External auditory canal squamous cell carcinoma

• Artefact associated with previous surgery in the right parotid gland.
• Intense enhancement around the retromandibular surgical bed extending into infratemporal fossa and masticator space with involvement of the digastric posterior belly. Likely local recurrence.
• Enhancement extending to the stylomastoid foramina and along the right facial nerve mastoid segment.
• There is also increased soft tissue enhancement around V3 below foramen ovale ?definite V3 involvement. V2 is intact.
• More inferiorly centred in the superficial lobe/parotid tale is is a 2.5cm heterogeneously enhancing lesion with central necrosis with evidence of extracapsular extension.
• There is enhancement extending to the carotid space medially.
• There is involvement of the anterior margin of sternocleidomastoid muscle.
• 5mm nodular enhancement posterior to internal auditory canal is seen and also represents tumour.
• There is a right level two 9 mm lymph node immediately medial to the mass.

• Surgical clips in the right parotid region where there has been a right parotidectomy + fat graft.
• Large soft tissue mass adjacent to the surgical clips resulting in destruction of the anterior aspect of the right mastoid air cells which are filled with soft tissue and fluid in keeping with extensive right mastoiditis.
• There is soft tissue in the right external ear extending to the tympanic membranes.
• There is also soft tissue in the epitympanic recess without definite auditory ossicular chain destruction.
• The right TMJ is normal.
• Extensive sinus inflammatory disease.

No pathological deep cervical lymphadenopathy.