Metastatic head and neck cancer. Head CT:There is no evidence of intracranial hemorrhage or infarction. There is extensive soft tissue abnormality extending from masticator space through the foramen ovale into the right middle cranial fossa and into the right cavernous sinus, better seen on the prior MR study. This appears slightly less prominent. However the subtle interval difference may be secondary to imaging techniques. No new intracranial mass is seen.There is slight prominence of the right superior ophthalmic vein which is unchanged, probably secondary to involvement of mass at the right orbital apex and cavernous sinus, causing impairment of drainage of the vein.Neck CT:Extensive post-treatment changes are again present at the right maxillofacial region. There is extensive enhancing soft tissue abnormality extending from the masticator space, superiorly into the right orbit with involving the right orbital apex, and inferior and medial aspect of the right orbit, along the lamina papyracea. The lesion extends through the skull base, including the foraminal ovale, into the intracranial compartment. Soft tissue abnormalities are also seen in the right ethmoid air cells. There is opacification in the right frontal sinus and frontal sinus ostium, which likely represent trapped secretions. There is involvement of right pterygo-maxillary fissure, pterygopalatine fossa, sphenopalatine foramen, inferior orbital fissure, and foramen rotundum, which is better seen on prior MRI study. Accounting for sampling differences, there is no significant change of the extensive soft tissue abnormality. There is possibly minimal decrease at the right orbit. Opacification of right mastoid air cells is likely secondary to eustachian tube dysfunction.No evidence of adenopathy is seen in the neck.There is degenerative disease of the cervical spine, but no ossenous metastasis is identified.
1. Status post surgical changes in right maxillofacial region.2. Extensive soft tissue abnormality extending from the right masticator space through the skull base into the right middle cranial fossa, with involvement of the right orbit, cavernous sinus, and right ethmoid air cells. Perineural spread is better seen on prior MRI study. Accounting for sampling differences, there is no significant interval change. There is possibly minimal decrease of the lesion at the medial aspect of the orbit.