E1365. Revisiting the "Puffed Cheek" Technique: Advantages, Fallacies, and Improvisation
  1. Shehbaz Ansari; Rush University Medical Center
  2. Miral Jhaveri; Rush University Medical Center
  3. Pokhraj Suthar; Rush University Medical Center
  4. Eric Basappa; Rush University Medical Center
  5. Surjith Vattoth; University of Arkansas for Medical Sciences
  6. Santhosh Gaddikeri; Rush University Medical Center
The puffed cheek technique is performed with CT neck studies obtained in patients suspected of oral cavity cancers. Approximately 476,125 people were diagnosed with oral and oropharyngeal cancer in 2022 across the world. The artifacts associated with this technique are underrecognized and less understood. These artifacts can themselves mimic a lesion, forfeiting the primary indication of using this technique.

Educational Goals / Teaching Points
Illustrate techniques and advantages of the puffed cheek technique in evaluation of oral cavity cancers. Understand the mechanism and morphology of artifacts caused due to inadvertent breath-holding during the puffed cheek technique and to not mistake them for pathology. Modification of the conventional puffed cheek technique to decrease the occurrence of artifacts.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The technique and its importance in the early and accurate diagnosis of oral cavity lesions will be first discussed. This will be followed by a general overview of the mechanism responsible for most artifacts associated with this technique. Each type of artifact will then be illustrated with cases. These include, but are not limited to, pneumoparotid, soft palate elevation, posterior and superior displacement of the tongue, sublingual gland herniation, inferior displacement of the epiglottis, vocal cord adduction, and exposed thyroid cartilage. Modification of the puffed cheek technique will be proposed to avoid these artifacts. Lastly, different techniques described in the literature tailored to better visualize different subparts of the aerodigestive tract will be discussed.

Artifacts associated with the puffed cheek technique is common and minimally understood. Even less understood is the underlying mechanism associated with faulty technique. This exhibit aims to educate the viewer regarding the same and inform them about the modifications that they can use to avoid these artifacts.