Male, 61 years old, with history of multiple tonsil cancer recurrences, with a new recurrence in the nasopharynx, compare to previous exams. Redemonstrated are postoperative findings compatible with resection of the posterior right hemimandible with hardware fixation and flap reconstruction of the right-sided pharyngeal soft tissues. Sequelae of right neck dissection are also redemonstrated.The previously described infiltrative tumor centered on the right nasopharynx with involvement of the pterygoid plates and parapharyngeal space is less bulky and less well-defined than on the prior examination. The lesion is no longer accurately measurable as it cannot be definitively isolated from the normal nasopharyngeal structures.Architectural distortion of the tongue is seen which may reflect hemiatrophy or flap reconstruction of the right oral tongue. Since the prior examination, the right hemitongue region has become T2 hyperintense and enhances mildly, also appearing slightly more edematous than on the prior exam.Generalized hyperemia of the residual native pharyngeal and soft palate mucosa is seen with edema spreading into the left masticator space. Pooling secretions are seen within the piriform sinuses.The right parotid gland is enlarged relative to the left and slightly hyperemic but this is not significantly changed from prior. The salivary glands and the thyroid are otherwise unremarkable. Small scattered lymph nodes are seen within the neck but none of which is pathologically enlarged by size criteria. Patchy fluid is evident within the right mastoid air cells. Patchy mucosal thickening is also seen within the paranasal sinuses.
1.Since the prior examination, infiltrative tumor that had been centered on the right nasopharynx is significantly decreased in conspicuity and bulk and is now no longer discretely measurable.2.New edema and hyperenhancement is seen within the right hemitongue. This could represent a treatment related mucositis, or assuming that this tissue is not a flap construct, a denervation related effect. Tumor involvement is felt to be unlikely, though the area should be evaluated with direct inspection.3.Likewise, progressive edema is seen within the residual nasopharyngeal and soft palate mucosa. Findings are favored to reflect treatment related mucositis but these areas should be inspected directly to exclude tumor involvement.4.No pathologic adenopathy is detected in the neck.