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Case: A 62-year-old woman receiving romosozumab for 3 months underwent extreme lateral interbody fusion (XLIF) for lumbar degenerative spondylolisthesis. From 1 week after surgery, she experienced gradually increasing pain from the right groin to the front of the thigh. Examination revealed ossifying myositis in bilateral psoas major muscles. Etidronate treatment was initiated, improving pain after 4 days. Computed tomography showed lesion disappearance by 3 months after surgery., Conclusion: We report a rare case of myositis ossificans in bilateral psoas major muscles following XLIF surgery, possibly influenced by intraoperative manipulation and romosozumab treatment. Etidronate administration may be effective, as with heterotopic ossification., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C372)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Fibrodysplasia ossificans progressiva (FOP) as a rare and heritable disorder with the infrequent genetic transmission of the condition is a catastrophic disorder of heterotopic ossification (HO) and a cause of extraskeletal bone formation in humans. Given the lack of effective treatment for this disease, the important point is to avoid aggravating factors such as bone biopsy, surgery, and intramuscular injection., Case Presentation: In this report, we present a 52-year-old female patient, Kurdish ethnic, suspected to FOP who had a surgical intervention on the second toe of the right foot, which subsequently, it caused further deterioration of the disease in the person including necrosis and amputation of the distal phalanx of the second toe., Conclusions: Although, based on our investigation and the available scientific evidence, surgery may a cause for faster progression and worsening of the FOP disorder, but its proof requires further studies., (© 2023. The Author(s).)

Myositis ossificans of the temporalis muscle results in a cosmetic problem both before and after treatment because of the preoperative swelling and the postoperative defect respectively. The authors hypothesized that a patient-specific Polyether-ether ketone implant can be appropriate for immediate obliteration and reconstruction of such defect benefiting from the accuracy of CAD/CAM technology and computer-guided maxillofacial surgery. A Forty-year-old male patient with myositis ossificans affecting the left temporalis muscle was treated with a computer-guided surgical approach, a patient-specific implant was fabricated to obliterate the defect and avoid temporal hollowing using PEEK material. The functional and cosmetic results were satisfactory both immediately and at the 5-year follow-up, except that the skin over the implant was noticed to be stretched after 5 years. Hence, it can be concluded that virtual surgical planning and PEEK patient-specific implants are reliable in the immediate reconstruction of post-surgical temporal hollowing., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Myositis ossificans Traumatica (MOT) is a non-neoplastic, heterotrophic ossifying disease process in muscle and soft tissue rarely involving the craniofacial area. Treatment depends on the extent of ossification and functional limitations. We present the first case of MOT of the temporalis muscle following neurosurgical intervention. This is the case of a 28-year-old male patient who underwent numerous neurosurgical interventions and reported progressive trismus following these interventions. Imaging demonstrated a right temporal region radio-opacity consistent with ossification of the temporalis muscle. The patient underwent coronoidectomy with excision of the ossified right temporalis muscle and reconstruction with an anterolateral thigh adipofascial vascular free flap. Postoperatively, he maintained intact function with increased incisal opening and no cosmetic defects. Limited mouth opening after the neurological procedure has a wide differential, and MOT must be considered. Surgical repair and reconstruction are multifaceted problems. Free flap reconstruction should be considered in multiple operated patients., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Rationale: Myositis ossificans circumscripta (MOC) is a rare disorder that causes heterotopic bone formation in soft tissues. It usually occurs after trauma and affects large muscles of the extremities. MOC of the pectineus muscle is extremely rare and has not been reported to be treated surgically., Patient Concerns: A 52-year-old woman presented with left hip pain and dysfunction 4 months after a traffic accident that caused pelvic and humeral fractures and cerebral hemorrhage., Diagnoses: Radiological imaging revealed isolated ossification of the left pectineus muscle. The patient was diagnosed with MOC., Interventions: The patient underwent surgical resection of the ossified pectineus muscle followed by local radiation and medical therapy., Outcomes: At 12 months postoperatively, she was asymptomatic and had normal hip function. No recurrence was observed on radiography., Lessons: MOC of the pectineus muscle is a rare condition that can cause severe hip dysfunction. Surgical resection combined with radiation and anti-inflammatory drugs can be an effective treatment option for patients who do not respond to conservative management., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Ankylosis forming between the zygomatic arch and the coronoid process is a rarely encountered pathological extracapsular ankylosis. Its treatment protocol consists of surgical removal of the coronoid process with the ankylotic mass and jaw opening-closing exercises after surgery. Myositis ossificans (MO) is a self-limiting, benign ossifying lesion. It affects all types of soft tissues including subcutaneous adipose tissue, muscles, tendons and nerves. It is most frequently found in the muscle as a solitary lesion. The clinical appearance of MO is generally in the form of a mass characterized with an ossified soft tissue. When it develops alone, cross-sectional imaging might not be specific, and it may appear similar to worse etiologies. It is suggested multiple imaging modalities should be used in the assessment of a suspicious soft tissue mass. MO is a benign self-limiting disease. In this case report, in the radiographic examination of a 41-year-old female patient, ankylosis between the left coronoid process and the zygomatic bone accompanied by possible MO in the left medial pterygoid muscle was observed. Resection of the coronoid process with the ipsilateral route, resection of the ankylotic mass with the hemicoronal approach and resection of the contralateral coronoid process with the intraoral approach were performed, but the ossified formation in the medial pterygoid muscle was not touched., (© 2021. The Author(s), under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd.)

BACKGROUND Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder of the connective tissue. Over time, patients with FOP experience decreased range of motion in the joints and the formation of a second skeleton, limiting mobility. Patients with FOP are advised to avoid any unwarranted surgery owing to the risk of a heterotopic ossification flare-up. For patients who do require a surgical procedure, a multidisciplinary team is recommended for comprehensive management of the patient's needs. CASE REPORT A 27-year-old woman with FOP underwent a hysterectomy for removal of a suspected necrotic uterine fibroid. To aid in presurgical planning and management, patient-specific 3-dimensional (3D) models of the patient's tracheobronchial tree, thorax, and lumbosacral spine were printed from the patient's preoperative computed tomography (CT) imaging. The patient required awake nasal fiberoptic intubation for general anesthesia and transversus abdominus plane block for regional anesthesia. Other anesthesia modalities, including spinal epidural, were ruled out after visualizing the patient's anatomy using the 3D model. Postoperatively, the patient was started on a multi-modal analgesic regimen and a course of steroids, and early ambulation was encouraged. CONCLUSIONS Patients with FOP are high-risk surgical patients requiring the care of multiple specialties. Advanced visualization methods, including 3D printing, can be used to better understand their anatomy and locations of heterotopic bone ossification that can affect patient positioning. Our patient successfully underwent supracervical hysterectomy and bilateral salpingectomy with no signs of fever or sepsis at follow-up.

Fibrodysplasia ossificans progressiva (FOP) is one of the genetic and developmental forms of heterotopic ossification. We report a case of FOP on the volar surface of the distal radius, located close to the median nerve and radial artery with neurologic symptoms secondary to median nerve entrapment. The patient underwent surgical excision of the heterotopic lesion followed by radiation therapy. He had no signs of recurrence with more than 1 year of follow-up. Careful microsurgical dissection of the heterotopic mass must be performed to prevent the formation of new painful lesions and iatrogenic neurovascular injury. In this syndrome, the possibility of nerve entrapment due to the heterotopic lesion should be considered as the cause of neuropathic pain. Early genetic testing for confirmation of the suspected diagnosis can avoid having to do an unnecessary biopsy., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Myositis ossificans (MO) can compress peripheral nerves and cause neuropathy. We herein describe a patient with ulnar neuropathy caused by MO at the medial elbow. A 28-year-old man with a drowsy mentality and multiple organ damage following a traffic accident was admitted to our hospital. After 3 weeks of postoperative care, the patient's mental status recovered. However, he complained of severe sharp pain in his left medial forearm and fourth and fifth fingers. He exhibited weak fifth finger abduction and wrist adduction. Severe elbow joint pain was elicited during range-of-motion testing of his left elbow. Ultrasound also showed an edematous, enlarged, hypoechoic ulnar nerve lying above the MO, and the MO outwardly displaced the ulnar nerve. Elbow radiographic examination, computed tomography, and magnetic resonance imaging revealed MO development and compression of the left ulnar nerve. The patient underwent surgery; the following day, his left medial forearm pain completely disappeared with slight improvement in the motor weakness of fifth finger abduction. Ultrasound is a useful tool to easily evaluate the presence of MO and compression of peripheral nerves caused by MO.

Abstract: The authors report a case of myositis ossificans traumatica of the masseter muscles. A 21-year-old man developed masseter myositis after orthognathic surgery to treat facial asymmetry. The myositis may have been triggered by factors such as calcification of a hematoma, periosteum implantation after surgical trauma, and local soft tissue injury. An intraoral incision was made to excise the ectopic bone, resulting in resolution of the patient's symptoms including limited oral opening., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 by Mutaz B. Habal, MD.)

Rationale: Myositis ossificans (MO) is a benign condition characterized by heterotopic bone formation in the skeletal muscle of extremities. Marked variation can occur in the incidence and location of the bone formed as well as resulting complications. Femoral vessel obstruction caused by MO is an extremely rare but disabling complication. Arterial occlusion may aggravate ischemic conditions, resulting in necrosis in the lower extremity., Patient Concerns: We report a 41-year-old female with progressive pain and swelling of the right thigh region for 1 year., Diagnoses: We diagnosed it as obstruction of the superficial femoral artery and vein caused by external compression of the MO between the sartorius and vastus medialis of the thigh., Interventions and Outcomes: Adherent tissues and mass were excised with care without damaging the femoral artery or the vein. However, normal morphology did not recover due to loss of elasticity of femoral vessels. Therefore, after resection of the narrowed region of the femoral artery, a femoral-to-femoral graft interposition using the greater saphenous vein was performed. At 12 months after the surgery, vessel reconstruction computed tomography images confirmed normal continuous flow of the femoral artery., Lessons: Vascular compression and peripheral inflammatory response due to MO can cause loss of normal vascular morphology. Surgical excision of the mass and the involved femoral artery segment followed by femoral arterial reconstruction should be considered for lesions that do not spontaneously regress to prevent functional impairment and secondary complications in extremities.

Fibrodysplasia ossificans progressiva (FOP) is a rare disease in which heterotopic ossification (HO) is formed in muscles, tendons and ligaments. Traumatic events, including surgery, are discouraged as this is known to trigger a flare-up with risk of subsequent HO. Anesthetic management for patients with FOP is challenging. Cervical spine fusion, ankylosis of the temporomandibular joints, thoracic insufficiency syndrome, restrictive chest wall disease, and sensitivity to oral trauma complicate airway management and anesthesia and pose life-threatening risks. We report a patient with FOP suffering from life-threatening antibiotic resistant bacterial infected ulcers of the right lower leg and foot. The anesthetic, surgical and postoperative challenges and considerations are discussed. In addition, the literature on limb surgeries of FOP patients is systemically reviewed. The 44 year-old female patient was scheduled for a through-knee amputation. Airway and pulmonary evaluation elicited severe abnormalities, rendering standard general anesthesia a rather complication-prone approach in this patient. Thus, regional anesthesia, supplemented with intravenous analgosedation and N 2 O-inhalation were performed in this case. The surgery itself was securely planned to avoid any unnecessary tissue damage. Postoperatively the patient was closely monitored for FOP activity by ultrasound and [ 18 F]PET/CT-scan. One year after surgery, a non-significant amount of HO had formed at the operated site. The systematic review revealed seventeen articles in which thirty-two limb surgeries in FOP patients were described. HO reoccurrence was described in 90% of the cases. Clinical improvement due to improved mobility of the operated joint was noted in 16% of the cases. It should be noted, though, that follow-up time was limited and no or inadequate imaging modalities were used to follow-up in the majority of these cases. To conclude, if medically urgent, limb surgery in FOP is possible even when general anesthesia is not preferred. The procedure should be well-planned, alternative techniques or procedures should be tested prior to surgery and special attention should be paid to the correct positioning of the patient. According to the literature recurrent HO should be expected after surgery of a limb, even though it was limited in the case described., (Copyright © 2020 Botman, Treurniet, Lubbers, Schwarte, Schober, Sabelis, Peters, van Schie, de Vries, Grunwald, Smilde, Nieuwenhuijzen, Visser, Micha, Bravenboer, Coen Netelenbos, Teunissen, de Graaf, Raijmakers, Smit and Eekhoff.)

Background: Myositis ossificans (MO) is a heterotopic bone formation in soft tissues, usually caused by traumas or neuropathies. Although the aetiology remains unclear, MO is supposed to be an osteoblast metaplasia with a benign and self-limiting course. Remarkably, at onset MO can be clinically, radiologically and histologically indistinguishable to soft tissue malignancies, especially in cases lacking a history of trauma, leading to misdiagnoses and improper treatments., Case Presentation: A 13-year-old male was referred to the Oncology Department because of a previous diagnosis of osteogenic sarcoma of his left thigh. The diagnosis was made upon a history of isolated thigh pain in the absence of traumas, the evidence of a contrast-enhanced soft tissue mass on magnetic resonance imaging and the histological findings of atypical nuclei and mitotic figures. The lesion was eventually radiologically unchanged after five cycles of chemotherapy; thus, the child was referred for radical surgery. At admission, endorsing the child well-appearance, together with the evidence of a reduced calcified lesion on a further magnetic resonance, a clinical suspicion of myositis ossificans was raised. Hence, the excisional biopsy confirmed the pathognomonic zonal pattern of myositis ossificans., Conclusions: This case highlights some frequent diagnostic pitfalls facing myositis ossificans. A lacking history of traumas, along with a too early radiological and histological evaluation can lead to a misdiagnosis of soft tissue malignancies. Even in the absence of a clear history of trauma, a painful soft tissue swelling with a benign clinical course should raise the suspicion of myositis ossificans.

A football player was diagnosed with myositis ossificans of his right adductor longus muscle after an acute injury. Conservative treatment failed and 1 year after the initial trauma the patient underwent surgical excision of a large ossification. Seven months postoperatively, the patient was fully recovered and returned to his preinjury activity levels. We present our approach to this case and discuss our considerations, referring to background information about this rare disease., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: Myositis ossificans is a benign process of heterotopic bone formation developing in soft tissues that can mimic malignancy. Differential diagnosis can be difficult without a biopsy when it originates in atypical locations., Case Description: A 5½-year-old boy was admitted for a cervical tumor causing torticollis. The nodular tumor developed at the lateral border of the right C3-4 foramen, had calcification/ossification at its periphery, and was accompanied by a huge edematous reaction of the scalene muscles. The patient underwent an extensive work-up by pediatric oncologists. A biopsy was requested because of high suspicion of malignancy. At surgery, the lesion was benign on frozen sections and was completely resected, allowing the diagnosis of myositis ossificans. The patient made a rapid and complete recovery., Conclusions: Myositis ossificans circumscripta is rare in children, especially in the neck region. The diagnostic challenge is to differentiate it from bone and soft tissue malignancies. Appropriate management, including surgery if needed, leads to an excellent outcome. Another concern is to exclude fibrodysplasia ossificans progressiva when atraumatic myositis ossificans develops in a young child in the neck or shoulder region., (Copyright © 2019. Published by Elsevier Inc.)

Overuse myositis ossificans is considered an extremely rare diagnosis, with only a few cases reported so far. A case of a 54-year-old firefighter, involved regularly in training exercises, with bilateral myositis ossificans of the triceps, is presented. The patient had a 4 year history of painful masses at the posterior region of both arms. He never experienced any traumatic event, while physical examination revealed firm masses extending longitudinally within the lateral head of the triceps, bilaterally. The patient had painful restricted range of motion at both sides. Plain X-ray views of the humerus showed linear lobulated heterogeneous masses posterolateral. Surgical resection of both masses, which extended intramuscularly through the whole lateral triceps' head, was performed. Histological examination confirmed the diagnosis of myositis ossificans. Myositis ossificans represents a benign, relative rare clinical entity, defined as heterotopic ossification of the soft tissues. Only 5 cases of myositis ossificans due to overuse have been described so far. The present case is unique, since it is the first one describing bilateral appearance of two masses which extended through the whole length of the lateral head of the triceps. A detailed medical history, as well as imaging examination seem to be necessary in order to establish the diagnosis. Treatment should be decided upon the stage of the lesion. For mature lesions surgical treatment is advised.

Fibrodysplasia ossificans progressiva (FOP) is a rare disorder that causes heterotopic bone formation leading to chest wall and spinal deformities. This case describes an 11-year-old female with FOP who presented in respiratory failure necessitating two emergent fiberoptic nasotracheal intubations. The patient had severe trismus, rotary flexion of the neck, and distortion of the airway. A three-dimensional printed model based off of a computed tomography reconstruction was created for an in situ simulation before the true procedure. The surgery and trach change were both uneventful. We propose that with careful preoperative planning, tracheotomy can be an appropriate option for FOP patients. Laryngoscope, 129:812-817, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: A 5-year-old pediatric patient developed scoliosis associated with nontraumatic myositis ossificans in the lumbar region. Although there have been reports in literature of syndromes leading to widespread muscle ossifications resulting in shoulder deformities owing to impaired movement in the facet joints, to the best of our knowledge there has been no report of scoliosis associated with myositis ossificans., Case Description: The case presented is of a 5-year-old girl who developed scoliosis associated with nontraumatic myositis ossificans in the lumbar region. On the thoracolumbar radiograph, a hyperintense lesion was seen at the right-side L2-L3 level and scoliosis with a Cobb angle of 16.2° to the right side. The decision for surgery was made with the consideration of the existing scoliosis and that the complaints were associated with paravertebral calcified lesions adjacent to the facet joints. After surgery, the scoliosis improved., Conclusions: Nontraumatic, paravertebral myositis ossificans at an early age is a very rare pathology. Therefore, it must be recognized that spine deformities such as scoliosis and kyphosis can develop in neglected cases of paravertebral myositis ossificans. In addition, there is a high risk of confusion with malignant pathologies, such as osteosarcoma, in this area. Removal of the mass eliminates both the pain of myositis ossificans and prevents the development of scoliosis., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Paraspinal tumors with benign histology in the absence of trauma rarely arise in children. Treatment of such benign tumors, in contrast to malignancies, generally consists of surgical resection of the lesion with confirmation of histology via pathologic evaluation. We present a pediatric case of an atraumatic paraspinal mass with a histologic diagnosis of aneurysmal bone cyst, and USP6 gene rearrangement supporting the histologic diagnosis. The patient underwent gross total resection of the paraspinal lesion with no additional intervention. We highlight the differential diagnosis of paraspinal tumors in children and key features that led to the diagnosis in this patient.

Myositis ossificans circumscripta (MOC) is a rare benign condition characterized by heterotopic ossification occurring in the soft tissues. We report the case of a 15-year old patient complaining of mixed hip pain. No trauma has been reported during the interview. The joint had inflammation appearance and a non-mobilizing swelling adhered to the deeper structure with parietal projection over the groin fold. Radiographs of the hip showed a thickening of the soft tissues of the hip and some periarticular calcifications with unclear appearance. Excisional biopsy of the calcifications was decided and performed. Diagnosis was confirmed by histological examination of the surgical specimen. At six months follow-up the patient was very satisfied with his functional results. Returning to school sports was authorized. The patient had successful outcome.

Purpose: The purpose of this study was to report characteristics and outcomes of surgical excision of symptomatic mature posttraumatic myositis ossificans in adult athletes. The hypothesis was that surgical excision of the ossified mass in these circumstances can effectively relief symptoms and result in return to high-level sports with minimal postoperative complications., Methods: All operations involving excision of posttraumatic heterotopic ossifications performed between 1987 and 2015 were reviewed. Included cases had isolated excision of posttraumatic myositis ossificans, whereas excluded cases had: (1) concomitant reattachment of tendon to bone; (2) chronic overuse injuries which preceded the development of the heterotopic mass or large calcifications which were excised from tendon-to-bone insertions; and (3) excision of heterotopic ossification from a ligament, capsule, or tendon insertion following avulsion injury without tendon-to-bone repair. After surgery, return to sports was allowed at 4-6 weeks., Results: Of 57 athletes undergoing excision of heterotopic ossifications, 32 were eligible as isolated excision of posttraumatic myositis ossificans. Twenty-four (75%) were ice hockey or soccer players. Median age was 23 years. Prior to surgery, patients were unable to continue their sports. At surgery, the ossification was excised from a thigh muscle in 27 (84%) cases. Median follow-up was 2 years (range 1-20 years). Outcome was Good/Excellent in 26 (81%) patients, corresponding to return to preinjury sports with minimal symptoms at sports activities. Preinjury Tegner activity level was resumed after surgery in 30 of 32 (94%) athletes, of whom 28 (94%) were involved in high-level sports corresponding to Tegner levels 8-10. No postoperative complications were recorded other than minimal insensitive areas at the periphery of skin incisions., Conclusion: In high-level athletes who present chronic disabling mature posttraumatic myositis ossificans that interferes with their sports career, surgical excision of the heterotopic mass results in effective clinical improvement with return to sports and minimal postoperative risks., Level of Evidence: Case series, Level IV.

We report a case of a 23-year-old female with pain and fullness in the right popliteal fossa. An MRI scan demonstrated an ossified enhancing soft tissue mass. Evaluation of the resected specimen showed a high-grade extraskeletal osteosarcoma juxtaposed to the three zones of myositis ossificans. At 1-year follow-up the patient is alive and disease free. A review of the literature purporting to document such an association failed to demonstrate a single case in which an osteosarcoma and MO with its zonal architecture co-existed.

Background Myosits ossificans (MO) is a rare but important differential diagnosis for a heterotrophic bony tumor in the muscles. It is often misdiagnosed as a malignant tumor. With a previous trauma the diagnosis is myositis ossificans traumatic (MOT). In most cases, it is benign and predominantly seen in the big muscles. But there can be malignant etiologies too. Case Description We report a rare case of MO in the muscle of the craniocervical junction. This 37-year-old woman had a riding accident years ago. Because of persisting pain and cervical dysfunction, we did a total resection. Clinical Implications MOT is a benign tumor that can be treated conservative in most cases. In case of persistent pain or neurological deficits, and especially for securing diagnosis, surgical resection is recommended., Competing Interests: Interessenkonflikt: Nein., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Myositis ossificans (MO) is a rare, non-neoplastic lesion characterized by heterotopic ossification of soft tissue. The condition is predominantly seen in young adults and adolescents and is most commonly secondary to trauma. Although the exact etiology remains unclear, patients typically present with pain and restricted range of motion following trauma or overuse. MO rarely presents in the popliteal fossa of adult patients and has not been previously reported in that of a pediatric patient., Methods: We present a 12-year-old patient with no history of direct trauma with MO in the right popliteal fossa, a highly unusual location. Initial x-rays failed to show the lesion; however, later radiographs showed an ossified mass. At peak dimensions, the ossification measured 3.8 cm anteroposterior×2.5 cm transverse×3.2 cm craniocaudal. After 14 months of observation and conservative therapy, the mass was excised., Results: The patient was ultimately able to return to full activity. Radiographs taken 14 months after the excision showed no signs of recurrence of the lesion., Conclusions: To our knowledge, this is the first reported case of MO excised from the popliteal fossa of a pediatric patient and followed for >1 year., Level of Evidence: Level IV-case report.

Background: Neurogenic Myositis Ossificans (NMO) is a rare disabling pathology characterized by peri-articular heterotopic ossifications following severe peripheral or central nervous system injuries. It results in ankylosis and vessels or nerves compressions. Our study aimed to describe the pre-operative findings of patients with NMO of the hip using biphasic computerized tomography (CT)., Methods: Between 2006 and 2012, we retrospectively analyzed 101 consecutive patients with hip NMO. We analyzed all CTs and surgical reports following a standardized grid depicting the osteoma and its relations with joint capsule, vessels and nerves and bone mineralization. We studied surgical complications and recurrence during follow-up. Chi2-test and Fischer's test were performed to compare qualitative values with respectively normal and non-normal distribution. Quantitative values were analyzed with a one factor analysis of variance (ANOVA) test. Agreement between pre-surgical CT and surgical observations was evaluated with Cohen's kappa test., Results: Correlation between pre-operative CT and surgical findings was excellent regarding relationships with vessels (0,82) and was good concerning relationships with sciatic nerves (0.62) and with joint capsule (0.68). Close contact or disruption of joint capsule (p = 0.005), joint space narrowing (p = 0.007) and bone demineralization (p < 0.001) were correlated with NMO recurrence., Conclusions: Biphasic enhanced-CT allows pre-operative assessment of NMO with good correlation to surgical observations and helps prevent surgical complications.

Posttraumatic myositis ossificans (PTMO) is the most common form of myositis ossificans, but it rarely affects the hand. Due to the aggressive behavior of this unusual tumor, it is commonly misdiagnosed as malignancy or local infection. This report describes a case of PTMO of the hand in a 25-year-old women, and reviews the clinical, radiologic, and histologic characteristics. By understanding the disease characteristics and maturation process, physicians can avoid a misdiagnosis that may lead to functional impairment or improper treatment.

Computer-assisted surgery is now a common procedure in the field of orthopedics. We present two patients who developed myositis ossificans, a rare complication after navigated knee surgery. Due to careful follow-up and conservative treatment, surgical excision was avoided in both patients with good clinical results. Development of myositis ossificans after navigated knee surgery should be considered in cases of thigh pain and restricted range of motion of the knee., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Myositis Ossificans Cicumscripta is a rare condition characterized by aberrant bone formation in paramuscular soft tissue of the extremities usually associated with trauma or a genetic mutation. Very few cases involve the head or neck and it is rarely found in the pediatric population., Objectives: We present a case of a 5-month old with a rapidly growing posterior neck mass suspicious for neoplasia, which was treated with surgical resection and found to be a non-traumatic, non-genetic form of Myositis Ossificans. The workup, treatment, and findings of the patient are outlined and a review of the literature on this disease is discussed., Conclusion: Myositis Ossificans is characterized by aberrant bone formation typically occurring after trauma but may be secondary to an underlying genetic abnormality. The case presented in the absence of trauma or an underlying genetic abnormality and is therefore an exceedingly rare instance of the sporadic form that presented spontaneously in the head and neck of a pediatric patient., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Myositis ossificans circumscripta (MOC) is a kind of self-localized, benign and tumor-like lesions often seen in adults, with approximately 75% of cases caused by trauma. We reported a case of non-traumatic MOC occurred at the elbow joint in a 9-year old child and it has been excised by surgery. After 18 months follow-up, a favorable outcome has been achieved with the Broberg-Morrey score of 100. We suggest that surgical resection should be done as soon as the diagnosis is confirmed.

Soft tissue sarcomas are a rare, heterogeneous group of malignancies that should be included in the differential diagnosis for any patient presenting with a soft tissue mass. This article reviews strategies for differentiating between benign and malignant soft tissue masses. Epidemiology, appropriate workup, and treatment of soft tissue sarcomas are reviewed., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To report clinical signs, diagnostic imaging findings, and outcome in a dog with traumatic myositis ossificans of the origin of the extensor carpi radialis muscle., Study Design: Clinical report., Animals: An 8-month-old intact female Irish Setter Dog., Methods: After radiographic and computed tomographic evaluation of an osseous proliferation arising from the cranial cortex of the right distal humeral diaphysis, the protruding bone was surgically removed and evaluated by histopathology., Results: Traumatic myositis ossificans was successfully treated with surgical removal of the osseous proliferation resulting in improved postoperative range of motion of the right elbow joint. There was no evidence of lameness or abnormal bone regrowth associated with the surgical site radiographically at follow up., Conclusion: Surgical removal of a traumatic myositis ossificans lesion resulted in full return to function in a young, competitive show dog., (© Copyright 2014 by The American College of Veterinary Surgeons.)

Introduction: Myositis ossificans usually occurs in the vicinity of the elbow, knee joints, or hip joints, following obvious trauma or surgery. This is the first report on myositis ossificans of the serratus anterior., Case Presentation: In this report we present a case of myositis ossificans within the serratus anterior which developed as a complication due to long-term nape massage. The patient was a 29-year-old Han woman. Because heterotopic ossificans constricted her brachial plexus the surface of her right upper arm was slightly numb; the symptom disappeared after surgery., Conclusion: This case highlights that myositis ossificans can occur in the serratus anterior following long-term nape massage.

Myositis ossificans is a rarely encountered benign lesion characterized by a non-neoplastic heterotopic bone formation in both soft tissue and skeletal muscle. Three subgroups of myositis ossificans are identified: myositis ossificans progressiva, which is hereditary; nontraumatic or pseudomalignant myositis ossificans, which is developed in the absence of any trauma; and myositis ossificans circumscripta, which is related to evident and direct trauma. In this case report, we present a girl with a swelling on the forearm who was finally diagnosed with nontraumatic myositis ossificans.

With a well-established incidence of 15% to 20% following a spinal injury, the occurrence of neurogenic myositis ossificans of the hip is quite rare. The most widely accepted theory supporting its occurrence is the repeated microtrauma by forceful passive mobilization during rehabilitation. An extensive involvement around the hip is quite disabling to the patient. We present the case of a 41-year-old man with an extensive involvement of the right iliopsoas following an incident of head injury with no primary injury to the hip, with a disabling restriction of movement. Computed tomography images and its 3D reconstruction were used to define the exact extent of involvement. The mass was excised piece meal using the iliofemoral approach with an osteotomy of the anterior superior iliac spine, which allowed us to have a better visualization to the extensive mass. Postoperatively the patient regained a good range of motion. In addition to adding a rare case of atraumatic myositis ossificans of the iliopsoas to literature, this reports describes a novel approach for its excision.

We present our personal experience in the anterior transperitoneal laparoscopic approach of a retroperitoneal tumour.The case we have in view is that of a 48-year old female patient P.V., with congenital single left kidney. The patient has a retroperitoneal tumour mass of the right flank. Following investigations (ultrasound, CT with contrast), the tumour appeared well defined, of small dimensions (approximately 6-7cm diameter) and without anatomical relationships with large retroperitoneal vessels (inferior vena cava). For the laparoscopic excision of the tumour, we used an operating device adapted from the one used in right hemi-colectomy. After the coloparietal dissection, the access into the right retroperitoneal flank by means of laparoscopy is achieved by applying our procedure.The surgical intervention was quick and of a minimally invasive nature. Postoperative evolution was favourable, without any complications; the patient was discharged after 48 hours. In anatomic situations where the tumour anatomy is well defined and its size is acceptable, without dangerous anatomic relationships with large retroperitoneal vessels, attempted laparoscopic transperitoneal removal is the preferred option., (Celsius.)

A 40-year-old male weightlifter presented with a 6-month history of a painless mass in the right deltoid. He had no history of trauma to the shoulder other than an arthroscopic rotator cuff repair a few weeks earlier. Physical examination showed a firm, nontender mass located longitudinally and coinciding with the deltoid, measuring 12×14×4 cm. There was no limitation in range of motion or functioning. Magnetic resonance imaging (MRI) and computed tomography (CT) scans suggested a lobulated, heterogeneous mass with multiple areas of calcification that raised suspicion for soft tissue sarcoma vs myositis ossificans. Marginal resection of the soft tissue mass was performed, and pathologic studies confirmed the diagnosis of xanthogranulomatous myositis ossificans with dystrophic calcifications and central cystic degeneration. At 2-week follow-up, the patient had improved range of motion and pain, but he noted a second soft tissue mass in the left deltoid. The MRI and CT scans showed a 10.5×16×3.4-cm linear, lobulated lesion with multiple calcifications, similar in appearance to the contralateral deltoid. The patient admitted to frequently injecting anabolic steroids into his deltoids. Because the patient was asymptomatic on the left side and the MRI appearance of the left deltoid mass was similar to that of the myositis ossificans seen on the right side, the patient opted for nonsurgical treatment. This is a rare case of myositis ossificans occurring bilaterally in the deltoids after repeated injections of anabolic steroids. There is currently no known association between anabolic steroids and myositis ossificans. This condition often mimics malignant neoplasms, illustrating the necessity of resection for diagnostic confirmation., (Copyright 2014, SLACK Incorporated.)

Fibrodysplasia ossificans progressiva is an extremely rare disease that is usually seen in the form of sporadic cases and seems to be localized outside of the thoracic cavity. Inflammation and trauma are accused in the etiology, and too many diagnostic mistakes are done. The disease, which may present genetic transmission and has not a definitive treatment, was seen as an intrathoracic mass for the first time. Intrathoracic mass was excised, and the cure was achieved in our patient, who was defined to be sporadic as a result of familial screening., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Fibrodysplasia ossificans progressiva (FOP) is a rare genetic condition characterized by progressive heterotopic ossification of skeletal muscle and soft connective tissues, leading to progressive ankylosis of all joints of the axial and appendicular skeleton. Cervical spine fusion, ankylosis of the temporomandibular joints, thoracic insufficiency syndrome, restrictive chest wall disease, and sensitivity to oral trauma complicate airway management and anesthesia and pose life-threatening risks., Methods: We conducted a retrospective chart review at 1 institution of patients with FOP who underwent general anesthesia (GA) for dental procedures., Results: Thirty patients underwent 42 general anesthetics. In 35 of 42 cases, GA was induced after the airway was secured by an awake fiberoptic intubation. In 4 of 42 cases, all of them pediatric, GA was first induced with maintenance of spontaneous ventilation, and the trachea was then intubated using a fiberoptic scope. In 2 cases, 1 adult and 1 pediatric, GA was first induced, and the trachea was then intubated using a GlideScope. In 1 case, the patient had a cuffed tracheostomy device in place that was accessed for GA. In 36 of 42 cases, the patients were discharged home on the same day as their dental procedure. No significant postoperative complications were encountered., Conclusions: GA can be administered safely to patients with FOP for dental procedures with attention to perioperative and airway management using a multidisciplinary approach. An awake nasal fiberoptic intubation should be considered the first choice for airway management. Most patients can be discharged home on the same day as their dental procedure.

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary disorder of skeletal malformations and progressive heterotopic ossification. The worldwide prevalence is estimated to be one in 2 million. This report outlines the management of a patient with FOP limited to the maxillofacial region where the FOP lesion produced a fusion between the mandibular ramus and the zygomatic complex and trismus. The patient underwent three surgical procedures and various medical treatments during a 19-year period in attempts to manage the trismus, all in vain. The initial difficulty in establishing the diagnosis and ignorance of the true nature of the disease led to unsuccessful surgery., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Myositis ossificans, also known as traumatic myositis ossificans or myositis ossificans circumscripta, is the product of an unusual reactive process of mesenchymal stem cells within the muscle produced secondary to a traumatic insult or inflammatory process. In approximately 75% of cases, the process has a direct correlation with a single or repetitive, traumatic, penetrating, or crushing injury to the muscle. However, in up to 25% of cases, there is no recollection of a traumatic event. The most commonly accepted mechanism of traumatic etiology includes the embedment and lysis of bone fragments within the soft tissue causing subsequent exposure of bone morphogenic proteins to extraosseous cells. This environment stimulates osteoblasts to form true bone, dystrophic calcifications, or a calcified chondroid matrix. A concomitant mechanism that occurs involves the overproduction of bone morphogenic protein-4 produced by the muscle cells or the muscle fascia., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Myositis ossificans is ossification and bone formation within muscle. It is a rare and unusual pathologic entity that has defied most efforts to establish definite etiology, pathogenesis, and satisfactory treatment. Myositis ossificans is mainly of 2 types: myositis ossificans progressiva (MOP) and myositis ossificans traumatica (MOT). Myositis ossificans idiopathic is also reported in the literature. When it affects the muscles of mastication, it causes severe trismus. Computed tomography scans and magnetic resonance imaging can effectively delineate the calcified mass. In this article, we present a case of MOT of the medial, lateral pterygoid, and contralateral temporalis muscles., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Myositis ossificans (MO) may be included in the group of lesions described as pseudosarcomas. Its clinical and histological picture frequently mimics a malignant neoplasm and therefore, ultimate diagnosis and implementation of adequate treatment requires the cooperation of interdisciplinary team of physicians. The paper presents the case of 20-year old female patient suffering from severe pain in the right thigh. The patient was initially diagnosed with the lower limb overload. Rest and administration of non-steroidal anti-inflammatory drugs (NSAID) were recommended. Due to the lack of the efficacy of the recommended conservative treatment and detection of tumorous mass on ultrasound examination, the patient was referred to the cancer centre. The diagnostic procedures were extended and an open biopsy of the lesion was performed which revealed the presence of MO. The patient underwent a surgical procedure during which the pathological mass was entirely removed. Follow up examinations conducted upon the conclusion of the rehabilitation indicate no pathologies in the operated area.

Myositis Ossificans (MO) is an unusual pathological entity still largely unknown, characterized by dystrophic calcification leading to heterotopic ossification of intramuscular connective tissue. The masticatory muscles are exceptionally involved. Four distinct types of myositis ossificans have been described: MO Progressiva, which is a genetic disorder involving several muscular groups; MO Circumscripta, limited to a single muscle and generally due to calcification of an intramuscular haematoma following severe trauma and progressive ossification; MO Pseudo-malignant limited to soft tissue and not associated to any trauma; MO associated to paraplegia. A case of circumscribed myositis ossificans of the masseter muscle in a 62 years-old woman is reported.

A 20-month-old male Rottweiler dog was presented with the complaint of chronic right forelimb lameness that was unresponsive to conservative treatment. Physical examination allowed for the topographical identification of the source of the problem as a firm enlargement of the soft tissues that was partially movable from humeral bone and compatible with an alteration of the triceps brachii muscle. Radiographic images showed signs that were highly suggestive of myositis ossificans. Computed tomography allowed for a more accurate characterization of the lesion, to exclude involvement of the elbow joint and humeral bone, and to localize anatomically the lesion in the caput accessorium and longum of the triceps brachii muscle. Surgical excision of the ossified portion of the triceps muscle was performed. Histological examination of the excised tissue substantiated the diagnosis of myositis ossificans. A one year clinical and radiographic follow-up examination showed a complete recovery, with no evidence of complications or recurrence. Despite myositis ossificans in dogs having previously been identified in the hindlimbs, this case of myositis ossificans circumscripta of the triceps muscle suggests that it may also occur in the muscles of the forelimb.

Myositis ossificans traumatica (MOT) is a disease in which muscular ossification develops following trauma. Almost all cases of MOT are found in skeletal muscle. The authors report in a 39-year-old man MOT involving several muscles in the head and neck, namely, bilateral masseter muscles, the left temporal muscle, the left lateral pterygoid muscle, and the left frontal muscle. Involvement of the lateral pterygoid muscle is especially rare.

Fibro-osseous pseudotumors of the hand are rare lesions in children. Clinical and radiological presentation can be challenging and simulating a malignant neoplasm. We present the case of a 5-year-old boy with a rapidly growing soft tissue tumor of the right palm. Diagnosis was confirmed by biopsy and the patient was treated with a tissue preserving resection. There was no evidence for recurrence 1 year after the operation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The present paper reported the case of a trauma-related myositis ossificans, with focus on considerations for a differential diagnosis process., Case Report: A 50-year-old male with a severe painful limitation (12 mm) of jaw opening referred a trauma to the right temporomandibular joint (TMJ) area occurring about 40 days before. Posttraumatic TMJ ankylosis was ruled out on the basis of negative magnetic resonance and cone-beam computerized tomography findings, and the patient underwent treatment with arthrocentesis, botulinum toxin injections, and physiotherapy on the basis of two diagnostic hypotheses, viz., an anchored disk phenomenon or a myofibrotic contracture of the right masseter muscle due to prolonged myospasm. After 4 months, jaw opening was slightly increased to 23 mm, but limitation and pain persisted. A new CT was performed to investigate for the emerging clinical picture compatible with traumatic myositis ossificans of the right temporalis muscle. Once the diagnosis was confirmed, the patient underwent surgery for coronoidectomy. At the 6-month follow-up, mouth opening was increased to up to 35 mm and pain was absent., Discussion: It is fundamental that patients suspected of having uncommon clinical pictures leading to mouth opening restriction are promptly referred to specialized centers, where the differential diagnosis process should be based on a comprehensive assessment taking into account for the potential etiologic factors described in the literature.