Parotid tumour with involvement of V3 and VII cranial nerves
3 month history of left facial palsy with lower motor neuron signs. Background of previously treated squamous cell carcinoma of the lip
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Thickening and enhancement of the branches of the V3 division of the right trigeminal nerve with thickening of the auriculotemporal nerve posterior to the ramus of the mandible, inferior alveolar nerve, and V3 within the infratemporal masticator space extending into the foramen ovale with intracranial spread into the middle cranial fossa.
In addition there is a mass within the superior aspect of the deep lobe of the right parotid gland with enhancement of the adjacent facial nerve at the stylomastoid foramen and extending along the descending segment of the facial nerve.
Further enhancement is seen along the intra parotid branches of the facial nerve.
The findings suggest extensive perineural tumour spread involving the branches of right V3 and facial nerve.
Key learning points:
1. Malignant lesions in the parotid gland can demonstrate perineural spread via the facial nerve and the auriculotemporal branch of the V3 nerve.