Findings:
There is an ovoid soft tissue mass arising from the posterior soft palate on the left side with clear margins. It is largely iso to hypointense on T1 weighted imaging. There is heterogenous signal intensity within the lesion on T2 weighted imaging, with surrounding areas of hyperintensity. There is diffusion restriction and moderate enhancement on post contrast imaging. The lesion measures approximately 3.2 x 4 x 4.5 cm.
Extension is seen into the left retromolar trigone; the left lateral pharyngeal wall is displaced towards the parapharyngeal space. The uvula is displaced to the right. There is invasion of the left para pharyngeal space and the lesion overlies the left medial pterygoid and styloglossus muscles with possible infiltration of the left styloglossus muscle.
There is also a smaller similar soft tissue mass in the posterior aspect of the soft palate on the right side measuring approximately 1.7 x 1 x 2 cm.
Approximately 2 x 1.3 cm measuring, partially necrotic lymph node is seen in the left level Ib. Rounded 1.1 centimetre measuring lymph node is also seen in the right level Ib. Several smaller lymph nodes are also noted in bilateral level II.
The parotid, submandibular and thyroid glands are unremarkable.
The tongue and the floor of the mouth have a normal appearance.
The glottic region is normal.
Dear imaged brain parenchyma is unremarkable. Partial obliteration of the mastoid air cells on the right side is seen. The paranasal sinuses and mastoid air cells are otherwise clear.
No bony abnormality is seen.
Conclusion:
Large soft tissue mass arising from the soft plate, more pronounced on the left side with extension into the left para pharyngeal space, possible invasion of the left styloglossus muscle and bilateral submandibular lymph node metastases (T4aN2c).
Histological evaluation and further staging is advised.