Imaging Sci Dent.  2016 Dec;46(4):285-290. 10.5624/isd.2016.46.4.285.

Incidental finding of an extensive oropharyngeal mass in magnetic resonance imaging of a patient with temporomandibular disorder: A case report

• Omolehinwa TT
• Mupparapu
• Akintoye S

• KMID: 2362748
• DOI: http://doi.org/10.5624/isd.2016.46.4.285

Abstract

In this report, we describe the incidental finding of an oropharyngeal mass in a patient who presented with a chief complaint of temporomandibular pain. The patient was initially evaluated by an otorhinolaryngologist for complaints of headaches, earache, and sinus congestion. Due to worsening headaches and trismus, he was further referred for the management of temporomandibular disorder. The clinical evaluation was uneventful except for limited mouth opening (trismus). An advanced radiological evaluation using magnetic resonance imaging revealed a mass in the nasopharyngeal/oropharyngeal region. The mass occupied the masticatory space and extended superioinferiorly from the skull base to the mandible. A diagnostic biopsy of the lesion revealed a long-standing human papilloma virus (HPV-16)-positive squamous cell carcinoma of the oropharynx. This case illustrates the need for the timely radiological evaluation of seemingly innocuous orofacial pain.

Keyword

Magnetic Resonance Imaging; Oropharyngeal Neoplasms; Human Papillomavirus 16; Facial Pain

MeSH Terms

Biopsy
Carcinoma, Squamous Cell
Earache
Estrogens, Conjugated (USP)
Facial Pain
Headache
Human papillomavirus 16
Humans
Incidental Findings*
Magnetic Resonance Imaging*
Mandible
Mouth
Oropharyngeal Neoplasms
Oropharynx
Papillomaviridae
Skull Base
Temporomandibular Joint Disorders*
Trismus
Estrogens, Conjugated (USP)

Figure

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  Fig. 1 T1-weighted axial magnetic resonance imaging shows a mass in the left posterior wall of the nasopharynx, with deviation of the nasal septum to the right.

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  Fig. 2 T1-weighted axial magnetic resonance imaging shows a mass in the left nasopharyngeal wall, left soft palate, vomer, and choana, and inseparable from the inferior turbinate.

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  Fig. 3 T1-weighted axial magnetic resonance imaging shows the extension of abnormal soft tissue to the left parapharyngeal space, with no separation from the left masticator space and muscles, specifically the pterygoid and masseter muscles. In addition, extension of the mass to the skull base is present.

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  Fig. 4 T1-weighted axial magnetic resonance imaging shows evidence of erosion of the lingual cortex of the left mandibular ramus and presence of abnormal soft tissue in the left retromolar trigone.

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  Fig. 5 Enhanced T1-weighted axial magnetic resonance imaging shows the presence of abnormal soft tissue in the left retromolar area.

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  Fig. 6 Nonenhanced T1-weighted coronal magnetic resonance imaging shows the involvement of the pharyngeal area on the left side, with extension to the base of the brain.

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  Fig. 7 T1-weighted axial magnetic resonance imaging shows erosive changes on the superficial surface of the left condylar head.

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  Fig. 8 T1-weighted coronal magnetic resonance imaging shows a discontinuity in the lingual cortex of the left mandibular ramus, signifying involvement.

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  Fig. 9 A positron emission tomography-computed tomography image shows a hypermetabolic mass centered on the left naso-oropharynx with involvement of the left ramus.

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