To the Editor: Myositis ossificans circumscripta (MOC) is defined as extraosseous nonneoplastic new bone formation within skeletal muscle or soft tissue. Etiological factors include (single or repetitive) traumatic penetration and crushing injury to the muscle. 1,2 Here, the authors report a case of MOC involving the unilateral masseter muscle, the imaging features of which resembles phleboliths.
CLINICAL REPORTA 64-year-old woman was referred to our clinic because of pain, which was exacerbated by opening the mouth and chewing. Clinically, moveable and painful solitary masses were evident in the superior external oblique ridge, and just anterior to the anterior border of the ramus, upon bimanual palpation of the left masseter muscle. She had no limitation in mandibular range of motion, and the skin over the left cheek region and the intraoral soft tissue, were normal. The left Stenson's duct exhibited normal salivary flow. Her medical history and systemic review were unremarkable. She reported that a blunt trauma had been applied to her left cheek a few years before.Panoramic radiography revealed 2 ovoid calcified masses and 1 rather small calcified mass in the region of the left anterior mandibular ramus (Fig. 1A). Computed tomography (CT) imaging revealed 2 calcified masses featuring small rounded radiolucent areas with central calcifications, surrounded by peripheral highdensity rings, suggestive of mature bone, and 1 small completely calcified mass clearly separated from the lateral mandibular ramus (Fig. 1B). Upon coronal CT, all calcified masses were localized within the left masseter muscle (Fig. 1C). A combination of patient's history, and the clinical and radiographic findings, allowed us to diagnose an MOC involving the masseter muscle.