 NECK: There are extensive postoperative findings related to right orbital and sinonasal exenteration with myocutaneous flap reconstruction. There marked interval decrease in size of the enhancing lesion in the roof of the left posterior nasopharynx along the surgical margin, now measuring up to approximately 5 mm, previously 15 mm. In addition, the previously demonstrated punctate right temporal scalp subcutaneous tissues nodule is no longer apparent. The right temporal fossa enhancing lesion with an adjacent underlying calvarial defect has decreased in size, measuring up to 5 mm, previously 9 mm. Likewise, the right squamosal temporal bone calvarial lesion with extension into the overlying scalp has decreased in size, now measuring up to approximately 4 mm, previously 6 mm. The right mandibular body lesion is also smaller, measuring 14 mm in the anteroposterior dimension, previously 16 mm, such that the lesion no longer protrudes through the anterior cortical defect. There is unchanged asymmetric enhancement in the right foramen rotundum. There are persistent obstructed secretions in the frontal and sphenoid sinuses with new mucosal thickening and fluid level in the left maxillary sinus. There is nonspecific high T2 signal in the right mastoid air cells. There is no evidence of significant lymphadenopathy in the neck. The thyroid and salivary glands appear unchanged.BRAIN: There is no abnormal intraparenchymal enhancement, acute infarct, mass, herniation, or midline shift. There are unchanged scattered T2 hyperintensities in the subcortical and periventricular white matter, which are nonspecific. The ventricles and sulci are unchanged.
1.Interval decrease in size of the metastases in the skull and mandible, left posterior nasopharynx along the surgical margin, and in the right scalp have decreased in size, consistent with response to therapy.2.Persistent mild asymmetric enhancement in the right foramen rotundum may be post-treatment in nature.3.No evidence of intraparenchymal brain metastases.4. Findings suggestive of acute left maxillary sinusitis with otherwise persistent obstructed secretions associated with the exenteration flap. 