Value of Soft-Tissue Technic in the Diagnosis and Treatment of Head and Neck Tumors

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Abstract
The progress in the management of malignant neoplasms of the head and neck has been brought about by a better understanding of the clinical aspects. It has also been demonstrated that a more accurate knowledge of the point of origin and extent of the tumor is necessary before any treatment is instituted. The usual clinical methods remain the basis of the diagnosis but often they do not determine the true degree of extension of the lesion. In some instances, as in tumors of the nasopharynx, the most careful examination will fail to reveal the primary lesion, and in many cases of laryngopharyngeal tumors, the examination may be so difficult that it yields little information. In 1922, Coutard (3) devised and developed the roentgenographic examination of the pharynx and larynx by means of a profile plate. Later on, the discovery of tomography furnished a complementary method. The foreign radiological literature, mainly the French, has dealt extensively with the roentgenologic diagnosis of tumors of the soft tissues of the head and neck, but in this country the method has not met with widespread use, and it has been the subject of relatively few articles in the American radiological and otorhinolaryngological literature. A complete study of the subject can be found in the classical treatises of Baclesse and Leborgne (1, 4). The present article does not claim to cover systematically all of the roentgenologic findings or to add any new ones to those described in previously published works (2, 5–7). Although the field of usefulness of the soft-tissue technic extends beyond malignant neoplasms, this paper will be limited to its application in such diseases, giving instances where roentgenologic study adduced information not obtainable by the clinical examination. The help of conventional or tomographic roentgenograms is invaluable in tumors of the paranasal sinuses and anterior oral cavity. These, however, will be excluded from this study, which will concern itself only with soft-tissue tumors and soft-tissue extensions. The information obtained may be of four types: (1) Diagnosis of a tumor which escapes clinical observation. This applies primarily to tumors of the nasopharynx and of the pyriform sinus, and to subglottic tumors. (2) Determination of the degree of extension and clinical variety. (3) Aid in planning the x-ray treatment (mapping of the area to be treated and checking the accuracy of the location and size of the portals). This is of greater value since x-ray therapy machines are now equipped with light localizers which permit exact adaptation of the x-ray fields to the lesion. (4) Evaluation of the results of treatment by changes in the roentgenologic findings. The material has been divided on the basis of the anatomic location, i.e., nasopharynx, oropharynx, laryngohypo-pharynx, cervical esophagus, and thyroid.

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