FIG 7.

A 35-year-old man with secondary otalgia caused by perineural tumor spread from parotid adenoid cystic carcinoma. Axial T1-weighted postcontrast fat-saturated MR imaging shows cordlike enhancement (white arrow) along the course of the auriculotemporal nerve, which serves as an extracranial bridge linking the intraparotid facial nerve to CN V3 (black arrow) in the infrazygomatic masticator space. Note hyperenhancement along the descending mastoid segment of CN VII (white arrowhead) from additional perineural tumor spread. In this case, referred otalgia may occur along the auriculotemporal nerve, CN V3, and/or CN VII.