Findings:
Known, left-sided mastoid and TMJ osteomyelitis is noted again. Compared to the previous study progressive destruction of the left skull base noted with areas of bony defect at the left temporal base.
Also, newly appreciated centrally necrotic soft tissue density is seen within the left infratemporal and masticator fossa with multiple flecks of gas and intracranial extension, where an encapsulated, multiloculated fluid collection measuring approximately 2.7 x 2.1 x 2.5 cm is seen. Adjacent oedema is noted in the left temporal lobe. No hydrocephalus or midline shift.
Medially the soft tissue thickening extends to the left para-pharyngeal space with left nasopharyngeal recess and mucosal soft tissue, measuring approximately 2.2 x 2.7 cm.
A newly inserted soft tissue drain is seen in the left periauricular region.
Multiple, mildly enlarged bilateral cervical and submandibular lymph nodes are seen.
Previous left hemimandibulectomy with unchanged appearance of the bony graft.
Complete opacification of the left-sided mastoid and middle ear cavity is seen again. Also, soft tissue thickening is seen obliterating the left external auditory canal.
Mild mucosal thickening is seen in the right maxillary sinus. The paranasal sinuses and mastoid air cells on the right are otherwise clear.
Partially imaged peripherally inserted central venous catheter on the right. The lung apices are clear.
Mild degenerative changes of the lower cervical spine is seen.
Conclusion:
Newly appreciated, large, inflammatory soft tissue thickening within the left infratemporal fossa, extending medially into the left nasopharynx with thickening of the left nasopharyngeal recess and mucosal soft tissue.
Also, intracranial extension with relatively large fluid collection in the lower lobe left temporal fossa with associated perifocal oedema. Further evaluation with MRI brain and neck is advised.