Search Results (7)

Background: Trismus, or restricted mouth opening, can present significant challenges in oral and maxillofacial surgery and trigger substantial functional and psychosocial disabilities. Intra-articular causes, such as temporomandibular joint ankylosis and arthritis, are thoroughly described; however, extra-articular pathologies like neoplastic, traumatic, infectious, and fibrotic conditions of adjacent soft and hard tissues are less frequently reported and present distinct diagnostic complexities and therapeutic hurdles. This retrospective study aims to investigate the difficulties encountered in diagnosis and surgical interventions associated with rare extra-articular causes of trismus. Material and Methods: This article describes five rare causes of extra-articular trismus. The cases range from benign pathologies like coronoid hyperplasia and osteomas to more complex diagnoses of myositis ossificans, external auditory canal abscess, and chronic osteomyelitis. A thorough diagnostic workup was performed for each patient, and specific surgical interventions were administered based on their pathology. Results: All five patients showed significant improvements in mouth opening after surgery. Diagnostic accuracy was ensured with advanced imaging modalities and innovative surgical techniques, and adequate postoperative care translated the favorable outcome. Conclusions: Although based on individual case descriptions, this study emphasizes the potential importance of early diagnosis, a multidisciplinary approach, and individualized treatment planning in managing rare extra-articular causes of trismus. These cases suggest a basis for a more organized system for the timely identification and treatment of such conditions. Additional research is needed to improve diagnostic accuracy, optimize surgical management, and develop evidence-based aftercare treatment to improve patient care and quality of life. Full article

Calcifications in soft tissue tumors present critical diagnostic challenges in musculoskeletal imaging. Their presence and morphology can provide key clues for differentiating benign from malignant lesions, influencing both prognosis and management strategies. This pictorial review aims to explore the imaging characteristics, patterns, and implications of soft tissue calcifications, with a focus on distinguishing between benign and malignant soft tissue tumors based on the World Health Organization classification. A systematic evaluation of imaging findings in various soft tissue tumor subtypes, including adipocytic, smooth muscle, vascular, chondro-osseous, and tumors of uncertain differentiation, is presented. Additionally, non-neoplastic causes of soft tissue calcifications, such as metabolic and inflammatory conditions, are reviewed for comprehensive differential diagnosis. Our review shows that the presence, distribution, and morphology of calcifications, such as stippled, punctate, coarse, and amorphous patterns, play a crucial role in tumor characterization. Some important examples are phleboliths, which strongly suggest a benign hemangioma, while dystrophic calcification is more commonly associated with malignant entities such as synovial sarcoma and dedifferentiated liposarcoma. Peripheral calcifications with zonal distribution are characteristic of myositis ossificans, whereas central dense calcifications may indicate extra-skeletal osteosarcoma. The review also discusses the significance of calcifications in non-neoplastic conditions, such as calcific tendinitis, tumoral calcinosis, and metabolic diseases, which can mimic soft tissue tumors. Recognizing the imaging characteristics of soft tissue calcifications is essential for accurate tumor classification and appropriate clinical management. This review highlights the importance of integrating radiologic findings with clinical and histopathological data to avoid misdiagnosis and unnecessary interventions. Full article

Diseases of the musculature can be caused, for example, by alimentary or traumatic issues. In three bald eagles with painful lameness and/or a reduced range of the hip joint, a muscular disease was diagnosed via radiographic examination. The eagles were kept in a falconry and trained as demonstration birds, which were displayed on a gloved hand and flown in falconry education programs. The imaging revealed varying degrees of calcification of the adductors along the course of the puboischiofemoral muscle of the left hind limb in all cases. A histological examination of the affected musculature of one eagle confirmed the presence of a myopathy with muscle fiber atrophy, fibrosis, and metaplastic bone formation. Increased mechanical stress and injuries to the affected muscle groups are discussed as the cause of these alterations. The adductor muscles of the left leg of bald eagles in falconry husbandry appear to be particularly prone to muscular injuries and the development of heterotopic ossification. The healing process of such an injury with the stiffened musculature can lead to restrictions in the movement of the hip joint. Thus, the conscious and professional handling of the eagles is essential for maintaining the health of these birds. Full article

Fibrodysplasia ossificans progressiva (FOP) is an exceptionally rare genetic disorder characterized by the progressive formation of heterotopic bone in soft tissues. Here, we present the radiological findings of an 18-year-old female diagnosed with FOP who had severe spinal and right-upper-limb abnormalities. Her SF-36 scores suggested significant impairment in physical function, affecting work and other regular daily activities. Radiographic evaluation with X-rays and CT scans revealed scoliosis and total fusion of almost all levels of the spine, with only a few disc spaces spared. A large mass of heterotopic bone was observed, corresponding to the location of the paraspinal muscles in the lumbar region, branching upwards and fusing with the scapulae on both sides. On the right side, this exuberant heterotopic bone mass fused with the humerus, resulting in a fixed right shoulder, while the rest of the upper and lower limbs are spared and have a range of motion. Our report highlights the extensive ossification that can manifest in patients with FOP, resulting in restricted mobility and a poor quality of life. While there is no definite treatment that can reverse the effects of the disease, preventing injuries and minimizing iatrogenic harm is of critical importance in this patient as inflammation is known to play a key role in triggering heterotopic bone. Meanwhile, ongoing research into therapeutic strategies holds the key to unlocking a potential cure for FOP in the future. Full article

Myositis ossificans (MO) is a benign heterotopic bone formation in muscle or soft tissue. It is a self-limiting disease that is usually initiated by trauma and often occurs in the extremities of the body. Here we report a rare case of traumatic myositis ossificans caused by unusual trauma (extracorporeal shock wave therapy) at thoracic paraspinal muscles. After a needle biopsy, the lesion increased in size, and the patient’s symptoms worsened. Malignant soft tissue tumors such as osteosarcoma should be differentiated, so excision of the mass was performed. The final diagnosis was MO with aneurysmal bone cystic change. This case is a very rare form of MO that showed an unusual cause, location, clinical course, and pathologic result on follow-up. This can be an instructive case for radiologists as it is a common disease entity with unusual manifestations. Full article

Background: Foam rolling is a type of self-massage using tools such as foam or roller sticks. However, to date, there is no consensus on contraindications and cautions of foam rolling. A methodological approach to narrow that research gap is to obtain reliable opinions of expert groups. The aim of the study was to develop experts’ consensus on contraindications and cautions of foam rolling by means of a Delphi process. Methods: An international three-round Delphi study was conducted. Academic experts, defined as having (co-) authored at least one PubMed-listed paper on foam rolling, were invited to participate. Rounds 1 and 2 involved generation and rating of a list of possible contraindications and cautions of foam rolling. In round 3, participants indicated their agreement on contraindications and cautions for a final set of conditions. Consensus was evaluated using a priori defined criteria. Consensus on contraindications and cautions was considered as reached if more than 70% of participating experts labeled the respective item as contraindication and contraindication or caution, respectively, in round 3. Results: In the final Delphi process round, responses were received from 37 participants. Panel participants were predominantly sports scientists (n = 21), physiotherapists (n = 6), and medical professionals (n = 5). Consensus on contraindications was reached for open wounds (73% agreement) and bone fractures (84%). Consensus on cautions was achieved for local tissue inflammation (97%), deep vein thrombosis (97%), osteomyelitis (94%), and myositis ossificans (92%). The highest impact/severity of an adverse event caused by contraindication/cautions was estimated for bone fractures, deep vein thrombosis, and osteomyelitis. Discussion: The mechanical forces applied through foam rolling can be considered as potential threats leading to adverse events in the context of the identified contraindications and cautions. Further evaluations by medical professionals as well as the collection of clinical data are needed to assess the risks of foam rolling and to generate guidance for different applications and professional backgrounds. Full article

Myositis ossificans is a disease that is characterized by nonneoplastic, heterotopic bone formation within a muscle. Myositis ossificans traumatica, also called myositis ossificans circumscripta, is a disease in which muscles are ossified presumably following acute trauma, burns, surgical manipulation, or repeated injury. It is often remitted after surgical excision though some patients have repeated recurrences. Myositis ossificans traumatica of masticatory muscles is not frequently reported in the literature, with the most common clinical finding being a progressive limitation of motion in the mandible. The aim of this article is to present and discuss a case of myositis ossificans traumatica of the left medial pterygoid muscle and to review the literature of myositis ossificans of the masticatory muscles. Full article