Myositis ossificans traumatica of the medial pterygoid muscle: A case report

Abstract

Object of studyOssification of medial pterygoid muscle is a rare clinicopathological entity due to complication of maxillofacial trauma. We present a case of myositis ossificans traumatica (MOT) of the left medial pterygoid muscle that has developed following repeated maxillofacial trauma. MethodA 31-year-old male patient was referred to the Division of Oral and Maxillofacial surgery. He sustained panfacial trauma due to road traffic crash in November 2005. He was managed by ORIF for panfacial trauma. He reported again in July 2006 for restricted mouth opening and was diagnosed as a case of fibrous ankylosis of left TMJ. He was treated by interpositional arthroplasty. In May 2008 he again reported with progressive reduction of mouth opening following fall on left side of face. On examination maximum inter-incisal opening was 8mm. A hard and non tender mass was palpable on the left submandibular region which was fixed to the medial aspect of angle of mandible. CT examination revealed calcification of medial pterygoid muscle. Surgical excision was planned. The area was exposed and the ossified muscle was delineated. Mouth opening of 37mm was achieved. Specimen was sent for histopathological examination. Histopathological examination confirmed the diagnosis of myositis ossificans of the medial pterygoid muscle. ResultPatient has been followed up for 30 months and has improved mouthopening. ConclusionDiagnosing the condition is very challenging. There are no established treatment protocols for MOT as the literature is unclear about the need for surgical intervention, surgical timing, recurrence rates, and effectiveness of nonsurgical therapies.