T4N2cM1 tonsil ca admitted for cycle 4/7-8 FHX elderly frail. There is a lingual cortex defect and diffuse enhancement in the right mandible, with ill-defined enhancement in the adjacent soft tissues measuring up to approximately 30 mm. There is diffuse thickening of the right trigeminal nerve from the inferior alveolar canal to the cavernous sinus and perhaps into the right foramen rotundum. There is also mildly prominent enhancement and thickening of the adjacent dura along the floor of the middle cranial fossa. There are denervation changes in the right tongue and right masticator muscles. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is a lesion in the C7 vertebral body with endplate deformities. There is a punctate lesion in the superior portion of the C5 vertebra. There is multilevel degenerative cervical spondylosis with disc-osteophyte complexes at C3 through C7 that mildly indent the spinal cord. There is fluid within the bilateral mastoid air cells. There is mild mucosal thickening in the right maxillary sinus.
1. A lingual cortex defect and diffuse enhancement in the right mandible, with ill-defined enhancement in the soft tissues, measuring up to approximately 30 mm, which likely corresponds to the previously treated tumor, superimposed upon right tongue denervation changed. 2. Diffuse thickening of the right trigeminal nerve from the inferior alveolar canal to the cavernous sinus is compatible with perineural tumor spread, with denervation changes in the right masseter muscles.3. Treated metastatic lesion in the C7 vertebral body with endplate deformities. A punctate lesion in the superior portion of the C5 vertebra is nonspecific.4. No significant residual cervical lymphadenopathy based on size criteria. 5. Nonspecific fluid within the bilateral mastoid air cells. 