case_images: PMC10673330_01
case_images: a Plain CT prior to treatment. A peripheral bone fracture image was observed in the left maxillary sinus, as shown by yellow arrowheads. b MRI following 2 months of treatment. A high signal intensity area was observed in the left lateral pterygoid muscle, as indicated by yellow arrowheads. c MRI following 4 months of treatment. There was an increase in the high signal intensity area of the left lateral pterygoid muscle, as shown by yellow arrowheads. d A skin ulceration with bone exposure was observed on the left cheek around 5 months after treatment.
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case_images: F1
case_images: The tissue biopsy revealed squamous cell carcinoma, with various imaging tests, including PET-CT, leading to a diagnosis of left maxillary sinus cancer cT4aN0M0 (Fig. 1a). Two months after the end of treatment, while MRI confirmed CR, the STIR image showed a high signal intensity area in the left lateral pterygoid muscle group (Fig. 1b). The MRI taken 4 months following the end of treatment showed an increase in the high signal intensity area of the lateral pterygoid muscle (Fig. 1c), with the development of corneal perforation G4 as well. A skin ulceration with bone exposure emerged 5 months following the end of treatment (Fig. 1d).
case_images: Contrast-enhanced CT following 6 months of treatment. A ring-shaped contrast effect was observed within the left lateral pterygoid muscle group, as shown by yellow arrowheads. There was no sign of bone destruction.
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case_images: F2
case_images: A contrast-enhanced CT examination confirmed a ring-shaped contrast effect within the left lateral pterygoid muscle, raising suspicions of abscess, tumor recurrence, and muscle necrosis (Fig. 2).
case_images: Endoscopic view during surgery. The posterior wall of the left maxillary sinus was penetrated, and the sphenoidal sinus fossa was opened. A white fragile necrotic tissue was observed inside, as indicated by yellow arrowheads.
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case_images: F3
case_images: When the sphenoidal sinus fossa was opened by piercing through the medial wall of the left maxillary sinus (Fig. 3), a small amount of pus was observed.