MyMedR

Fulltext Management of heterotopic ossification affecting both hips and knees

Devnani AS

Singapore Med J, 2008 Jun;49(6):501-4.

The management of heterotopic ossification is controversial. This is a rare case affecting both hips and knees of a 22-year-old woman that prevented her from walking. The management and the outcome, three years after excision of the ossific masses, as well as the measures to prevent recurrence after excision of the heterotopic ossification, are discussed.

Matched MeSH terms: Ossification, Heterotopic/etiology; Ossification, Heterotopic/radiography; Ossification, Heterotopic/surgery*

Stylohyoid ossification with a case report

Pallie W, Hussein MA

Med J Malaya, 1970 Sep;25(1):61-4.

PMID: 4249499

Matched MeSH terms: Ossification, Heterotopic*

Osseous choristoma of the tongue

Wei Cheong Ngeow, Chin Boon Lian, Shanmahasuntharam P

J Nihon Univ Sch Dent, 1996 Mar;38(1):49-51.

PMID: 8648411

The term "choristoma" is used to describe a mass of histologically normal tissue presenting in an aberrant site. A rare case of osseous choristoma of the tongue is presented and the literature is briefly reviewed.

Matched MeSH terms: Ossification, Heterotopic/pathology*

Ossified lumbar pseudomeningocele: imaging findings

Al-Edrus SA, Mohamed Mukari SA, Ganesan D, Ramli N

Spine J, 2011 Aug;11(8):796-7.

PMID: 21724472 DOI: 10.1016/j.spinee.2011.05.013

Matched MeSH terms: Ossification, Heterotopic/etiology; Ossification, Heterotopic/pathology*; Ossification, Heterotopic/surgery

Fulltext The Development of Eagle's Syndrome after Neck Trauma

Rahman SA, Singh J, Muthusamy R, Alam MK

Contemp Clin Dent, 2018 6 8;9(2):319-322.

PMID: 29875581 DOI: 10.4103/ccd.ccd_870_17

Eagle's syndrome (ES) refers to a group of various types and patterns of pain which spans over the head-and-neck region owing to an elongated styloid process or calcified stylohyoid ligament. These symptoms are often confused with those attributed to a wide variety of facial neuralgias. The diagnosis of ES is usually made through clinical exclusion which is then confirmed radiographically. Patients with ES are initially managed with nonsurgical therapy, but surgical resection seems to be the treatment of choice. The styloid process shortening can be achieved through an intraoral or extraoral approach. This clinical case report describes such a case of ES after sustaining neck trauma.

Matched MeSH terms: Ossification, Heterotopic

Heterotopic implantation of autologous bone marrow in rock pigeons (Columba livia): possible applications in avian bone grafting

Sanaei MR, Abu J, Nazari M, Faiz NM, Bakar MZ, Allaudin ZN

J. Avian Med. Surg., 2011 Dec;25(4):247-53.

PMID: 22458179

Autologous bone marrow, alone or as a composite marrow graft, has received much attention in various species. To assess the potential osteogenicity of autologous, extramedullary bone marrow implants in an avian model, 24 adult pigeons (Columba livia) were given intramuscular implantations of autologous marrow aspirated from the medial tibiotarsus. Birds were euthanatized at 1, 4, 6, 8, 10, and 12 weeks after surgery to evaluate whether ectopic bone had formed at the implant sites. Primary evaluations by in situ radiography and postmortem histologic examinations showed no evidence of bone formation. Further evaluation with histologic scores and histomorphometry revealed a significantly increased rate of angiogenesis at the implant sites by the sixth and tenth week postimplantation (P < .05). No significant differences between the treatment and control sites were present at any other endpoints. Results of this study show that, although autologous bone marrow lacks heterotopic osteogenic potentials in this avian model, it could still function as a useful adjunct to routine bone grafting techniques because of its unique capabilities to promote early angiogenesis.

Matched MeSH terms: Ossification, Heterotopic/veterinary*

Heterotopic ossification in skeletal muscle metastasis from colonic adenocarcinoma--a case report

Naik VR, Jaafar H, Mutum SS

Malays J Pathol, 2005 Dec;27(2):119-21.

PMID: 17191396

Colonic adenocarcinoma metastasising to the skeletal muscle is rare. A-56-yr-old Malay man was diagnosed to have adenocarcinoma of the right colon [Dukes B] for which a right hemicolectomy was performed, followed by radiotherapy and chemotherapy. Five years later the patient presented with a mass in the rectus abdominis muscle. The serum carcinoembryonic antigen was 71 ng/Ml. The mass was resected. Gross and microscopical examination showed multiple deposits of mucin-secreting adenocarcinoma with prominent heterotopic ossification in the stroma. The exact pathogenesis and significance of heterotopic ossification is not clear, but bone morphogenetic proteins may play an important role.

Matched MeSH terms: Ossification, Heterotopic/pathology*

Cervical cord compression due to ossified posterior longitudinal ligament associated with diffuse idiopathic skeletal hyperostosis

Yusof ZB, Pratap RC

Aust N Z J Med, 1990 Oct;20(5):697-8, 700.

PMID: 2126728

We describe a case of cervical cord compression due to ossified posterior longitudinal ligament in association with diffuse idiopathic skeletal hyperostosis, in a young female. Characteristic CT findings are described.

Matched MeSH terms: Ossification, Heterotopic/complications*

Fulltext Anatomical and Radiological Findings of Abnormal Calcified Structures within and around the Foramen Transversarium and Its Clinical Implications

Chakravarthi KK, Nelluri V, Reghunadhan D, Sugavasi R

Ann Afr Med, 2024 Oct 01;23(4):641-648.

PMID: 39138967 DOI: 10.4103/aam.aam_73_24

BACKGROUND: The foramen transversarium is a vital anatomical structure found in the cervical vertebrae of the spine. Typically, it serves as a passageway for important neurovascular structures, including the vertebral artery and vein, as well as the vertebral nerve. However, abnormal calcification or ossification of soft tissues in and around this area can lead to various clinical implications. Understanding the presence and implications of abnormal ossified structures in and around the foramen transversarium is crucial for clinicians involved in the diagnosis and management of cervical spine disorders.

AIMS: Accordingly, this present study was designed to evaluate the abnormal ossified structures anatomically and radiologically within and around the foramen transversarium.

MATERIALS AND METHODS: This study was conducted on 182 (26 sets of cervical vertebrae) dried human cervical vertebrae obtained from the respective departments of anatomy and on 190 (95 males and 95 females) adult patients who visited the radiology department for neck-related problems such as stiff neck, neck/shoulder pain, dizziness, vertigo, imbalance, visual disturbances, and cognitive impairment.

RESULTS: Among 182 examined cervical vertebrae, unilateral complete accessory foramen transversarium was found in 23 vertebrae (12.63%), bilateral complete in 19 (10.44%), bilateral incomplete in 6 (3.29%), unilateral complete double in 4 (2.19%), and unilateral complete absence of foramen transversarium in 3 (1.64%). Stenosis due to aberrant osteophytes was noted in 9 vertebrae (4.9%). Out of 190 patients, three males presented with cervical kyphosis, severe spinal canal stenosis, and spinal cord compression due to ossification of the posterior longitudinal ligament and osteophyte complexes at C3-C6, with the most significant compression at C5-C6.

CONCLUSION: A thorough understanding of abnormal ossifications in and around the foramen transversarium is crucial for the management of cervical spine disorders; imaging modalities such as X-ray, computed tomography, and magnetic resonance imaging are crucial for recognizing and intervening in these cases, which is essential to prevent adverse neurological outcomes associated with vertebral artery involvement.

Matched MeSH terms: Ossification, Heterotopic/pathology

Massive heterotopic ossification in Guillain-Barré syndrome: a rare case report

Ohnmar H, Roohi SA, Naicker AS

Clin Ter, 2010;161(6):529-32.

PMID: 21181081

Heterotopic ossification (HO) is the abnormal development of bone within soft tissue and a rare complication in Guillain-Barré syndrome (GBS). Only a few cases had been reported so far. We present the case of a 39-year-old man who had been diagnosed to have GBS about 10 years ago, presenting with severe limitation of both active and passive range of motion in bilateral shoulder, elbow and hip joints and was found to have massive heterotopic ossification. In our patient, it could be a myriad of factors such as prolonged ICU stay with mechanical ventilation and hypoxia, long-standing immobilization and hypomobility with incomplete flaccid paralysis.

Matched MeSH terms: Ossification, Heterotopic/etiology*; Ossification, Heterotopic/physiopathology; Ossification, Heterotopic/radiography

Postinfectious heterotopic ossification of the ilium involving the iliacus muscle

Muhamad Effendi F, Nam Y, Shin CH, Cho TJ, Yoo WJ, Cheon JE, et al.

J Pediatr Orthop B, 2018 Sep;27(5):407-411.

PMID: 28704300 DOI: 10.1097/BPB.0000000000000477

Heterotopic ossification in soft tissue or muscle is rare in the pediatric and adolescent age group. Most cases are associated with musculoskeletal injury and trauma to the central nervous system. Here, we describe an adolescent patient without a history of trauma or lesions in the central nervous system who presented with a painful limp with limited motion of the left hip. Investigations indicated unusually large heterotopic ossification extending from the inner aspect of the ilium down to the anterior part of the hip, highly likely to have developed after an unrecognized periacetabular pyomyositis primarily involving the iliacus muscle. Surgical excision was performed successfully without perioperative complications. No recurrence was detected at the final follow-up.

Matched MeSH terms: Ossification, Heterotopic/etiology*; Ossification, Heterotopic/psychology

Fulltext Transoral surgical resection of bilateral styloid processes elongation (eagle's syndrome)

Baharudin A, Rohaida I, Khairudin A

Acta Inform Med, 2012 Jun;20(2):133-5.

PMID: 23322967 DOI: 10.5455/aim.2012.20.133-135

Eagle's syndrome represents a symptomatic styloid process elongation or calcification of stylohyoid or stylomandibular ligament. The symptoms include the throat pain radiating to ipsilateral ear or foreign body sensation in the pharynx causing odynophagia and dysphagia. It is commonly unilateral and bilateral cases are rare. We report a case of bilateral elongation of styloid processes treated surgically by transoral approach.

Matched MeSH terms: Ossification, Heterotopic

Radiographic and computed tomographic assessment of the development of the antebrachia and elbow joints in Labrador Retrievers with and without medial coronoid disease

Lau SF, Hazewinkel HA, Voorhout G

Vet Comp Orthop Traumatol, 2015;28(3):186-92.

PMID: 25804656 DOI: 10.3415/VCOT-14-09-0144

To compare the development, monitored by radiography and computed tomography, of the antebrachia and elbow joints in seven Labrador Retrievers with healthy elbow joints and in seven Labrador Retrievers that developed medial coronoid disease (MCD), in order to determine whether disturbances in the development of the antebrachia and elbow joints, between the age of six and 17 weeks may lead to medial coronoid disease.

Matched MeSH terms: Ossification, Heterotopic/pathology; Ossification, Heterotopic/radiography; Ossification, Heterotopic/veterinary

Mesenteric bones: Intra-abdominal heterotopic ossification

Michael A, Narasimman S, Jasjit Singh N

Med J Malaysia, 2018 04;73(2):110-111.

PMID: 29703875 MyJurnal

Intra-abdominal heterotopic ossification usually develops after abdominal surgery and can cause complications such as bowel obstruction and even intestinal perforation. Bisphosphonates, NSAIDs and even local radiation is used as prophylaxis or treatment. Surgeons must consider heterotopic ossification and its complications as a differential when managing complex polytrauma patients with suspicious radiographic densities.

Matched MeSH terms: Ossification, Heterotopic

Fibrous lesions of the gingiva: a histopathologic analysis of 204 cases

Zain RB, Fei YJ

Oral Surg. Oral Med. Oral Pathol., 1990 Oct;70(4):466-70.

PMID: 2120653

Two hundred four cases of fibrous lesions of the gingiva were studied histologically for the presence of calcified tissue, the nature of the connective tissue, the type of keratinization, and the degree of epithelial thickness. Initially these lesions were subcategorized into four specific entities, namely fibrous epulis, fibroepithelial polyp, calcifying fibroblastic granuloma, and ossifying fibrous epulis. It was found that 46.5% of the lesions contained calcifications. The connective tissue was represented predominantly by either the collagenous type (50.5%) or the mixed (cellular and collagenous) type (44.6%). It was also found that 36% of the lesions were ulcerated, and, of these, 79.5% were associated with the cellular type of connective tissue and calcifications. In an attempt to subcategorize the fibrous lesions into specific entities, it was found that 32 cases (15.7%) had mixed features. This fact supports the suggestion that these lesions are stages in the spectrum of a single disease process and should collectively be termed fibroblastic gingival lesions. However, it is also suggested that the two terms, namely peripheral fibroma and fibrous epulis with and without ossification, should be retained whereas the usage of other terminologies should be avoided.

Matched MeSH terms: Ossification, Heterotopic/pathology

Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery

Das S, Suri R, Kapur V

Sao Paulo Med J, 2007 Nov 01;125(6):351-3.

PMID: 18317606

CONTEXT: The medial end of the posterior border of the sphenoid bone presents the anterior clinoid process (ACP), which is usually accessed for operations involving the clinoid space and the cavernous sinus. The ACP is often connected to the middle clinoid process (MCP) by a ligament known as the caroticoclinoid ligament (CCL), which may be ossified, forming the caroticoclinoid foramen (CCF). Variations in the ACP other than ossification are rare. The ossified CCL may have compressive effects on the internal carotid artery. Thus, anatomical and radiological knowledge of the ACP and the clinoid space is also important when operating on the internal carotid artery. Excision of the ACP may be required for many skull-based surgical procedures, and the presence of any anomalies such as ossified CCL may pose a problem for neurosurgeons.

CASE REPORT: We observed the presence of ossified CCL in a skull bone. A detailed radiological study of the CCL and the CCF was conducted. Morphometric measurements were recorded and photographs were taken. The ACP was connected to the MCP and was converted into a CCF. Considering the fact that standard anatomy textbooks do not provide morphological descriptions and radiological evaluations of the CCL, the present study may be important for neurosurgeons operating in the region of the ACP.

Matched MeSH terms: Ossification, Heterotopic/pathology*

Fulltext A rare case of heterotopic ossification in a newborn: a case report

Khoo S, Felix L, Azura L, Manmohan S, Jeffry A

Malays Orthop J, 2012 Nov;6(3):48-50.

PMID: 25279058 MyJurnal DOI: 10.5704/MOJ.1207.006

Heterotopic ossification (HO) is the growth of bone in soft tissue, and can be broadly classified into neurogenic, genetic and traumatic causes. The pathophysiology of HO remains unknown. This disorder is extremely rare in infants and can mimic or coexist with thrombophlebitis, cellulitis or osteomyelitis. Most importantly, HO has to be differentiated from bone-forming tumours such as osteosarcoma and osteochondroma. We report a case of traumatic HO in a fiveday- old newborn following intravenous cannulation of the right wrist and left ankle, with the latter complicated with osteomyelitis. We highlight the clinical and radiological features of HO and differential diagnoses of soft tissue ossification in early childhood.

Matched MeSH terms: Ossification, Heterotopic

Fulltext Heterotopic ossification in stroke is not that rare: lesson from rehabilitation standpoint

Fatimah Ahmedy, Nurul Diyanah Zenian, Wan Juhaini Paizi, Teh Yong Guang, Khin Nyein Yin, D. Maryama Ag Daud, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):71-71.

MyJurnal

Introduction:Stroke is a major public health concern and treating its complications is important for functional recov-ery. Heterotopic ossification (HO), a condition where bone is developed in non-skeletal tissue, is not an uncommon stroke-related complication with reported occurrence up to 12%. It typically presents with joint range of motion (ROM) limitation, pain and swelling. Detecting HO is important to prevent forceful joint manipulation during reha-bilitation that can cause pain and fracture. Two cases of diagnosing HO during the course of stroke rehabilitation are presented. Case description: First case was a subacute stroke in 25 year-old male with right-sided hemiparesis and right hip joint ROM limitation. He did not consent to have passive ROM exercise and refused to be seated due to severe right hip pain. Second case was a 41 year-old male with chronic right-sided hemiparetic stroke exhibiting ipsilateral lower limb neurological recovery but inability to perform bed mobility and walking despite regaining motor function. The right hip joint ROM was limited in the absence of pain. Radiographs demonstrated presence of HO in the affected hip of both patients. Gentle hip ROM exercise was prescribed and noted improvement in ROM with subsequent ability for sitting (first case) and short-distance ambulation (second case). Conclusion: HO should be considered as a differential diagnosis in stroke patients having limited ROM, hence the importance of thorough physical examination. Presence of HO would guide rehabilitation process by encouraging gentle ROM exercise in the attempt to reduce public health burden from halted functional recovery in stroke.

Matched MeSH terms: Ossification, Heterotopic

Heterotopic ossification in psammomatous spinal meningioma: a diagnostic controversy

Wong YP, Tan GC, Mukari SAM, Palaniandy K

Int J Clin Exp Pathol, 2021;14(5):627-632.

PMID: 34093948

Heterotopic ossification (HO), a synonym for osseous metaplasia, is a pathological phenomenon, characterized by abnormal bone formation outside the skeletal system observed commonly in various neoplastic and non-neoplastic diseases. HO occurring in meningioma is exceptionally rare. We reportherein an unusual case of spinal meningioma containing numerous calcified psammoma bodies and extensive HO in a 75-year-old woman, who presented with progressive worsening bilateral lower limb weakness and numbness. The presence of remarkable bone formation within a meningioma is controversial among pathologists; while some regard them as psammomatous meningioma as the primary diagnosis, others prefer osteoblastic meningioma, a form of metaplastic meningioma. There is compelling molecular data to advocate that HO is an active disease process involving metaplastic (osseous) differentiation of meningioma stroma mesenchymal stem-like cells, but not the meningothelial-derived tumor cells. Henceforth, the term "metaplastic meningioma" may not be appropriate in this context. A plausible designation as "psammomatous meningioma with osseous metaplasia" defines this entity more accurately. This paper highlights the need for a unifying nomenclature to reduce diagnostic controversy caused by conflicting terms in the literature. The possible pathogenesis of this intriguing phenomenon is discussed.

Matched MeSH terms: Ossification, Heterotopic

Fulltext Olecranon Osteotomy Approach for Complex AO-13C Fractures of Distal Humerus: A Prospective Analysis of 24 Cases

Singh R, Singh H, Kanodia N

Malays Orthop J, 2019 Mar;13(1):30-35.

PMID: 31001381 DOI: 10.5704/MOJ.1903.005

Introduction: Olecranon osteotomy is well described approach for complex intra-articular distal humeral fractures. In this study, we investigated the usefulness and complications of olecranon osteotomy approach for such fractures. We hypothesise that outcome is comparable in young adults and middle age group and also functional outcome is independent of fracture subtype following surgical fixation. Materials and Methods: Between December 2012 and September 2015, twenty-four adult patients (male: 15, female: 9) having mean age of 41.4 years with closed intra-articular fracture (AO-13C) were surgically managed using olecranon osteotomy approach and were followed-up for a mean of 28.5 months (range: 22-35 months). Functional outcome was measured using Mayo Elbow Performance Score (MEPS) and complications were observed. Statistical analysis was done using Student t-test and Kruskal Wallis test. Results: All fractures united by the end of three months. Mean elbow flexion achieved was 123°, mean extension lag was 9° and mean active arc of motion was 114°. Mean MEPS was 87 (excellent: 8, good: 14, fair: 1 and poor: 1). Post-operative transient ulnar nerve palsy was noted in two cases, heterotopic ossification (HO) was in one case, infection in two cases, implant prominence in five and elbow stiffness in three cases. Motion arc was higher in young adults and MEPS was comparable in both age group. Functional outcome was also dependent on fracture subtype. Conclusion: The olecranon osteotomy approach for distal humerus fractures had good functional outcome with fewer complications. Joint congruity and fixation could easily be assessed intraoperatively.

Matched MeSH terms: Ossification, Heterotopic

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