History of left parotid region squamous cell carcinoma with radiation necrosis of the temporal bone status post resection and reconstruction concern for abscess/cerebritis: pain, fever, and AMS. There are postoperative findings related to left lateral temporal bone resection with myocutaneous graft reconstruction. There is interval decrease in size of the heterogeneous fluid within the anterior portion of the resection bed. 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 also appears to be a fluid collection that measures up to 3 mm in thickness along the floor of the left middle cranial fossa. There is no evidence of acute territorial infarction. There is mild enhancement of the left cochlea and cranial nerves in the left internal auditory canal. There appears to be persistent 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 with interval decrease in size of the fluid collection within the anterior portion of the surgical bed.2. Apparent defect in the left tegmen, with mild herniation of the inferior temporal lobe, with persistent vasogenic edema, which likely represents radiation necrosis, perhaps with superimposed cerebritis, as well as an apparent small extra-axial fluid collection along the floor of the left middle cranial fossa.3. Persistent enhancement of the left cochlea and cranial nerves in the left internal auditory canal may represent infectious and/or radiation-induced labyrinthitis and neuritis.