Findings:
Large enhancing infiltrative mass is seen involving the superficial and deep lobes of the left parotid gland with bulk dimensions of 4.2 x 2.8 x 6 cm. The lesion extends and infiltrates the skin laterally with some small necrotic/cystic changes in the cutaneous and subcutaneous part.
Superiorly it extends to the left temporomandibular joint and the mastoid process on the left side.
Medially it extends to the left carotid and para pharyngeal spaces encasing the external carotid artery.
Anteriorly the tumour infiltrates the masseter and the medial pterygoid muscles as well as the left styloglossus and hyoglossus muscles.
Inferiorly the lesion invades the left sternocleidomastoid muscle and the left platysma.
There is a small enhancement and signal changes of the left mandibular angle, suspicious of tumour infiltration.
The left internal jugular vein is compressed and possibly infiltrated.
An enhancing soft tissue mass is also noted in the left tonsillar fossa measuring 2.3 x 2.2. x 1.8 cm, abutting the uvula and the soft palate and extending to the retropharyngeal space with possible encasement of the left internal carotid artery.
Suspicious lymph nodes are seen in the left level I and II.
Prominent perivascular spaces are noted in the imaged brain parenchyma, predominantly centred in periventricular location. The imaged brain parenchyma is otherwise unremarkable.
Mucosal thickening is seen in the paranasal sinuses. Minimal fluid is seen in several mastoid air cells on both sides.
The imaged upper spine is unremarkable. The craniocervical junction and spinal canal appear patent.
Conclusion:
Large, locally advanced tumour (likely SCC), centred in the left parotid gland and the left palatine tonsil, infiltrating the extrinsic muscles of the tongue , medial pterygoid muscle, masseter and the sternocleidomastoid on the left side and infiltrating the adjacent skin and possibly the mandibular angle. Possible left level 1 and 2 lymph node metastases (T4, N1).