58-year-old female with two years history of left cheek swelling on 3 separate occasions. Swelling decreases with antibiotics. Patient has bony defect in the left maxillary sinus anterior wall in the region of intra-orbital foramina. Also asymmetric enlargement of the left infera-orbital canal along the roof of the left maxillary sinus with a small defect in orbital floor. Examination demonstrates soft tissue thickening anteriorly to the anterior wall of left maxillary sinus which appears to extend superiorly anterior to the body of the zygoma. There is also evidence of increased soft tissue density along the floor of the orbit lateral to the infraorbital nerve groove. There is also soft tissue thickening within the maxillary sinus immediately posterior to the anterior wall of the left maxillary sinus. Soft tissue prominence appears to extend slightly posteriorly and posterior laterally to the left maxillary sinus. Bony density of area of the exam demonstrates subtle suspected lytic changes of the left zygoma. There is also uniformly enlarged infraorbital nerve groove which is filled with soft tissue density which is contiguous with above described soft tissue changes. Considering provided clinical data the findings are suspicious for an infectious process. However possibility of a mass cannot be entirely ruled out particularly considering presence of expansion of infraorbital nerve groove (V2). Further evaluation with an MRI examination with infusion is recommended. The retro-orbital fat remains within normal limits. Extraocular musculature and globe remain within normal limits. No definitive abnormality of cavernous sinus or Meckel's cave on this exam is detected. Limited view of nasopharynx demonstrates no abnormality. Minimal chronic sinus disease of bilateral ethmoids is also present.
Abnormal soft tissue within the left maxillary sinus, left orbit, left inter-temporalis fossa with associated bony changes of zygoma and anterior wall of the maxillary sinus as well as left infraorbital nerve groove as detailed. Follow-up been an MRI examination with infusion is highly recommended. Please see above comments.