Myositis ossificans traumatica of the masticatory muscles: etiology, diagnosis and treatment

Abstract

BackgroundMyositis ossificans describes a heterotopic bone formation within a muscle. Thereby myositis ossificans is classified in two different groups: myositis ossificans progressiva (MOP) which describes a genetic autosomal dominant rare disease and myositis ossificans traumatica (MOT). The exact pathogenesis of MOT is unclear. The aim of this article was to analyse and interpret the existing literature reporting MOT of masticatory muscles and compare the results with our own clinical experience with MOT. Risk-factors, etiology, clinical features, diagnostic imaging, as well as different treatment options were evaluated and recommendations for the prevention, diagnosis, and therapy of MOT of the masticatory muscles were given.MethodsFollowing the PRISMA-Guidelines, a systematic search within the PubMed/Medline database with a view to record literature of MOT of the masticatory muscles was performed. Furthermore, the database of our own clinic was screened for cases of MOT.ResultsIn total, 63 cases of MOT of the masticatory muscles which were reported in English-based literature were included in this study. Overall, 25 female and 37 male patients could be analysed whereas one patient’s gender was unknown. Complication of wisdom-tooth infection (n = 3) as well as the results of dental procedures like dental extraction (n = 7), mandibular nerve block (n = 4), periodontitis therapy (n = 1) were reported as MOT cases. From the 15 reported cases that appeared after dental treatment like extraction or local anesthesia the medial pterygoid (n = 10) was the most affected muscle. Hereof, females were more affected (n = 9) than males (n = 6). The most reported clinical symptom of MOT was trismus (n = 54), followed by swelling (n = 17) and pain (n = 13). One clinical case provided by the authors was detected.ConclusionsDental procedures, such as local anesthesia or extractions, may cause MOT of the masticatory musculature. Demographical analyses demonstrate that females have a higher risk of developing MOT with respect to dental treatment. The most important treatment option is surgical excision. Subsequent physical therapy can have beneficial effects. Nevertheless, a benefit of interpositional materials and drugs as therapy of MOT of the masticatory muscles has not yet been proven. Myositis ossificans progressiva has to be excluded.Electronic supplementary materialThe online version of this article (10.1186/s13005-018-0180-6) contains supplementary material, which is available to authorized users.

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

“…The patient of the present case report underwent two surgeries as follows: Coronoidectomy on the left side in 2011 and excision of calcified lesion and buccal fat pad reconstruction in 2013. Complete excision of the ossified mass appears to be a generally accepted treatment for this disease (12). Following removal of the ossified mass, inter-positional fat graft is used as a means of reconstruction by a limited number of surgeons (13).…”

Miositis osificante del músculo pterigoideo medial secundaria a enucleación de quiste dentígero: reporte de caso

“…Los reportes de involucro de la región maxilofacial son escasos, siendo el masetero el músculo más comúnmente afectado seguido del temporal y en raras ocasiones el pterigoideo medial o lateral. Hanisch et al 22 , publicó una revisión sistemática y reporte de 21 casos de compromiso del músculo pterigoideo medial a nivel mundial, siendo esta la mayor serie informada, sin embargo, no incluye ningún paciente de la región Latinoamérica.…”

“…La realización de estudios complejos tales como tomografía axial computariza y resonancia magnética ayudan a delimitar la localización extraesquelética, extensión de la lesión, y son utilizadas para hacer una adecuada planeación quirúrgica, dado que ayudan a delimitar la zona y el patrón de mineralización con mayor precisión 20,21 . Debe realizarse después de la tercera semana y suele identificarse un área hiperdensa producida por las calcificaciones que rodea a una lesión central de densidad variable 22 . Dado estos hallazgos no es necesaria la confirmación histopatológica previa a la resección quirúrgica, la cual es el tratamiento de elección.…”

Medial Pterygoid Myositis Complicated by Numbness of the Tongue and Nonodontogenic Toothache: A Case Report

“…The onset of MOT in the medial pterygoid muscle is said to be rare [12]. Previous studies report have suggested that the cause of the MOT was profound trauma [13] [14] [15] [16]. There are no descriptions of trauma caused solely by mastication of hard food.…”