We read with great interest the article entitled ‘Myositis ossificans traumatica of the medial pterygoid’ by T hangavelu et al. The authors described a rare case of traumatic ossification developing within the medial pterygoid muscle following extraction of a lower third molar, resulting in painful limitation of jaw opening. This case is of particular interest since we encountered a similar patient who underwent maxillary antrostomy and later developed dystrophic calcification with bone formation.
In 2009, we encountered a 73-year-old man with a history of bilateral maxillary antrostomy 10 years earlier. Since then, the patient had developed diffuse, slow-growing firm masses in the bilateral upper lips, cheeks, and mandibles, mainly involving the right face. The patient also complained of painful limitation of jaw opening. A panorex delineated diffuse radio-opaque structures in the bilateral labio-bucco-mandibular areas. Computed tomography scans demonstrated subcutaneous calcified masses close to the maxilla and facial muscle ( Fig. 1 ). Laboratory analysis demonstrated normal findings on blood counts, serum calcium, phosphate, alkaline phosphatase, C-reactive protein, vitamin D, parathyroid hormone levels and renal functions, ruling out metastatic calcification, which usually results from the deposition of calcified product in otherwise normal tissues as the result of hyperphosphatemia . Furthermore, the patient did not demonstrate any of the phenotypic changes of connective tissue disease related to facial calcification such as dermatomyositis, systemic scleroderma including CREST syndrome, and rheumatoid arthritis . As described in the article by T hangavelu et al. , complete removal of the calcified masses was performed under general anaesthesia. The bony-hard, yellow-white masses on the surface of the buccinator muscle were segmented and dissected from the surrounding tissue. Histopathological examination of the mass demonstrated well-formed lamellar bone structures including basophilic, amorphous, irregular calcium deposits, surrounded by fibrous connective tissue containing multinucleated giant cells ( Fig. 2 ). Therefore, taking into account the medical history, clinical features, laboratory data and histopathological findings, this case was diagnosed as dystrophic calcification resulting from precipitation of calcium salts in previously injured, degenerated, or dead tissue in the presence of normal phosphate and calcium metabolism . Since the calcified masses were not within the muscle and consisted of not only bone but also basophilic, amorphous, irregular calcium deposits with multinucleated giant cells, we denied traumatic myositis ossificans.