PMC9520337_01
Fascial contracture of right neck and mandibular angle. Panels (A,B) was preoperative condition and panel (C) was 2 years after operation.
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F1
Two years back, she was admitted due to drooping of the right corner of the mouth and ossification of the back fascia (Figures 1A,B, 2, 3A,B). Physical examination showed improved facial asymmetry and mandibular angle fascia contracture and a mass in the left iliopsoas muscle with bulging but intact overlying skin (Figures 1C, 3C).
Halluces were characterized by hallux valgus deformity with macrodactyly.
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F2
Two years back, she was admitted due to drooping of the right corner of the mouth and ossification of the back fascia (Figures 1A,B, 2, 3A,B).
Multiple irregular, non-tender, bony hard swellings were found on the back and spinal scoliosis. The osseous lesion beginning from the left chest wall, extending to the ilium region. (A,B) Preoperative physical examination. (C) Two year follow-up.
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F3
Two years back, she was admitted due to drooping of the right corner of the mouth and ossification of the back fascia (Figures 1A,B, 2, 3A,B). There was a stiff, osseous lesion originating from the left chest wall and extending to the ilium region (Figure 3B). Physical examination showed improved facial asymmetry and mandibular angle fascia contracture and a mass in the left iliopsoas muscle with bulging but intact overlying skin (Figures 1C, 3C).
Anteroposterior and axial x-ray radiographic evaluation showed a massive radiopaque formation located predominantly in the region of back and spinal scoliosis.
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F4
Anteroposterior and axial radiographic evaluation showed that a large amount of radiopaque formation was mainly located in the back area and scoliosis (Figures 4A,B). Anteroposterior radiography and computed tomography scan showed recurrent heterotopic ossification of the left back with spinal scoliosis and chest wall malformations (Figures 4C, 5B).
Computed tomography revealed spontaneous cervical fusion, heterotopic ossification of the left dorsal fascia causing scoliosis, and developmental deformity of the right chest wall.
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F5
Computed tomography scan revealed spontaneous cervical fusion, heterotopic ossification of the left dorsal fascia causing scoliosis, and developmental deformity of the right chest wall (Figure 5A). Anteroposterior radiography and computed tomography scan showed recurrent heterotopic ossification of the left back with spinal scoliosis and chest wall malformations (Figures 4C, 5B).
Passive left hip ROM was restricted to 80  of flexion, 5  of external rotation, and 15  of abduction with no abnormal gait pattern.
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F6
Passive left hip range of motions (ROMs) were restricted to 80  flexion, 5  external rotation, and 15  abduction with abnormal gait pattern (Figure 6).
Anteroposterior view of the Computed tomography scan of the left hip confirmed aforementioned findings and additionally revealed heterotopic ossification of the iliopsoas muscle. (A) Preoperative CT reconstruction. (B) 6-month follow-up.
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F7
The mass originated from the left medial side of the iliac and extended to the lesser trochanter on the left leg region (Figures 7A, 9A). During the follow-up of 6 months after operation, no signs of disability, hip pain and infection were observed, and there were no radiological indications of ossification recurrence (Figure 7B).
Intraoperative removed ossification mass.
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F8
We performed careful dissection to reach the edge of the heterotopic ossified mass, thereby preventing any damage to the neurovascular supply (Figure 8). Resection of the iliopsoas ossification was conducted, and the ossification distal to the lesser trochanter was left to prevent vascular and nerve injury (Figure 8).
Immediate postoperative anteroposterior pelvis x-ray showed tailored removal of ossification mass according to the preoperative plan. (A) Preoperative X-ray. (B) Immediate postoperative X-ray.
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F9
The mass originated from the left medial side of the iliac and extended to the lesser trochanter on the left leg region (Figures 7A, 9A). Immediately after operation, anteroposterior pelvis radiography showed successful resection of heterotopic ossified mass, which was in accordance with the preoperative plan (Figure 9B).