By Vincent Vander Poorten (auth.), Robert Hermans (eds.)

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Routine head and neck CT study. Midline sagittally reformatted image from native axial MDCT images. The data acquisition extended from just above the sphenoid sinus to the thoracic inlet. From the native images, two sets of axial images are routinely reformatted for display: the first set (1), parallel to the hard palate, from the skull base to the lower margin of the mandible; the second set (2), parallel to the vocal cords (or C4–C5/C5–C6 intervertebral space), from the oral cavity to the thoracic cavity.

A modified Valsalva maneuver (blowing air against closed lips, puffing out the cheeks) produces substantial dilatation of the hypopharynx, allowing better visualization of the pyriform sinuses, including the postcricoid region (Robert et al. 1993) (Fig. 6). This modified Valsalva maneuver may also be of use in the evaluation of oral cavity tumors, as the inner cheek walls and gingivobuccal sulci become better visible. The success rate of these dynamic maneuvers is variable, especially when an incremental CT technique is used, and is strongly dependent on patient cooperation.

In most instances the diagnosis is made by a thorough clinical examination which includes mirror examination of the larynx for adequate assessment of the surface extent of the primary tumor and mobility of the vocal cords. Examination must be carried out carefully to identify the possible spread of tumor beyond the larynx either directly or by metastasis to the regional lymph nodes. A neck mass almost always indicates lymphatic metastasis but may result from direct extension of the tumor into the soft tissues of the neck.

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