Female, 57 years old, status post resection and reconstruction for left retromolar trigone cancer, evaluate for disease extension, specifically in the skull base. Neck:Extensive postoperative findings are redemonstrated including resection of the left hemimandible, left floor of mouth, portions of the left oral tongue, left pharynx, left masticator space and the overlying lateral cutaneous and subcutaneous tissues. A soft tissue graft has been interposed within the surgical defect.A superficial fluid-filled cavity along the left posterolateral aspect of the graft is again seen most likely representing seroma. A somewhat more complex appearing, tracking fluid collection is also redemonstrated deep to the left sternocleidomastoid muscle which likely also represents a postoperative seroma. Without the benefit of contrast enhanced images, the possibility of lymph nodes within this space cannot be adequately assessed.Ill-defined signal abnormality seen throughout the left masticator space. Thickening of the V3 segment of the cranial nerve V is also suspected within the masticator space extending to the level of the foramen ovale. The inferior aspect of Meckel's cave is mildly thickened as well, but no obvious abnormalities are detected in the cavernous sinus.Brain:Elsewhere intracranially, patchy white matter T2 hyperintense lesions are seen which are nonspecific but produce no significant edema or mass effect. Parenchymal morphology and signal characteristics are otherwise unremarkable. No evidence of restricted diffusion is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.
1.Extensive postoperative findings are seen in the left face and neck status post resection of a large tumor centered on the left mandible. A soft tissue graft has been interposed in the surgical defect.2.A superficial fluid collection is seen along the left posterolateral aspect of the graft which likely represents a seroma. A more complex appearing fluid collection tracking along the undersurface of the left sternocleidomastoid muscle may also represent a seroma. The possibility that there may be lymph nodes interspersed in this space cannot be excluded in the absence of contrast.3.The extracranial V3 segment appears to be thickened in the left masticator space extending up to the level of the foramen ovale. The inferior aspect of Meckel's cave may also be involved. Findings are concerning for perineural tumor involvement.4.Elsewhere intracranially, no evidence of metastatic disease is seen.