Adenoid cystic carcinoma of parotid gland with perineural spread along left auriculo temporal nerve, V CN in to foramen ovale and left mandibular nerve.

Status post left superficial parotidectomy.

An extensive irregularly marginated infiltrative heterogeneously enhancing mass lesion involving the deep lobe of left parotid gland, extending medially , partially encasing the left IJV with anterior extension into the left masticator space as described –consistent with Known case of adenoid cystic carcinoma of left parotid gland.

Anterior aspect of the mass lesion is encasing the posterior cortex of left condylar process, ramus of mandible with a thick curvilinear soft tissue along the posterior cortex of left condylar process of mandible, suggesting perineural spread along left auriculotemporal nerve (branch of fifth cranial nerve).

Superior extension along the course of left auricular temporal nerve, 5th cranial nerve extending into the left foramen ovale causing mild widening of the foramen.

Further *intracranial extension of the mass is noted involving the left medial inferior temporal epidural space causing encasement of the left cavernous ICA with mild vasogenic edema involving the left temporal lobe.

Left mandibular foramen is slightly enlarged, suggesting early inferior perineural spread along left mandibular nerve .

The left submandibular gland is surgically absent.