Rectal cancer has the potential to metastasize to multiple anatomical sites. The hallmark of treatment
presides with sound oncologic surgery, adjunct with chemotherapy and radiation therapy when indicated.
The initial presentation determines the management regimen, consisting of physical examination and
diagnostic imaging. A 54-year-old female presented with locally advanced rectal cancer. Upon conclusion
of neoadjuvant chemotherapy and radiation therapy, she underwent a low anterior resection with total
mesorectal excision. Her surgical margins were negative; however, of the 21 lymph nodes retrieved, 11
were positive for cancer. The patient underwent further adjuvant chemotherapy. 2 years, 8 months later, the
patient presented to the emergency department with worsening swelling of the right side of the face, with
increasing pain, hearing, and visual impairments. Diagnostic imaging revealed a large lesion in the cranial
anatomy, invading the temporal bone, temporomandibular joint, sphenoid bone and anterior superior
epitympanum of the right middle ear. The patient underwent operative intervention followed by radiation
and chemotherapy. Asynchronous metastasis of rectal cancer to the cranium is a rare finding and an invasion
into the temporal bone even more scarcely reported. The prognosis for distant metastatic disease is poor
because it involves metastatic spread via the lymph channels or vascular system. Patients that have
undergone treatment for advanced rectal cancer must be approached with a high index of suspicion for
distant metastatic disease, even in the advent of routine negative surveillance
Diagnostic imaging of the temporomandibular joint
