Mouth Opened with Tongue Extended (MOTE) maneuver: improvement in tomographic T-staging accuracy of oral cavity cancer: a prospective cross-sectional study

BACKGROUND: Accurate T-staging of oral squamous cell carcinoma (SCC) is essential for surgical planning and prognosis. However, conventional computed tomography (CT) may underestimate tumor extent, particularly when performed without dynamic maneuvers. OBJECTIVES: To evaluate the accuracy of CT in predicting the T-staging of primary SCC of the oral cavity by comparing scans in the neutral position and with the mouth open and tongue extended (MOTE) maneuver. METHODS: This prospective cross-sectional study analyzed patients with oral SCC who underwent CT in both positions. Two blinded head-and-neck radiologists measured tumor size and depth of invasion (DOI). An anatomopathological study served as the reference. The accuracy of classifying early and advanced T-stage tumors was determined using diagnostic tests. RESULTS: Twenty-five patients (72% male, mean age 65.6 ± 11.3 years) were included. Tumor detection sensitivity increased from 72% (95% CI: 51.9-86.9) in the neutral position to 100% (95% CI: 83.4-100) with the MOTE maneuver. Correct T-staging prediction improved from 52-56% in the neutral position to 7276% with MOTE. Accuracy for early-stage (T1/T2) classification rose from 60.0% (95% CI: 39.3-78.1) to 88.0% (95% CI: 68.7-97.4, h = 0.66). Lesion size overestimation decreased from 20.9-23.7% to 15.3-16.1% (p < 0.05), whereas DOI differences were not significant (p > 0.05). CONCLUSIONS: The MOTE maneuver significantly improved both the sensitivity and accuracy of CT in the preoperative T-staging of oral cavity SCC. Its incorporation into diagnostic protocols may enhance lesion detection and staging reliability in daily clinical practice.