Comprehensive assessments of the open mouth dynamic maneuver and metal artifact reduction algorithm on computed tomography images of the oral cavity and oropharynx

PLoS One. 2021 Mar 18;16(3):e0248696. doi: 10.1371/journal.pone.0248696. eCollection 2021.


Objectives: To determine the optimal utility of the open mouth maneuver and Metal Artifact Reduction for the Orthopedic Implants (O-MAR) technique for CT of the oral cavity and oropharynx.

Methods: Between July 2017 and May 2019, 59 subjects who underwent both conventional and open mouth head and neck CT scans were included in this retrospective study. All images were reconstructed using the O-MAR algorithm. With conventional CT with/without the O-MAR (CTc_O/CTc) and open mouth CT with/without O-MAR (CTo_O/CTo), one reader measured the noise level in multiple anatomic regions of the oral cavity and oropharynx. Visual scores for the streak artifact and overall subjective image quality were assessed by two independent readers.

Results: For the mobile tongue, retromolar trigone, and palatine tonsil, the mean noise was significantly lower, and the mean visual scores were significantly higher, with CTo than with CTc or CTc_O (all, P < 0.001). The mean visual scores were higher with CTo_O than with CTo for the mobile tongue and palatine tonsil (all, P < 0.001). Contrarily, for the mouth floor and tongue base, the mean noise was significantly higher with CTo_O than with CTc or CTc_O, and the mean visual scores were significantly higher with CTc than with CTo or CTo_O (all, P < 0.001).

Conclusions: The open mouth maneuver and O-MAR technique can have different influences on the CT image quality according to the anatomical subsites of the oral cavity and oropharynx.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Artifacts*
  • Dental Implants / adverse effects*
  • Female
  • Humans
  • Male
  • Metals / adverse effects
  • Middle Aged
  • Mouth / diagnostic imaging*
  • Mouth Neoplasms / diagnosis
  • Neoplasm Staging / methods
  • Oropharyngeal Neoplasms / diagnosis
  • Oropharynx / diagnostic imaging*
  • Retrospective Studies
  • Tomography, X-Ray Computed / methods*


  • Dental Implants
  • Metals

Grant support

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2019R1F1A1063771) and grant No. 09-2019-003 from the SNUBH Research Fund, all of which were received by YJB.