Distension technique to improve computed tomographic evaluation of oral cavity lesions

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.     

The forced response test and myringoplasty results

Pre-operative assessment of the Eustachian tube function using a Passive Eustachian tube function test ’The Forced response test‘ and the results of tympanoplasty in safe Ch. SOM. Adhesive Otitis Media and Posterosuperior inpouching cases have been mentioned in this study     

Hemangiomas of the salivary glands

Five salivary gland hemangiomas in adults are reported. The feasibility of preoperative diagnosis on clinical and radiologic grounds is emphasized. Adult hemangiomas are of the cavernous type and can be differentiated from infantile capillary hemangiomas clinically as well as histologically. Cavernous hemangiomas in the adult should be treated by surgical excision.     

Recurrent infiltrating lipoma of the head and neck. Case report and literature review

Lipomatous tumors with intramuscular infiltration are uncommon in the head and neck. Oral lipomas have been recorded in the literature; however, infiltration and recurrence have rarely been documented. We describe a case of an oral lipoma that did not have microscopic characteristics of malignancy, lipoblastomatosis, or atypia, but which showed intramuscular invasion and recurred twice after surgery. Although certain characteristics distinguish our case from congenital lipomatosis, the clinical picture is quite similar. Lipomas with intramuscular invasion uniformly tend to recur when they are not widely resected, whether in the trunk and extremities or in the head and neck. These lesions can rapidly enlarge and infiltrate local tissues, and they require wide resection with an attempt at preservation of important structures. Preoperatively, computed tomographic analysis allows a lipoma to be diagnosed by its low attenuation, and a grossly infiltrating tumor can be distinguished from the ordinary well-encapsulated lesion.     

MRI of the paranasal sinuses and nasal cavity

In the evaluation of soft tissue masses of the paranasal sinuses and nasal cavity, MR has excelled, not only in sensitivity, but in specificity. Without question, MR has improved the diagnostic accuracy for distinguishing neoplasms from inflammatory diseases. This improved discrimination is primarily due to the combination of the superior soft tissue contrast of MRI and the widely disparate T2-relaxation values between the neoplasms and inflammatory processes indigenous to this anatomic area. MR's expanding role as the primary imaging modality for clinical problems in the sinonasal region will accompany the decrease in exam time and increase in spatial resolution. In the past few years there has been a rapid expansion in MRI's utility for a variety of clinical situations in the sinonasal region. This trend should accelerate, especially with the decrease in exam time and increase in spatial resolution that will accompany other expeditious technologic advancements.     

Hemorrhaged cystic hygroma and facial nerve paralysis: CT and MR findings

The association of peripheral facial nerve paralysis and cystic hygroma is rare, this being only the third reported case. In this patient paralysis was secondary to hemorrhage within the cyst and nerve compression. Although the magnetic resonance studies allowed the diagnosis to be made eventually, the complex signal intensities due to excessive bleeding within the cyst confused the issue. In this case, CT allowed an immediate diagnosis to be established.     

Deafness in paediatric age group

Incidence and predominant causes of deafness in 20 neonates, 100 infants and 1340 school going population in the northern region of the Indian subcontinent, was investigated by the E. N. T. Department, of Dayanand Medical college and Hospital, Ludhiana, Punjab. The recorded incidence of deafness in school going children was 12.16% comprising conductive loss (98%) and S. N. loss 2%. Out of many cases more notable were chronic rhinitis, tonsillitis, adenoiditis etc.     

Perineural tumor extension through the foramen ovale: evaluation with MR imaging

Perineural tumor extension is a form of metastatic disease in which primary tumors spread along neural pathways and gain access to non-contiguous regions. The treatment and prognosis are altered when perineural extension occurs. Awareness and proper evaluation are critical for the radiologist. The third (mandibular) division of the trigeminal nerve (V3), passing through the skull base via the foramen ovale, is a common route of perineural spread of head and neck lesions. Seven patients with perineural tumor involvement of the mandibular nerve were evaluated with magnetic resonance imaging with use of standard spin-echo pulse sequences emphasizing T1-weighted information. Three patients had adenoid cystic carcinoma, three had squamous cell carcinoma, and one had well-differentiated lymphocytic lymphoma of the orbit. MR imaging signs of perineural involvement included smooth thickening of V3, concentric expansion of the foramen ovale, replacement of the normal trigeminal cistern hypointensity by an isointense mass, lateral bulging of cavernous sinus dural membranes, and atrophy of masticator muscles.     

Hypointense MR signal in chronically inspissated sinonasal secretions

Six patients with chronically obstructed sinuses were examined with computed tomography (CT) and magnetic resonance (MR) imaging prior to surgical decompression. In all six patients, hypointense signal was present on all MR sequences despite CT evidence of the presence of high-attenuation material filling the sinus. At surgery, all specimens were viscid or pastelike with no evidence of hemorrhagic products as a cause for the MR findings. Sinonasal secretions may have a spectrum of MR signal intensity, ranging from hyperintense to signal void with all pulse sequences. These findings must be kept in mind when interpreting images of patients with suspected chronic sinusitis.