This patient was operated on 4 years ago for a malignant
fibro-histiocytoma of the right maxillary sinus (total
right maxillar resection including the orbital floor and
the hard palate and the pterygoid processes). An osseous
reconstruction was performed in a second time. One year
later, apparition of a local relapse involving the base of
the skull treated by chemo- and radiotherapy. Status quo
during 2 years. Now the patient consults for apparition of
a trismus; the clinical examination shows a local
re-evolution.
MRI is done with the following sequences: T1w SE axial and
coronal pre and post Gd DOTA.
The relapse involves massively the pterygo-maxillary fossa
including the lateral and medial pterygoidsmuscles
causing the trismus.There is a perineural extension along
the ways of the V2 (enlarging the foramen rotundum) and V3
(foramen ovale) up to the Meckel's cave.
Unfortunately, in spite of multiple chemotherapies, the
evolution was bad and the patient is now in end-stage
of disease.