Right tonsil p16+squamous cell carcinoma T4N? treated with CRT 2011 at OSH with multiple recurrences, status post salvage oropharyngectomy with flap and right neck dissection 2/2014 at OSH no PNI or LVSI, followed by second local recurrence to right neck and salvage surgery right oral cavity with negative margins but dysplasia 12/10/14 at OSH, referred here with right nasopharynx recurrence, which was treated with induction chemotherapy, followed by chemo/re-irradiation to a total dose of 75Gy completed on 0/30/15. There are postoperative findings related to resection of the posterior right hemimandible with hardware fixation and flap reconstruction of the right-sided pharyngeal soft tissues. There are also postoperative findings related to right neck dissection. There is no measurable residual tumor within the right nasopharynx. There are denervation changes in the right tongue. There is no evidence of significant cervical lymphadenopathy. The thyroid and remaining salivary glands appear unchanged. There is newly apparent patchy T2 hyperintensity and enhancement in the left C1 and C2 vertebrae. There is scattered fluid within the right mastoid air cells. The right internal jugular vein is absent. The imaged intracranial structures are unremarkable.
1. Post-treatment findings in the right nasopharyngeal region without measurable residual tumor.2. Newly apparent patchy T2 hyperintensity and enhancement in the left C1 and C2 vertebrae is of uncertain significance and may be treatment related or inflammatory versus less likely neoplastic. Perhaps follow up via PET may be useful. 