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  • Print publication year: 2008
  • Online publication date: August 2009

5 - Oral cavity and oropharyngeal cancer



Malignant tumors of the oral cavity and oropharynx are among the most common head and neck malignancies. Although many of these malignancies are clinically evident, others are not. In other cases, the patient presents with nodal metastases, and imaging is used to detect a primary cancer. In either case, imaging plays an integral role in the staging evaluation of these patients, as well as in their post-treatment work-up. This chapter will review the spectrum of imaging findings for malignant tumors of the oral cavity and oropharynx. The focus will be on the initial imaging evaluation, not post-treatment. Imaging of cervical lymphadenopathy will be covered in Chapter 7.

Choice of modality and technique

The choice of the most appropriate imaging modality remains controversial, or at least influenced by regional and institutional preferences. In some centers, imaging of the oral cavity and oropharynx is conducted primarily with magnetic resonance imaging (MRI). The emergence of position emission tomography (PET) and PET linked with computed tomography (CT) has changed that equation somewhat, but at the moment, few would argue that PET/CT should be the sole imaging modality for these lesions. However, in our institution, unless there is a contrast allergy or renal dysfunction preventing the use of iodinated contrast material, it is our preference to use CT. This preference is based on the consistent and reproducible high-quality images that can be expected from CT, its relatively lower cost and short acquisition time and, with newer, multidetector scanners (MDCT), the availability of multiplanar images.

Harnsberger, H. R., Wiggins, R. H., Hudgins, P. A., et al. Diagnostic Imaging. Head and Neck, vol. 1 (Salt Lake City, UT: Amirsys, 2004), various pages.
Mukherji, S. K., Castelijns, J., Castillo, M.. Squamous cell carcinoma of the oropharynx and oral cavity: How imaging makes a difference. Semin Ultrasound, CT MRI 19 (1998), 463–475.
Mukherji, S. K., Pillsbury, H. R., Castillo, M.. Imaging squamous cell carcinomas of the upper aerodigestive tract: what clinicians need to know. Radiology 205 (1997), 629–646.
Wiener, E., Pautke, C., Link, T. M., Neff, A., Kolk, A.. Comparison of 16-slice MSCT and MRI in the assessment of squamous cell carcinoma of the oral cavity. Eur J Radiol 58 (2006), 113–118.
Dammann, F., Horger, M., Mueller-Berg, M., et al. Rational diagnosis of squamous cell carcinoma of the head and neck region: comparative evaluation of CT, MRI, and 18FDG PET. Am J Roentgenol 184 (2005), 1326–1331.
Ng, S. H., Yen, T. C., Liao, C. T., et al. 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 46 (2005), 1136–1143.
Sobin, L. H., Wittekind, C. (eds.) UICC TNM Classification of Malignant Tumors, 6th edn (New York: Wiley-Liss, 2002).
Ginsberg, L. E.. Imaging of perineural tumor spread in head and neck cancer. In Head and Neck Imaging, ed. Som, P. M., Curtin, H. D. (St. Louis: Mosby, 2003).
Ginsberg, L. E.. MR imaging of perineural tumor spread. Neuroimaging Clin North Am 14 (2004), 663–677.
Winn, D. M., Blot, W. J., Shy, C. M., et al. Snuff dipping and oral cancer among women in the southern United States. N Engl J Med 304 (1981), 745–749.
Weissman, J. L., Carrau, R. L.. “Puffed-cheek” CT improves evaluation of the oral cavity. Am J Neuroradiol 22 (2001), 741–744.
Fatterpekar, G. M., Delman, B. N., Shroff, M. M., et al. Distension technique to improve computed tomographic evaluation of oral cavity lesions. Arch Otolaryngol Head Neck Surg 129 (2003), 229–232.
Smoker, W. R. K.. The oral cavity. In Head and Neck Imaging, ed. Som, P. M., Curtin, H. D. (St. Louis: Mosby, 2003), pp. 1377–1464.
Mukherji, S. K., Weeks, S. M., Castillo, M., et al. Squamous cell carcinomas that arise in the oral cavity and tongue base: can CT help predict perineural or vascular invasion?Radiology 198 (1996), 157–162.
Kirsch, C.. Oral cavity cancer. Top Magn Reson Imaging 18 (2007), 269–280.
Ginsberg, L. E., Demonte, F.. Palatal adenoid cystic carcinoma presenting as perineural spread to the cavernous sinus. Skull Base Surg 8 (1998), 39–43.
Goldenber, D., Scuibba, J., Koch, W. M.. Cystic metastasis from head and neck squamous cell cancer: a distinct disease variant?Head Neck 28 (2006), 633–638.
Stambuk, H. E., Karimi, S., Lee, N., Patel, S. G.. Oral cavity and oropharynx tumors. Radiol Clin North Am 45 (2007), 1–20.