Traumatic myositis ossificans in the masseter muscle

Traumatic Myositis Ossificans of Temporalis Muscle: Systematic Review, Meta-Analysis and Case Reports

Introduction

Traumatic myositis ossificans is rare pathology affecting muscles/soft tissue. Its involvement in temporalis muscle is rarely reported in literature. The aetiopathogenesis is unknown, the diagnosis is based on clinco-radiological findings. Surgical management and follow-up are paramount.

Materials and Methods

A database search was done using Science Direct and PubMed search engines along with other published and unpublished literature. The final publications were tabulated using a custom made Performa. The available publications were subjected to appropriate statistical analysis. The data were recorded on excel spreadsheet (Microsoft Inc), and review was made using Review Manager (Rev Man) software for meta-analysis.

Results

A total of 21 articles were considered for systemic review and meta-analysis. Forest plotting for demographics included the gender predilection/age of involvement. The data segregation was done with "temporalis involved" group and "other than temporalis involved" group. The study was free of homogeneity ( τ 2 = 0.26 I 2 = 5%) for gender and age. The overall analysis revealed that Temporalis muscle although rare to be affected shows greater propensity for involvement. This is supported by a lesser degree of heterogeneity ( τ 2 = 0.000) with a I 2 value of (The test showed a higher degree of significance for overall effect of muscle involvement (Z = 2.33, p = 0.02) (< 25%). The test showed a higher degree of significance for overall effect of muscle involvement (Z = 2.33, p = 0.02) (< α = 0.05).Case reports.Two male cases with similar age predilection, reported after sustaining trauma. Both the cases presented with limited mouth opening and ultrasound was done for the first time to arrive at clinic-radiological diagnosis. The management was conservative with temporalis myotomy and coronidectomy.

Conclusion

Traumatic myositis ossificans presents as a rare disorder that poses a dilemma to the treating surgeon. The present article makes an attempt to critically analyse the pathology that is scantly reported in the literature.

Myositis Ossificans Traumatica of the Temporal Muscle: a Case Report and Literature Review Emphasizing Radiographic Features on Computed Tomography and Magnetic Resonance Imaging

Objectives

Heterotopic bone formation within a muscle is designated as ‘myositis ossificans’, and it is associated with multiple aetiologies, such as trauma, genetic predisposition, post-infection, or undetermined causes. When the disease develops as a result of a trauma, the myositis ossificans is classified as ‘myositis ossificans traumatica’. In this case report, a case of myositis ossificans traumatica is described, emphasizing its imaging features. Additionally, a literature review of the imaging features of myositis ossificans is discussed.

Material and Methods

A 60-year old male patient presented with restricted mouth opening and pain during mastication. Multislice computed tomography and magnetic resonance imaging examinations were conducted. Case reports in the literature of myositis ossificans were searched databases from August 1984 until April 2019 using the keyword ‘masticatory muscles’ combined with ‘myositis’; ‘inflammatory myositis’; infectious myositis’; ‘inflammatory muscle diseases’; ‘focal myositis’ and ‘proliferative myositis’. Data was summarised and evaluated according to a critical appraisal checklist for case reports.

Results

Multislice computed tomography demonstrated an ectopic hyperdense area arising from the coronoid bone and within the temporal muscle. Magnetic resonance imaging demonstrated the same area with a hypointense signal. In the literature review, 53 myositis ossificans cases were identified, and 12 cases affecting the temporal muscle were found.

Conclusions

The main imaging feature of myositis ossificans is the presence of a radiopaque, hyperdense or hypointense mass in the affected muscle, which is seen on multislice computed tomography and magnetic resonance imaging, respectively. The final diagnosis is through histopathological examination, although imaging can suggest the most likely diagnosis.

Myositis ossificans traumatica of the masticatory muscles: etiology, diagnosis and treatment

BACKGROUND

Myositis ossificans describes a heterotopic bone formation within a muscle. Thereby myositis ossificans is classified in two different groups: myositis ossificans progressiva (MOP) which describes a genetic autosomal dominant rare disease and myositis ossificans traumatica (MOT). The exact pathogenesis of MOT is unclear. The aim of this article was to analyse and interpret the existing literature reporting MOT of masticatory muscles and compare the results with our own clinical experience with MOT. Risk-factors, etiology, clinical features, diagnostic imaging, as well as different treatment options were evaluated and recommendations for the prevention, diagnosis, and therapy of MOT of the masticatory muscles were given.

METHODS

Following the PRISMA-Guidelines, a systematic search within the PubMed/Medline database with a view to record literature of MOT of the masticatory muscles was performed. Furthermore, the database of our own clinic was screened for cases of MOT.

RESULTS

In total, 63 cases of MOT of the masticatory muscles which were reported in English-based literature were included in this study. Overall, 25 female and 37 male patients could be analysed whereas one patient's gender was unknown. Complication of wisdom-tooth infection (n = 3) as well as the results of dental procedures like dental extraction (n = 7), mandibular nerve block (n = 4), periodontitis therapy (n = 1) were reported as MOT cases. From the 15 reported cases that appeared after dental treatment like extraction or local anesthesia the medial pterygoid (n = 10) was the most affected muscle. Hereof, females were more affected (n = 9) than males (n = 6). The most reported clinical symptom of MOT was trismus (n = 54), followed by swelling (n = 17) and pain (n = 13). One clinical case provided by the authors was detected.

CONCLUSIONS

Dental procedures, such as local anesthesia or extractions, may cause MOT of the masticatory musculature. Demographical analyses demonstrate that females have a higher risk of developing MOT with respect to dental treatment. The most important treatment option is surgical excision. Subsequent physical therapy can have beneficial effects. Nevertheless, a benefit of interpositional materials and drugs as therapy of MOT of the masticatory muscles has not yet been proven. Myositis ossificans progressiva has to be excluded.

Myositis Ossificans of the Temporalis Muscle

Traumatic myositis ossificans (TMO) is a rare ossifying disease that occurs in the muscle or soft tissues. A case of TMO isolated in the temporalis muscle is reported. In the case described, calcification in the temporalis muscle was confirmed after computed tomography. Surgery, physiotherapy, and histopathological analysis were performed. One year after treatment, further ossification was present but without interference in function. The most accepted treatment for TMO in the maxillofacial region is excision followed by physiotherapy. The high rate of non-recurrence may be concealed due to the short follow-up period. TMO is a lesion that may frequently recur and long-term follow-up must be provided.

A rare isolated unilateral myositis ossificans traumatica of the lateral pterygoid muscle: a case report

Introduction

Myositis ossificans traumatica is a pathological condition characterized by the extraskeletal formation of bony tissue, induced by violent or repeated trauma.

Case presentation

A 30-year-old Italian man, after surgical treatment for multiple facial fractures, presented with a progressive limitation of mouth opening. A computed tomography scan showed a significant calcification of the fibers of the left lateral pterygoid muscle. The working diagnosis was myositis ossificans traumatica of the left lateral pterygoid muscle. Surgical excision was suggested but not performed. Our patient underwent physiotherapy treatment resulting not in a complete restoration of mandibular movements but in an acceptable recovery of mouth opening.

Conclusions

Myositis ossificans is a rare complication that can be caused by muscle trauma. Therefore, special attention should be paid to surgical trauma. In the present case, surgical excision was considered, in accordance with the literature, and suggested to our patient, but he declined due to the absence of any pain or any significant limitation to his daily life activities. He therefore underwent physiotherapy treatment, in line with our unit’s guidelines, resulting not in a complete restoration of mandibular movements but in an acceptable recovery of mouth opening.

Pseudomalignant myositis ossificans involving multiple masticatory muscles: Imaging evaluation

Myositis ossificans is a rare cause of trismus. We present a case of pseudomalignant myositis ossificans involving medial pterygoid, lateral pterygoid, and temporalis muscles. Patient presented with gross limitation in mouth opening. There was no history of trauma. Computed tomography (CT) images revealed a bone density mass located in the region of medial and lateral pterygoid muscles on the right and temporalis muscle on the left. Magnetic resonance imaging (MRI) showed similar findings. Radiological diagnosis was pseudomalignant myositis ossificans. The masses were resected and histopathologic examination confirmed the above diagnosis. This report describes the characteristic CT and MRI features. The unique feature of this case is the absence of history of trauma with involvement of multiple masticatory muscles, which, to the best of our knowledge, has not been reported before.

Myositis ossificans traumatica of temporalis and medial pterygoid muscle

Myositis ossificans is a rare disease that is characterized by bone deposition in the muscle or soft tissues. Myositis ossificans of the masticatory muscles is an uncommon finding. The condition is benign and results in heterotopic bone formation in the muscles of mastication, usually producing limitation of opening of the jaws. It is important to know the exact cause of the limitation of opening of the jaws for successful treatment. Computed tomographic scan and panoramic radiographs along with histological findings are essential diagnostic aids for evaluating conditions such as myositis ossificans. A rare case of myositis ossificans traumatica of temporalis and medial pterygoid muscle is presented here along with the discussion of clinical, radiological and histological features. The present case emphasizes not only on the importance of considering myositis ossificans in the differential diagnosis of limitation of opening of the jaws but also on the improvement of the overall mouth opening and treatment results.

Myositis ossificans of the left medial pterygoid muscle: case report and review of the literature of myositis ossificans of masticatory muscles

Myositis ossificans is a disease that is characterized by nonneoplastic, heterotopic bone formation within a muscle. Myositis ossificans traumatica, also called myositis ossificans circumscripta, is a disease in which muscles are ossified presumably following acute trauma, burns, surgical manipulation, or repeated injury. It is often remitted after surgical excision though some patients have repeated recurrences. Myositis ossificans traumatica of masticatory muscles is not frequently reported in the literature, with the most common clinical finding being a progressive limitation of motion in the mandible. The aim of this article is to present and discuss a case of myositis ossificans traumatica of the left medial pterygoid muscle and to review the literature of myositis ossificans of the masticatory muscles.

Myositis ossificans of the medial pterygoid muscle

Myositis ossificans (MO) is a disease whose main feature is the formation of heterotopic bone involving muscle or any other soft tissue. Pathogenesis is not all clear, but trauma is universally recognized as a trigger event. Myositis ossificans can be divided into 2 classifications: MO progressiva and MO traumatica. The authors present a case of a 64-year-old man who was diagnosed with MOT of the left medial pterygoid muscle. The patient had a long clinical history of signs and symptoms of temporomandibular articulation related to previous conditions, and no major traumatic events were reported, apparently related to MOT.

Myositis ossificans traumatica of the medial pterygoid

Myositis ossificans traumatica (MOT) is a non-neoplastic, heterotopic bone formation within muscle or fascia, presumably due to acute trauma, a burn, surgical manipulation, or repeated injury. A 36-year-old woman presented with progressive limitation of mouth opening over the past 5 months. Computed tomography revealed an irregular ossified mass attached to the medial aspect of the left ramus, extending to the medial and lateral pterygoid plates. MOT of the medial pterygoid is rare, with only four previously reported cases in the English language literature. Surgical excision of the ossification is the main treatment modality. The authors were able to establish a cleavage plane of 3 cm between the bony mass and the medial surface of the ramus. Abdominal fat was placed as an interpositional material to prevent fibrosis and heterotopic bone formation.

Unusual causes of trismus: a report of two cases

Chronic inability to achieve normal mouth opening can be a symptom of several diseases. Mostly the causes of inability to open mouth are articular and sometimes the cause may be extra-articular. In the two cases which are being reported in this article the causes of limited mouth opening are extra-articular and that too from rare pathologies, of which one case is of OKC of the coronoid process and the other case is of myositis ossificans of the buccinator and medial pterygoid muscle. Both the cases had adequate mouth opening both intraoperatively and at long term follow up.

Bilateral myositis ossificans of the masseter muscle after chemoradiotherapy and critical illness neuropathy--report of a rare entity and review of literature

Myositis ossificans in the head and neck is a rare heterotropic bone formation within a muscle. Besides fibrodysplasia ossificans progressiva, traumatic and neurogenic forms are described in the literature.

We are presenting the case of a 35-year-old female patient with a very rare form of MO of both masseter muscles after 4 weeks of intensive care because of complications (critical illness neuropathy) after chemotherapy.

Therefore, special attention should be paid to surgical trauma. As in the present case, radiotherapy, long-time intubation with immobilization and critical myopathy and neuropathy can cause MO with severe problems, such as trismus and reduced mouth hygiene, which can lead to reduced quality of life.

Traumatic myositis ossificans (ossifying pseudotumor) of temporal muscle

The purpose of this paper is to present the clinical, radiographic, and histological aspects of a case of traumatic myositis ossificans of the temporal muscle. This is a rare, benign ossifying pseudotumor of skeletal muscles. It had developed 3 weeks after trauma to the left temple in a 33-year-old man. Differential diagnostic aspects of traumatic myositis ossificans confirming its benign character are discussed.

Myositis ossificans traumatica of the masseter muscle: review of the literature and report of two additional cases

Myositis ossificans traumatica of the masseter muscle is uncommon. The condition is benign and results in reactive heterotopic bone formation, usually producing limitation of opening of the jaws. Radiographic and microscopic examination can confirm the diagnosis. Treatment of myositis ossificans traumatica of the masseter muscle is surgical, with other modalities used when occurring in other muscles of the body.

The misdiagnosis of temporomandibular disorders in lateral pharyngeal space infections--two case reports

Two cases of lateral pharyngeal space infections which were initially misdiagnosed as temporomandibular disorders (TMD) are presented and discussed. Such symptomatology as chronic facial pain, trismus and decreased inter-incisal opening provide many viable different diagnoses. It is important for the clinician to evaluate these different diagnoses in a logical manner. Conservative therapy is advised in the initial treatment of many TMDs, therefore other diagnoses with a greater potential for morbidity should be ruled in or out before the diagnosis of TMD is considered. The symptomatology of lateral space infections and the relevance of this entity to clinical dentistry are discussed.

Facial trismus and myofascial pain associated with infections and malignant disease. Report of five cases

Five cases of facial pain and limited jaw opening, which include two infections, two primary carcinomas, and one metastatic carcinoma, each imitating TMJ dysfunction, are presented. These cases emphasize the importance of (1) a thorough working knowledge of the differential diagnosis of facial pain and limited jaw opening; (2) a complete evaluation, including a review of an adequate medical history as well as a full head and neck examination; and (3) the ability to make use of diagnostic radiographs, including computerized tomography.