Adenoid cystic carcinoma of the left submandibular gland s/p resection (2001) and radiation therapy c/b multiple cranial neuropathies and suspected bone metastases. There are post-treatment findings in the neck, including left submandibular gland resection, without evidence of gross tumor in this particular location. There are denervation changes in the left hemitongue and vocal cord. There appears to be a tumor in the central skull base region with extension to the left jugular foramen. There are also enhancing lesions within the anterior mandible, dens, and C5 through C7 vertebrae. Otherwise, there is a background of fatty marrow in the upper cervical spine likely related to radiation effects. There is no loss of vertebral body heights. There is degenerative spondylosis at multiple levels, most pronounced at C5-6 and C6-7, where there is mild indentation upon the spinal cord. The spinal cord signal is otherwise unremarkable. There does not appear to be significant lymphadenopathy in the neck. There is left tympanomastoid fluid. There are bilateral lens implants.
1. Multiple bone lesions likely represent metastatic disease. In particular, the skull base lesion may be responsible for denervation effects in the lower cranial nerves. Otherwise, abnormality in the anterior mandible may be related to metastatic disease, infection, or osteonecrosis, for example.2. Findings suggestive of left Eustachian tube dysfunction.