinsic and extrinsic tongue muscles, vessels and salivary glands were identified. Knowledge of the anatomic landmarks is mandatory for optimal US image reading.     

Computerized tomography in the staging of carcinoma of the oropharynx, the tongue and the mouth floor

Eighty-seven patients with carcinoma of oropharynx, tongue and floor of the mouth were examined by means of CT; (TNM criteria); tumor staging was reviewed and compared with that obtained by clinical examination, by endoscopy, at surgery and histology. CT proved to be a reliable technique to detect both the presence of neoplasms, with the exception of very superficial ones, and their deep spread to parapharyngeal space, to muscles of floor of the mouth and prevertebral pterygoid muscles. Lymph node metastases, especially to retropharyngeal nodes, were also clearly demonstrated on CT scans, which indicates this technique as the examination of choice in oropharyngeal and oral cavity tumor staging, for it yields valuable information which can integrate clinical findings.     

The use of sonography in the diagnosis of pathological changes in the mouth floor and tongue region

The application of real-time sonography in the area of the tongue and floor of the mouth is described. Its value is examined by a sonographic-surgical correlation of 40 examinations. In 38 cases, the sonographic findings correlated well with the clinical picture, as well as with the intraoperative and pathologic findings. Ultrasound seems to be a practicable imaging method, especially with malignant infiltration of the tongue.     

Results of interstitial curietherapy and combined transcutaneous radiotherapy-curietherapy in 150 patients with carcinoma of the tongue and/or mouth floor

The authors report their experience on the treatment of carcinoma of the oral tongue and floor of the mouth with interstitial brachytherapy, alone or in combination with external irradiation. One hundred and fifty patients were treated; among these, 116 with brachytherapy alone, 34 with combined treatment. The five years local control in those patients treated with brachytherapy alone was 72.5% in T1, 61.2% in T2 and 35% in T3; in those patients treated with external irradiation and brachytherapy the global five years control was 42.5%. The global five years survival was 64% in the patients treated with brachytherapy alone and 48% in the patients treated with combined therapy.     

T-staging of tongue and mouth floor tumors: comparison of ultrasonography and computerized tomography

A comparison was made between the pretherapeutic CT and ultrasound findings of 43 patients with tumors of the oral tongue and the floor of the mouth. Two tumors of the edge of the tongue (T1) each were not diagnosed by computed tomography and by sonography. In three cases a more precise determination of the tumor size was achieved by sonography. In 25 out of 38 cases the contrast between tumor and sound tissue was better in the sonographic image. The reduction and regressive modification of the tumor following to radiotherapy could be observed in eleven cases. Despite the benefits of sonographic investigation in this area due to the excellent contrast without any need of contrast media, the good availability and the absence of metal and movement artefacts, this method is not able to replace computed tomography. The most important disadvantages of sonography were found to be the incapability to show osseous erosions and the restricted or lacking possibility to assess the parapharyngeal and the retropharyngeal area.     

Evaluation of local and regional spread of malignant tumors of the tongue and floor of the mouth

Malignant tumors of the oral cavity grow rapidly, frequently and early metastazing to the surrounding regional lymph nodes. The aim of this study was to evaluate the correlation between clinically confirmed local and regional spread and intraoperatively and histopathologically verified local spread. A series of 74 patients with carcinoma of the tongue and floor of the mouth were analyzed. All the patients were surgically treated during the period 1991-1995. Clinical evidence of local spread (cT) was in high accord with intraoperatively and histopathologically evidenced spread (pT) amounting to 83.8%. The degree of correlation decreased with the increase of T stage. Clinically observed regional spread (cN) and intraoperatively and histopathologically confirmed regional spread (pN) was lower, amounting to 56.8% in comparison to the corresponding T categories.     

Oropharynx, oral cavity, floor of the mouth: CT and MRI

Pretherapeutic staging of tumors of the oropharynx, the oral cavity and the floor of the mouth is important and should be thorough and exact to ensure appropriate therapy. Particularly important is the assessment of infiltration of deeper compartments and the topographic relationship of tumor to vascular structures (lingual artery and vein, hypoglossal nerve), or the presence of spread of the tumor across the midline. As spread of tumor may occur to a large degree underneath normal appearing mucosa, clinical assessment of the true tumor extent is difficult.In the last 20 years computed tomography (CT) has proved its value as a supplementary non-invasive method and established its role in modern diagnostic evaluation. Magnetic resonance imaging (MRI) is an non-invasive scanning method that offers excellent tissue contrast. Ultrasonography (US) is of secondary importance, but provides useful guidance due to its wide availability and its easy use.This paper aims to depict the possibilities of modern CT and MRI to provide 'one-stop-shopping' information to the clinician as a basis for the right therapeutic approach and correct estimation of the individual patient's prognosis. A clear problem oriented imaging strategy with standardized diagnostic criteria will lead to a cost effective evaluation.     

多层螺旋CT口底癌灌注研究

目的:探讨口底癌MSCT灌注成像的可行性.研究口底癌的MSCT灌注特征.方法:19例口底癌患者行MSCT灌注检查.全部为活检或病理证实;分别测量口底癌组织和自身残存正常口底组织的血流量(BF)、血容量(BV)、毛细血管表面通透性(PS)和平均通过时间(MTT)作为灌注指标,比较灌注值差异,以评价口底癌的血流动力学改变及...     

Mangement of squamous cell carcinoma of the oral tongue and floor of mouth after excisional biopsy.

A review of the records of 23 patients with squamous cell carcinoma of the oral tongue and floor of mouth treated with irradiation after excisional biopsy has shown that: (a) Radiotherapy, primarily using interstitial radium implants, results in excellent local control of the primary area (100%) with preservation of function. (b) The frequency and severity of soft-tissue and bone necrosis may be reduced by not exceeding 5,500-6,000 rads from radium implants when only subclinical aggregates of cancer cells are probably present. (c) Theincidence of subsequent neck disease is low-8.7% (2 of 23 patients), and does not warrant routine elective irradiation of the cervical lymphatics.     

Computed tomographic scanning in patients with carcinoma of the tongue

Computed tomographic (CT) scanning is useful for staging patients with carcinoma of the tongue. In a study of 13 patients scanned prior to treatment, CT gave additional valuable information about the primary tumour in four patients. Computed tomography detetected non-palpable, abnormal cervical lymph nodes in three patients which directly affected the nature of the subsequent operation.