applied sciences Communication Myxofibrosarcoma Mimicking Inflammatory Lesion of Temporomandibular Joint—Case Presentation Dawid Zagacki 1,*, Krzysztof Sztychny 2, Marta Tyndorf 2, Robert Bibik 3, Dominik Sygut 4 and Marcin Kozakiewicz 2 1 International Doctoral School, Medical University of Łód´z,Pl. Hallera 1, 90-647 Łód´z,Poland 2 Department of Maxillofacial Surgery, Medical University of Łód´z,Pl. Hallera 1, 90-647 Łód´z,Poland; [email protected] (K.S.); [email protected] (M.T.); [email protected] (M.K.) 3 Department of Radiation Oncology, Radom’s Oncology Centre, 26-600 Radom, Poland; [email protected] 4 Department of Clinical Patomorphology and Cytopathology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland; [email protected] * Correspondence: [email protected] Abstract: Treating oncologic patients remains a challenge for surgeons aiming to provide patients with safe margins of resection while maintaining the highest possible quality of life. The latter, in the case of malignancies, requires using sophisticated methods of reconstruction. Thus, we present a case of a 75-year-old patient treated in our department with a rare neoplasm in the region of the temporomandibular joint—a myxofibrosarcoma that was mimicking an inflammatory lesion. The patient underwent two surgeries—firstly alloplasty of the TMJ due to the suspicion of an inflammatory lesion, lately extended to the resection of glenoid fossa and subtemporal fossa contents when the mandible was reconstructed using UHMW-PE (ultra-high molecular weight polyethylene). Citation: Zagacki, D.; Sztychny, K.; The patient was also referred for adjuvant radiotherapy and has remained disease-free for over Tyndorf, M.; Bibik, R.; Sygut, D.; 96 months with very good aesthetics and function of the mandible. The presented case highlights Kozakiewicz, M. Myxofibrosarcoma not only the need for increased oncologic awareness but also the possible use of UHMW-PE as a Mimicking Inflammatory Lesion of reconstruction material in the broad resection of the maxillofacial region. Temporomandibular Joint—Case Presentation. Appl. Sci. 2021, 11, 4373. Keywords: myxofibrosarcoma; TMJ; TMJ neoplasm; TMJ reconstruction; UHMW-PE https://doi.org/10.3390/app11104373 Academic Editor: Gabriele Cervino Received: 28 April 2021 1. Introduction Accepted: 10 May 2021 Myxofibrosarcoma (MFS) is a rare soft tissue neoplasm presenting a high incidence of Published: 12 May 2021 late recurrence (50–60%) and metastasis potential (33%) [1]. The most common location for the pathology is the soft tissues of the lower extremities followed by the trunk, retroperi- Publisher’s Note: MDPI stays neutral toneum and mediastinum [2]. The head and neck as a primary site are extremely rare with regard to jurisdictional claims in with only a few reports being present in literature. Previous cases reported in the region published maps and institutional affil- of head and neck included the cranial cavity, orbit, maxilla, parotid gland, hypopharynx, iations. sinus piriformis, vocal folds or thyroid gland [3]. No cases in the region of the temporo- mandibular joint were found in the literature, to the best of our knowledge. The rareness of the disease entity in this region may lead to many initial misdiagnoses, or even to the classification as benign lesions at first. What also should be highlighted is that most of the Copyright: © 2021 by the authors. MFS present as a painless and slow-growing mass [1] that is also very misleading during Licensee MDPI, Basel, Switzerland. the primary examination of the patient. We present a case of a 75-year-old male patient with This article is an open access article myxofibrosarcoma of the temporomandibular joint and symptoms similar to those of the distributed under the terms and rheumatoid inflammatory entity of the joint. The patient underwent a broad resection with conditions of the Creative Commons mandible reconstruction using UHMW-PE, thus, we would like to discuss in this article the Attribution (CC BY) license (https:// up-to-date challenges in maxillofacial surgery—the possibilities of reconstructions using creativecommons.org/licenses/by/ allogenic materials on the example of UHMW-PE and titanium. 4.0/). Appl. Sci. 2021, 11, 4373. https://doi.org/10.3390/app11104373 https://www.mdpi.com/journal/applsci Appl. Sci. 2021, 11, x FOR PEER REVIEW 2 of 9 Appl. Sci. 2021, 11, 4373 sibilities of reconstructions using allogenic materials on the example of UHMW‐PE2 and of 8 titanium. 2.2. MaterialsMaterials andand MethodsMethods RetrospectiveRetrospective analysisanalysis ofof thethe medicalmedical documentationdocumentation ofof thethe patient patient was was performed performed (the(the firstfirst admission admission of of the the patient patient was was in in 2013) 2013) and and updated updated with with the the most most recent recent follow- fol‐ uplow examination.‐up examination. 3.3. ResultsResults TheThe 75-year-old 75‐year‐old male male was was referred referred to the to Department the Department of Maxillofacial of Maxillofacial Surgery MedicalSurgery UniversityMedical University of Łód´z,Poland, of Łódź, due Poland, to weight due to loss weight caused loss by caused severe by pain severe in the pain left in temporo- the left mandibulartemporomandibular joint and joint restricted and restricted mouth opening mouth opening for four years.for four The years. patient The was patient burden was withburden ischemic with ischemic heart disease heart and disease benign and prostatic benign prostatic hyperplasia. hyperplasia. InIn thethe intra-intra‐ andand extra-oralextra‐oral examination,examination, aa restrictionrestriction ofof mouthmouth openingopening toto 1010 mmmm waswas notednoted (Figure 11),), also our patient patient presented presented with with insufficient insufficient lateral lateral movement movement of ofthe themandible. mandible. FigureFigure 1. 1. PatientPatient presentingpresenting mouthmouth restrictionrestriction to to 10 10 mm. mm. TheThe MRIMRI ofof TMJTMJ waswas performedperformed andand describeddescribed by by the the radiologist radiologist as as chronic chronic arthritis arthritis andand inflammationinflammation of of the the surrounding surrounding tissue tissue (33 (33× ×18 18× × 22 mm). Lateral pterygoid muscle,muscle, temporaltemporal musclemuscle andand massetermasseter werewere involvedinvolved asas wellwell (Figure (Figure2 ).2). A A consultation consultation with with a a rheumatologistrheumatologist was was commissioned commissioned and and scintigraphy scintigraphy was was performed—it performed—it was was described described as as a degenerative-inflammatorya degenerative‐inflammatory lesion, lesion, confirming confirming the the primary primary diagnosis diagnosis as chronicas chronic arthritis. arthri‐ tis. The patient qualified for total temporomandibular joint replacement with an indi- vidual prosthesis. Before the surgery, CT with 3D reconstruction was performed to de- sign a prosthesis. The mandibular fossa was made of UHMW-PE and the condylar part of titanium. Under general anesthesia, alloplasty of the TMJ was performed (Figure3). Glenoid fossa, discus, condyle process as well as part of the mandible ramus and part of pterygoid muscle were resected. Postoperatively, the improvement of mandible movement was seen. The patient presented slight facial nerve paresthesia—intense rehabilitation (massage, kinesitherapy, Kinesio Taping) was administered. Appl. Sci. 2021, 11, x FOR PEER REVIEW 3 of 9 Appl. Sci. 2021, 11, 4373 3 of 8 Appl. Sci. 2021, 11, x FOR PEER REVIEW 3 of 9 Figure 2. Imaging examination presenting the lesion (MRI on the left and scintigraphy on the right). Chronic arthritis and inflammation of surrounding tissue (33 × 18 × 22 mm). Lateral pterygoid muscle, temporalis muscle and masseter were involved. The patient qualified for total temporomandibular joint replacement with an indi‐ vidual prosthesis. Before the surgery, CT with 3D reconstruction was performed to de‐ sign a prosthesis. The mandibular fossa was made of UHMW‐PE and the condylar part of titanium. Under general anesthesia, alloplasty of the TMJ was performed (Figure 3). Glenoid fossa, discus, condyle process as well as part of the mandible ramus and part of pterygoid Figure 2. ImagingImaging examination examination presenting presentingmuscle the thewere lesion lesion resected. (MRI (MRI on on thePostoperatively, the left left and and scintigraphy scintigraphy the improvement on onthe theright). right). Chronic of Chronic mandible arthritis arthritis movementand was andinflammation inflammation of surrounding of surrounding tissue tissueseen. (33 × (33 The18 ×× patient2218 mm).× 22 mm).presentedLateral Lateral pterygoid slight pterygoid muscle,facial muscle, nerve temporalis temporalisparesthesia—intense muscle muscle and masseter and masseterrehabilitation were (mas‐ involved. were involved. sage, kinesitherapy, Kinesio Taping) was administered. The patient qualified for total temporomandibular joint replacement with an indi‐ vidual prosthesis. Before the surgery, CT with 3D reconstruction was performed to de‐ sign a prosthesis. The mandibular fossa was made of UHMW‐PE and the condylar part of titanium. Under general anesthesia, alloplasty of the TMJ was performed (Figure 3). Glenoid fossa, discus, condyle process as well as part of the mandible ramus and part of pterygoid muscle were resected. Postoperatively, the improvement of mandible movement was seen. The patient presented slight facial