 Enhancing soft tissue thickening is again seen within the left pre-maxillary cheek which continues along the inferolateral edge of the maxilla. As seen previously, this tissue erodes the maxilla slightly invading the floor of the maxillary sinus. Lobular mucosal thickening is seen in the maxillary sinus, whicho is probably largely reactive to tumor invasion. Compared to the previous studies, all the above findings are progressed.From the left cheek the mass spreads posteriorly along the lateral border of the maxilla into the masticator space, where there is invasion of the muscles of mastication. Vague soft tissue thickening and enhancement is seen extending further posteriorly below the zygomatic arch, reaching into the left parotid space.Abnormal enhancing tissue tracks up along the posterior wall of the left maxillary sinus to enter the widened pterygopalatine fossa. From here, abnormal tissue tracks along the V2 through the foramen rotundum and V3 through the foramen ovale. The cisternal portion of the trigeminal nerve is not involved. The left vidian nerve is also infiltrated.Along the left maxillary gingival tissue, there is an oval focus of low signal, which could represent a bubble of air within fluid trapped between the gum and the lip, an osseous fragment, or surgical material.Given the field of view, no pathologic lymph nodes are seen by size criteria. A hypoenhancing lesion is again seen in the right pituitary gland.
Progressive tumor is seen in the soft tissues of the left face. There is evidence of invasion of the left maxillary sinus, and perineural spread into the left pterygopalatine fossa with extension along V2, V3, and the vidian canal.