“Puffed-cheek” CT Improves Evaluation of the Oral Cavity

77-year-old woman with squamous cell carcinoma of the maxilla. A, Conventional axial CT scan through the lower maxilla shows the tumor (arrow) inseparable from the gingival (alveolar) and buccal (cheek) mucosal surfaces. B, On the normal (right) side, the puffed-cheek axial CT scan separates the gingival mucosa and the alveolus (open black arrows) from the buccal mucosa and the buccinator muscle (open white arrows). The tumor thickens the cheek on the left side (solid arrows) and extends around the sulcus to the gingival mucosa. The combination of direct extension of tumor and decreased pliability of the cheek because of tumor invasion makes the two surfaces (buccal, gingival) inseparable