Perineural spread of squamous cell carcinoma: infra-orbital nerve

Case contributed by Dr Chris O'Donnell

Presentation

PH of aggressive SCC right medial cheek excision. Now dysaesthesia right cheek/infra-orbital margin

Patient Data

Age: 50
Gender: Male

Subtle but definite asymmetrical swelling of the right infra-orbital nerve with subtle increase in T2 signal and definite enhancement. These changes do not obviously involve the cavernous sinus or other cranial nerves.

Case Discussion

Perineural spread of SCC in the head and neck is difficult to detect on MRI and requires meticulous technique (including high resolution pre and post contrast), high index of suspicion and careful examination of the cranial nerves adjacent to the site of primary neoplasm. The significance of detection is that prognosis following excision of SCC diminishes substantially and aggressive treatment including radiotherapy is required.  In this case there was excellent response to radiation therapy.

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Case information

rID: 37559
Case created: 12th Jun 2015
Last edited: 16th Oct 2016
System: Head & Neck
Inclusion in quiz mode: Included

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