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DISTANT METASTASIS - The Trigeminal Nerve

Now viewing: Case 6

Case 6 -Recurrent tumor of right lower lip with  metastasis to mandibular division and gasserian ganglion
This 49-year-old male had a V-lip excision for an ulcerative lesion on the right lower lip, followed with postoperative radiation therapy in 1986. There was recurrence in 1988 with soft tissue swelling on the right side of the mandible and hypesthesia of the right side of the tongue. Biopsy in 1989 showed recurrent undifferentiated carcinoma. MRI of the head and neck revealed recurrent tumor of the lower lip with perineural metastasis.
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Axial post-contrast T1-weighted MR image (TR 600/TE 30): a large soft tissue tumor with low to intermediate signal intensity in the right anterolateral aspect of the mandible (1). There is partial destruction of the outer margin of the right hemimandible (2) and involvement of the marrow space with intermediate signal intensity. Coronal post-contrast T1-weighted MR image (TR 600/TE 30) at the level of the foramen ovale: there is slight enlargement of the right foramen ovale (1) with abnormal contrast enhancement of the mandibular branch of the trigeminal nerve (V3) above the foramen (2).

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Axial post-contrast T1-weighted MR image (TR 600/TE 30) at the level of the cavernous sinus: the right gasserian ganglion is enlarged with high signal intensity (arrow). The left gasserian ganglion is normal in appearance.

 

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