Misdiagnosed fibrosarcoma of the mandible mimicking temporomandibular disorder: a rare condition Kaan Orhan, DDS, PhD, a Ays ¸e Isil Orhan, DDS, b Ulas ¸ Oz, DDS, c Filiz Namdar Pekiner, DDS, PhD, d and Cagri Delilbasi, DDS, PhD, e Ankara, Turkey and Istanbul, Turkey UNIVERSITY OF ANKARA, UNIVERSITY OF MARMARA, AND UNIVERSITY OF YEDITEPE The jawbones can be sites of various neoplastic conditions. Given the variety of processes affecting this particular anatomical area, formulation of a precise diagnosis can be challenging to clinicians. Limited jaw movement, pain, and facial asymmetry are common signs among patients, especially those with temporomandibular disorder (TMD). This paper reports a case of primary fibrosarcoma affecting the mandible and surrounding structures in a 14- year-old girl presenting signs and symptoms similar to TMD. Her condition was misdiagnosed, and she was treated for TMD over an extended period before the correct diagnosis was made for fibrosarcoma. The patient underwent surgical resection with postsurgical radiotherapy and chemotherapy and now is being followed up. Although malignant lesions are rare in the temporomandibular joint (TMJ) region, dentists are advised to be aware of the condition and to keep in mind that patients who are admitting for TMD can also possibly be affected from neoplasms. Hence, those patients have to be examined meticulously to avoid misdiagnosis and mistreatment. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e26-e29) Soft tissue sarcomas are rare in the oral and maxillo- facial region and account for less than 1% of the can- cers. At one time, fibrosarcoma was the most common soft tissue sarcoma. With the introduction of electron microscopy and immunohistochemistry, it became ev- ident that many previously diagnosed fibrosarcomas were other spindle cell malignant lesions. Today, fibro- sarcoma is defined as a malignant spindle cell tumor showing a herringbone or interlacing fascicular pattern without expression of other connective tissue cell mark- ers. 1-3 Clinically, soft tissue sarcomas are difficult to diagnose. They may grow to a considerable size before causing symptoms, and these symptoms in the head and neck region may be masked by a concurrent temporo- mandibular disorder (TMD). Therefore, they may be overlooked for a considerable amount of time. Symp- toms of neoplasms located in this anatomic region may mimic TMD. This manuscript describes a case of fibrosarcoma of the mandible misdiagnosed as TMD. CASE REPORT A 14-year-old girl was referred to Ankara University, Faculty of Dentistry, Department of Oral Diagnosis and Ra- diology. One year previously, she had a complaint of diffi- culty in opening her mouth and malocclusion (due to primary contacts), especially on the right-side teeth. She also had pain that appeared in the right preauricular region. After her symptoms had started, the patient was referred to a pediatric dentist and an orthodontist in a private clinic, who diagnosed the problem as TMD. Firstly, she was prescribed a myorelaxant and analgesic combination. She used prescribed medications, which did not change the symptoms. Again she appeared to the same clinic, and her doctor performed nu- merous occlusal adjustments and changed her filling in the mandibular left first molar. There was no improvement of symptoms after occlusal adjustments. She had significantly more difficulty in opening her mouth and an increase in pain intensity. The pain referred to the ear, eyes, forehead, and to the temple on the right side. Finally, after an unsuccessful treatment for some months, a bite splint (2 mm) was applied due to suspicion of disk displacement. After 1 year, the patient consulted at Ankara University, Faculty of Dentistry, Department of Oral Diagnosis and Ra- diology. The patient’s medical history was noncontributory. There was pain and crepitus on the right temporomandibular joint (TMJ) on palpation. However, paresthesia was not evi- denced and sensory-neural examinations were normal. On intraoral examination, the right lateral pterygoid muscle was painful on palpation, and we detected lymphadenopathy in the a Associate Professor, Department of Oral Diagnosis and Radiology, Faculty of Dentistry, University of Ankara. b Graduate Student, Department of Pediatric Dentistry, Faculty of Dentistry, University of Ankara. c Graduate Student, Department of Orthodontics, Faculty of Dentistry, University of Ankara. d Assistant Professor, Department of Oral Diagnosis and Radiology, Faculty of Dentistry, University of Marmara. e Associate Professor, Department of Oral and Maxillofacial and Surgery, Faculty of Dentistry, University of Yeditepe. Received for publication Dec 25, 2006; returned for revision Feb 12, 2007; accepted for publication Apr 25, 2007. 1079-2104/$ - see front matter © 2007 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2007.04.033 e26