History of left parotid region squamous cell carcinoma with radiation necrosis of the temporal bone status post resection and reconstruction 3 weeks ago now with concern for possible abscess/cerebritis History: fevers, chills, AMS. There are postoperative findings related to left lateral temporal bone resection with myocutaneous graft reconstruction. There is heterogeneous fluid within the anterior portion of the surgical bed, which extends to the overlying skin incision and measures approximately 25 mm in width, 15 mm anteroposteriorly, and 20 mm in height. There appears to be a defect in the left tegmen, with mild herniation of the inferior temporal lobe, where there is patchy cortical and subcortical T2 hyperintensity and enhancement, as well as diffuse, confluent T2 hyperintensity of the white matter. There is no large intracranial fluid collection or evidence of acute territorial infarction. There is mild enhancement of the left cochlea and cranial nerves in the left internal auditory canal. There also appears to be mild thickening and enhancement of a portion of the V3 segment of the left trigeminal nerve in the region of foramen ovale and mild asymmetric prominence of the left cavernous sinus. There are denervation changes in the left masticator and facial expression muscles. Low T1 and T2 bone marrow signal in the irregular left mandibular condyle may be attributable to degenerative changes with subchondral sclerosis. There is mucosal thickening and secretions in the left posterior ethmoid sinus and a small retention cyst in the right sphenoid sinus.
1. Postoperative findings related to left lateral temporal bone resection with myocutaneous graft reconstruction. There is heterogeneous fluid within the anterior portion of the surgical bed, which extends to the overlying skin incision and measures approximately 25 mm, which may represent s seroma with superimposed infection.2. Apparent defect in the left tegmen, with mild herniation of the inferior temporal lobe, where there is evidence of inflammatory changes, which may represent cerebritis superimposed upon underlying radiation necrosis.3. Mild enhancement of the left cochlea and cranial nerves in the left internal auditory canal may represent infectious and/or radiation-induced labyrinthitis and neuritis.4. Apparent mild thickening and enhancement of a portion of the V3 segment of the left trigeminal nerve in the region of foramen ovale and mild asymmetric prominence of the left cavernous sinus. 