Myositis Ossificans of the Temporalis Muscle: Case Report and Review of the Literature
Myositis Ossificans of the Temporalis Muscle: Case Report and Review of the Literature
STATEMENT OF PROBLEM:
This case report reviews a unique presentation of myositis ossificans (MO), a rare, reactive bone-forming lesion within a muscle produced secondary to a traumatic insult or inflammatory process. This particularly interesting case involves the temporalis muscle, a key muscle of mastication. Literature review covers MO etiology, classifications, differential diagnosis, radiographic and histological findings, and treatment options.
MATERIALS & METHODS:
Review of the case includes: physical examination of the patient at initial point of consultation and postoperative visits. Also, the orthopantomogram, computed tomography, complete blood counts and basic metabolic panels, as well as esophagogastroduodenoscopy performed by the General Surgery service are discussed. Literature review included cases of MO involving the head and neck.
RESULTS:
Cases of MO involving the head and neck in the literature are rare with the majority of cases involving the masseter or sternocleidomastoid muscle. There are approximately 52 cases of MO involving the head and neck muscles in the English literature. Of these, less than 30 cases involved the muscles of mastication. Furthermore, only 5 of these reported cases involved the temporalis muscle.
Of significance in this case, the patient had a noteworthy history of severe, long-standing systemic lupus erythematous (SLE). While calcinosis cutis, a subcutaneous calcification, is common in rheumatic disease processes like dermatomyositis and diffuse scleroderma, it is rarely reported in association with SLE. Currently, there are approximately 36 cases reported in the literature of this association and no known case of involvement of the soft tissues of the head and neck.
CONCLUSIONS:
The results of the treatment rendered in this case were successful in the immediate 8-month postoperative period. This case was not only rewarding to the practitioners involved, the surgery allowed this patient whom presented malnourished and cachectic, to thrive and significantly increased her quality of life. The maximum incisal opening increased from 2mm pre-operatively to 51mm status-post the Brisement procedure and mandibular coronoidectomy. The patient began taking oral feeds without difficulty, gained weight, and was able to speak without difficulty. While these results are promising, numerous reports have shown evidence that incomplete removal of the lesion leads to a high level of recurrence of the lesion and/or limitation of mandibular motion. Therefore, it is essential that clinicians follow these patients on regular intervals to monitor for signs of inflammation, decreased range of motion, or radiographic evidence of recurrent calcified mass formation.
REFERENCES:
1. Conner G, Duffy M. Myositis Ossificans: A Case Report of Multiple Recurrences Following Third Molar Extractions and Review of the Literature. 67, 2009, Journal of Oral Maxillofacial Surgery, pp. 920-926.
2. Ramieri V, Bianca C,Arangio P,Cascone P. Myositis Ossificans of the Medial Pterygoid Muscle. 4, July 2010, Journal of Craniofacial Surgery, Vol. 21, pp. 1202-1204.