 This is a case of a patient who presented with a submandibular region mass. When you look at the CT scan through the head neck region, you see that we have a very large mass which appears to extend below the level of the mandible, hence it was felt to be a submandibular mass. What you see here is the submandibular gland. So this was not a submandibular mass that was within the submandibular gland, but a mass that's posterior to the submandibular gland, and in point of fact extends all the way up into the paratiglian. You notice that the lesion has cystic components, as well as solid components, and not only that, but you see some subcutaneous spread into the platysma muscle on the right side, as well as the subcutaneous fat. So this very large lesion with regular borders spread to the platysma muscle, spread into the subcutaneous fat, is one that we would suggest represents a malignancy, even though it does have some cystic component. Now is this cystic or is this necrotic? Looks a little bit more necrotic based on the border here. Pay attention as I scroll superiorly. What do you see? Well, I see some component which is appearing to go into the deep lobe or deep portion of the paratiglian, and I see tissue which is extending from the paratiglian posteriorly to the stylo-mastoid foramen. This area should have nice clean fat, and instead we have this heterogeneous swath of tissue extending to the stylo-mastoid foramen. This is a marker for potential spread to the facial nerve via perinural spread. You've got the dermoid carcinomas generally have a low rate of perinural spread, but this is an example of one that did spread in that fashion. Let's look at the coronal and sagittal images and see whether we're convinced. Well, it's pretty easy to commit yourself that this is a lesion of the paratiglian given that it's in close opposition thereof. Here is the submandibular gland being displaced downward. We see this haziness even to the sternocleid amastoid muscle and the adjacent subcutaneous fat, and as we watch it go further superially, we see this tissue that is going right to the stylo-mastoid foramen here, this irregular tissue. Here's the clean stylo-mastoid foramen. This may be more or less convincing on the sagittal scan, so on this sagittal scan we got this big old mass in the paratiglian with irregular borders, subcutaneous fat infiltration, and as we come to the superior border of it, we see that it goes to the edge of the stylo-mastoid foramen on the sagittal scan as well. This was a mucoepidermoid carcinoma, in this case high-grade mucoepidermoid carcinoma, which has a potential for poor prognosis. You're going to look for lymph adenopathy. We see lymph nodes here that are enlarged. The patient has some large lymph nodes on the contralateral side. We probably deserve getting a PET scan to see how many of these are actually infiltrated with tumor, particularly if it's a high-grade mucoepidermoid carcinoma.