Background Heterotopic ossifications are lamellar bone formations within soft tissues. They can occur after trauma, orthopedic surgery, neurologic injuries, burns, hematoma, necrosis or even spontaneously. They can have major functional consequences. Ossifications of head and neck have already been reported, but never after cervical fasciitis. We describe here 26 cases.
Objectives To reported rare complication of cervical fasciitis
Methods Retrospective study of cervical fasciitis occurring between January 2008 and May 2013, with post surgery CT scans. Tomography images have been read by a neuroradiologist with anatomic expertise of the cervical region. Features of infections (origin, microbiology), patient demographic and clinical data (age, sex, diabetes, immunodepression) and ossifications are described.
Results Among 170 fasciitis cases, 98 had post surgery CT scan, 36 of which were performed more than 28 days after surgery. 26 cases of ossification were identified (6 women, 20 men). Mean age was 50.6±16.6 years. Comorbidities included hypertension (n=5), diabetes mellitus (n=3), ischemic cardiopathy (n=1), chronic bronchitis (n=2), allergy (n=3), dyslipidemia (n=4), neurovascular events (n=1), previous talus bone infection after fracture (n=1), and congenital deafness (n=1). 8 patients reported smoking, and one patient admitted regular important alcohol uptake. Origin of the infection was dental (n=9), sub-maxillary (n=5), parapharyngeal (n=1), peritonsillar (n=9), foreign body in piriform sinus (n=1), unknown (n=1). Mediastinitis was associated in 10 cases. Microbiology showed involvement mostly of streptococcus (n=18), staphylococcus aureus (n=2) and epidermidis (n=3), and anaerobic bacteriae (n=6). Seven patients had trismus. CT scan showed that bone formations lay within muscles, or in cervical fascias, along surgical detachment plans.
Conclusions Heterotopic ossifications are unknown and probably underestimated complications of cervical fasciitis, that can entail important functional impairment. CT scan is a sensitive imaging tool and can be performed in the presence of trismus.
Disclosure of Interest None declared