Myositis ossificans progressiva: five generations where the disease was exclusively limited to the maxillofacial region. A case report

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A database search was done using Science Direct and PubMed search engines along with other published and unpublished literature.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.

Temporomandibular joint ankylosis-"Knowing when not to operate": Case report and qualitative systematic review of literature

Temporomandibular joint ankyloses (TMJA) may manifest in patients with several predisposing systemic conditions. A case of extraarticular TMJA is presented in a patient diagnosed with fibrodysplasia ossificans progressive (FOP) is presented. The features, diagnosis, and management of TMJA superimposed on this condition are presented through a qualitative systematic review of literature.

Myositis ossificans of the masticatory muscle monitored over three generations: A case report and review of the literature

Myositis ossificans (MO) is a rare disease and its major feature is the formation of heterotropic bone involving muscle or any other type of soft tissue (tendons, ligament, fascia and connective tissue). In the present study, a case report of a patient diagnosed with MO is presented. The diagnosis was established by evaluation of the medical history of the patient and the patient's family, as well as clinical data, radiology and post-operative pathology. The patient underwent excision surgery of the calcified lesion. In addition, genomic DNA was examined from blood samples of the patient and the patient's father with their consent. A mutation in the non-coding region was detected but any direct causative effect remains elusive. The present case report provided significant information with regard to the incidence of MO in four members of the same family assessed over three generations. The disease exhibited a unique localization in the maxillofacial region.

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.

Craniofacial findings in fibrodysplasia ossificans progressiva: computerized tomography evaluation

OBJECTIVE

The aim of this study was the evaluation by using computerized tomography (CT) of craniofacial abnormalities in fibrodysplasia ossificans progressiva (FOP) patients regarding jaw restriction and retrognathia.

STUDY DESIGN

Seven FOP patients were evaluated retrospectively in this observational study. Inclusion criteria were detection of ACVR1 gene mutation and complete craniofacial CT examination. The age of jaw restriction and presence of retrognathia were clinically determined. The features analyzed were skull base structures and heterotopic ossification (HO).

RESULTS

Of this group (age range 4-23 years), the 3 oldest patients presented with jaw restriction and retrognathia as well as displayed elongation of the lateral pterygoid plate with HO of the pterygoid muscles that reached the medial surface of the right mandibular ramus. They had significant history of trauma or surgery. The other 4 patients did not have retrognathia or HO involving the facial or masticatory muscles, and the mouth opening was normal.

CONCLUSIONS

CT evaluation can reveal HO of the pterygoid muscles that probably may cause jaw restriction and retrognathia in older FOP patients.

Fibrodysplasia ossificans progressiva. An unusual cause of restricted mandibular movement

A 9-year-old girl is presented who was initially misdiagnosed and finally diagnosed with fibrodysplasia ossificans progressiva only after presentation with progressive limitation of her mouth opening. The clinical, histopathological, and molecular biological aspects of this uncommon disorder will be discussed. Furthermore, dental and surgical guidelines will be described.

The spine in fibrodysplasia ossificans progressiva: a case report

STUDY DESIGN

A case report of fibrodysplasia ossificans progressiva (FOP).

OBJECTIVES

To report a very rare cause of back pain.

SUMMARY OF BACKGROUND DATA

FOP is an autosomal dominant disorder with overexpression of bone morphogenetic protein 4 and negative HLA B27. Pathognomonic are congenital malformations of the big toes.

METHODS

The authors report on a patient with FOP who presented with back pain at their outpatient clinic.

RESULTS

On physical examination, several indurated masses were visible and palpable close to the left and right scapula and the thoracic spine. These were not tender or painful, nor warmed or inflamed. A significantly decreased range of motion of all levels of the spine and the shoulder were found. On the radiographs, segmentation defects of the cervical and lumbar spine as well as synostoses of the spinal processes were seen. The cervical vertebral bodies were small and unusually high. Heterotopic ossifications could be discerned in the lumbar postural muscles and the facet joints of the spine were ankylosed. Additionally to these findings, on the thoracic radiographs ossifications of the muscles of the shoulder girdle could be seen. The pathognomonic shortening of the first metatarsal bone and the proximal phalanx was bilaterally present. The surface shaded 3D-reconstruction of the computed tomography of the trunk showed multiple bulky and confluating ossifications of the shoulder girdle. The spinal processes of the thoracic spine were anklyosed by massive ossifications of the postural muscles.

CONCLUSIONS

In FOP, diagnosis can be made by the typical clinical and radiological features.