ok here we go.

Ct scan does show bone erosion of the maxilla posteriorly at the tuberosity with extension into the pterygopalatine and infratemporal fossa. The lateral pterygoid muscle is thickened. The planes between it and the medial pterygoid muscle are gone and this loss of fat planes continues all the way to the mandible and looks to go right up to the temporomandibular joint as well, though with outgoing erosion of the mandible. This definitely would explain his significant pain and subjective and odjective trismus. Surgically. it is extremely difficult or effectively impossible to be able to eradicate tumor when it has spread along these muscles and fascia planes of the infratemporal fossa, and even if one could technically achieve negative margins, rarely is it ever the case and local recurrance is high. His cure is going to depend on whether or not he has a good response to chemoradiation therapy and it makes every bit of sense to do that up front.