Infraorbital myxofibrosarcoma: Imaging features and surgical management of a rare facial case

Abstract

Myxofibrosarcoma is a rare malignant soft tissue sarcoma, typically arising in the extremities of elderly patients and exceptionally involving the head and neck region. Infraorbital localization is particularly uncommon and poses a diagnostic challenge due to the complex anatomy of the midface and the broad differential diagnosis in this region. We report the case of a 50-year-old man with a progressively enlarging, painless left infraorbital mass over 3 months. Contrast-enhanced maxillofacial computed tomography revealed a heterogeneous soft-tissue lesion with peripheral enhancement, central necrosis, subtle infiltration of adjacent fat planes, and smooth scalloping of the anterior maxillary sinus wall without cortical destruction. These findings raised suspicion of malignancy despite the relatively well-circumscribed appearance of the lesion. The patient underwent complete surgical excision with negative margins and reconstruction using a Mustardé cheek rotation flap. Histopathology confirmed a high-grade myxofibrosarcoma. Postoperative adjuvant radiotherapy was administered. At 6-month follow-up, no recurrence was observed. This case highlights an important radiological teaching point: smooth bone scalloping without cortical destruction does not exclude malignancy. Subtle imaging features such as necrosis, heterogeneous enhancement, and infiltration of adjacent fat planes may represent critical clues to aggressive behavior and should prompt careful evaluation.