 NECK: There are extensive postoperative findings related to right orbital and sinonasal exenteration with myocutaneous flap reconstruction. There is no measurable tumor in the roof of the left posterior nasopharynx along the surgical margin. The previously demonstrated punctate right temporal scalp subcutaneous tissues nodule, the right temporal fossa enhancing lesion and right squamosal temporal bone calvarial lesion with extension into the overlying scalp are also no longer discernible. The right mandibular body lesion has not significantly changed in size, measuring up to 18 mm. There is unchanged asymmetric enhancement diffusely in the right foramen rotundum, without appreciable mass effect. There are persistent obstructed secretions in the frontal and sphenoid sinuses and mucosal thickening and fluid in the left maxillary sinus. There is nonspecific high T2 signal in the bilateral mastoid air cells. There is no evidence of significant lymphadenopathy in the upper neck. The salivary glands appear unchanged.BRAIN: There is a new lobulated peripherally enhancing lesion in the anterior right temporal lobe measuring up to 33 mm with extensive surrounding vasogenic edema and mild uncal medialization, partial effacement of the right lateral ventricle and midline shift to the left, measuring approximately 2 mm. There are otherwise unchanged scattered T2 hyperintensities in the subcortical and periventricular white matter, which are nonspecific. There are no other enhancing intracranial lesions.
No measurable residual tumor in the left posterior nasopharynx along the surgical margin and in the right scalp and skull, but unchanged mandibular body metastasis.Persistent mild asymmetric enhancement in the right foramen rotundum may be post-treatment in nature.Interval development of what likely represent radiation necrosis in the anterior right temporal lobe, with extensive vasogenic edema. Otherwise, no evidence of brain metastases.4. Findings suggestive of acute left maxillary sinusitis with otherwise persistent obstructed secretions adjacent to the exenteration flap.