We report the case of a 47-year-old patient who presented a bone neoplasia (T4N0 squamous cell carcinoma) located on the mandible, diagnosed in 2010 and initially treated with induction chemotherapy (cisplatin-5-fluorouracil in an Al-Sarraf protocol) and undergoing surgery, with bilateral neck dissection, hemimandibulectomy, left mandibular reconstruction with an fibula implant and skin grafting; subsequently he underwent treatment with 60 Gray of external radiotherapy and concomitant chemotherapy.

The patient continued treatment without noticeable adverse effects, while maintaining the correct function of the mouth and lower jaw.

A few months after the end of treatment he presented pain, swelling in the area of the jaw and progressive difficulty for flexion and extension of the neck and mouth opening.

A bone scan was performed, showing localized technetium uptake in the mandible. An axial minimum intensity projection CT scan of the neck (MIP) (Fig. 1) and a 3D reconstruction (Fig. 2) were subsequently performed, showing an abnormal calcification linear stretching from the lower border of the mandible to the hyoid, following the anterior digastric muscle.

Fig. 1.

Axial maximum intensity projection (MIP) showing abnormal linear calcification.

(0.06MB).

Fig. 2.

Figure 3D reconstruction showing the path of abnormal calcification.

(0.17MB).

Circumscribed myositis ossificans appears during the second and third decades of life; the most common sites include the quadriceps muscle, leg, shoulder, arm and hand. Half of the patients have a history of multiple injuries or trauma in the affected area.1,2 A similar case of myositis ossificans in the facial muscles is described in the literature.3 Radiotherapy, surgery and prolonged immobilization of the mandible are factors that may play a role in the development of myositis ossificans in these cases.

Treatment is usually conservative; surgery is not recommended, especially in the early stages and in our patient was strongly discouraged due to recent radiotherapy. Treatment initially includes NSAIDs and rest followed by rehabilitation and physical therapy in order to restore function.4