Myositis Ossificians Traumatica of the Left Pterygoid Muscles

Case Report

Austin J Otolaryngol. 2017; 4(2): 1096.

Myositis Ossificians Traumatica of the Left Pterygoid Muscles

Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, USA

Natoya Reid, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, District of Columbia, USA

*Corresponding author: Natoya Reid, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, District of Columbia, USA

Received: November 28, 2017; Accepted: December 20, 2017; Published: December 29, 2017

Abstract

Myositis Ossificans (MO) is a rare benign ossifying lesion that is self-limiting. It affects the soft tissue and may develop in the muscle, fat, nerves or tendons. Myositis ossificans can be categorized into nonhereditary and hereditary types which are distinct entities. There are very few reports of Myositis Ossificans in the masticatory muscles. The treatment is usually complex and the relapse and recurrence rates are high. This case study discusses the successful management of a patient who developed Myositis Ossificans after a gunshot wound injury. The patient had relapse after initial surgical intervention however, he has remained disease free after the second surgical intervention and implementation of aggressive and early physiotherapy. We review the diagnosis, clinical manifestations, possible causes and recommendations for prevention as described in the literature.

Case Presentation

A 37-year-old male patient with no significant past medical history underwent closed reduction with Intermaxillary fixation after sustaining a gunshot wound to the face in 2002. Two years later he had developed chronic trismus. He had undergone a left coronoidectomy to improve mouth opening at another facility. The procedure did not result in improvement of his trismus. After reviewing the patient history, physical exam, laboratory and radiographic studies, it was concluded that the patient suffered from Myositis Ossificans Traumatica involving the left Pterygoid muscles as a result of a gunshot wound suffered in 2002. On presentation, his Maximal Incisal Opening (MIO) was 15mm. Subsequently, the patient was taken to the operating room and an osteotomy of the lesion through a transoral approach and a brisement procedure were performed to mobilize the mandible. The range of motion improved immediately after the surgery, the patient had an MIO of 30mm.

Shortly after the procedure, the patient was incarcerated and was lost to follow up. Physiotherapy could not be successfully executed. The patient later returned to our clinic after his release from the correctional facility in 2012. On presentation his MIO was 5mm. At that time, he was unable to perform protrusive or excursive movements. Computerized tomography (CT) scanning revealed an ossification in the left medial and lateral pterygoid muscles (Figure 1). Three-dimensional CT showed the position and shape of the ossification and the dimension of fusion of the pterygoid muscles to the pterygoid plates (Figure 2).