Clinical question: Head and neck cancer. Signs and symptoms: Headache cancer. Enhanced CT of soft tissues of the neck:70 cc of Omnipaque 350 is administered for the exam. Images through the skull base including cavernous sinuses, bilateral petrous bones are unremarkable.Images through the neck again demonstrate postoperative changes of partial mandibulectomy in the midline anteriorly with a bony graft. There is interval change with a new bony graft compared to prior study. There is no definitive evidence of fusion of bony graft and the native bone. There are bilateral sonolucencies of the marrow space immediately at the level of mandibulectomy and without appreciable change since prior examination.Subtle soft tissue thickening surrounding the mandibulectomy size and the bony graft are within expected range for postop changes. There is however more soft tissue density anterior to the mandible on the right since prior exam which may be present at it postop changes. No definitive evidence of tumor. Recommend MRI for follow it on physical exam there is suspected tumor recurrence at this site.Extensive postoperative changes of bilateral neck is noted. No detectable cervical adenopathy.Multiple small varying sized cysts within an enlarged right lobe of thyroid and the isthmus of thyroid appears similar to prior exam. Limited images of the apices of the lungs demonstrate emphysematous changes however without metastatic lesions. However these reviewed dedicated reports of CT of chest performed on this date.Enhanced head CT:There is no evidence of metastatic disease to the brain, leptomeninges or the calvarium.The cortical sulci, ventricular system, CSF cistern and the gray -- white matter differentiation remains within normal.Calvarium is intact. Minimal chronic pansinusitis.
1.Evidence of interval further surgery at the site of anterior mandibulectomy in the midline with a new bony graft and increased soft tissue density anterior to the mandible on the right. No definitive recurrence of tumor at this site. There is no fusion of bone graft with the mandible. There is no evidence of recurrence of tumor or lymphadenopathy in the neck. Please see above comments there2.negative enhanced CT of brain and calvarium.