Diagnosis: Malignant neoplasm of major salivary gland, unspecified Malignant neoplasm of parotid gland. Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasmClinical question: h/o salivary gland ca and CRT, compare to previous, measurements please. MRI brain:The patient is status post right parotidectomy. There is opacification of the right mastoid air cells.Enhancement along the tympanic portion, geniculate portion and descending portion of the right facial nerve remains stable compared to the prior examThe CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Incidental note is made of fenestration of the basilar artery.The visualized portions of the paranasal sinuses are clear. The visualized portions of the orbits are intact.MRI Neck:The patient is status post right parotidectomy. The right mandibular gland is smaller than the left submandibular gland. The patient is status post right neck dissection.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears stable to the extent of visualization...The carotid and vertebral vasculature visualized on this exam appears intact.The upper cervical vertebral bodies in general are intact with no evidence for canal stenosis.
1.There is redemonstration of enhancement and thickening of the right facial nerve which is suspicious for perineural spread of disease. This is stable compared to the prior exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Status post right parotidectomy and right neck dissection.4.Opacification of the right mastoid air cells continues to be present and has increased relative to the prior exam . It now also involves the petrous apex. This is nonspecific