title: Neck mass due to pedicle ossification after oromandibular reconstruction.
abstract: OBJECTIVE
  To determine the radiographic incidence of heterotopic ossification and the clinical incidence of neck masses secondary to heterotopic ossification in a series of patients who underwent fibula free flap oromandibular reconstruction.
  
  
  METHODS
  Retrospective review at a university medical center.
  
  
  METHODS
  Patient database of 520 consecutive fibula free flaps from 1995 to 2010 was reviewed to identify patients who had postoperative computed tomography (CT) scans of the neck to further investigate the radiologic presence of heterotopic ossification. Patient chart review was also performed to identify patients who had clinical evidence of neck masses consistent with heterotopic ossification.
  
  
  RESULTS
  Of the 66 patients who had postoperative CT scans available for radiologic assessment, 43 (65%) showed heterotopic ossification of the fibula periosteum. Clinically, 14 of 520 patients (2.6%) presented with firm, level I or II neck masses that proved to be secondary to heterotopic ossification.
  
  
  CONCLUSIONS
  Development of a firm neck mass after treatment of head and neck cancer often indicates recurrent tumor. Heterotopic ossification has not been previously reported as a potential etiology of neck masses after fibula free flap oromandibular reconstruction in the head and neck surgery literature. The radiographic incidence of this phenomenon is high, and the clinical incidence of neck masses secondary to heterotopic ossification is low. Heterotopic ossification can be distinguished from recurrent tumor on the basis of physical examination, radiographic assessment, and/or fine-needle aspiration biopsy. Awareness of heterotopic ossification should be included in the differential diagnosis of patients with a neck mass who have undergone fibula free flap reconstructions.
authors: Division of Head and Neck Surgery, University of California, Los Angeles, California 90095-1624, USA. adeconde@mednet.ucla.edu
authors: Adam S
authors: AS
authors: DeConde
authors: Darshni
authors: D
authors: Vira
authors: Keith E
authors: KE
authors: Blackwell
authors: John M
authors: JM
authors: Moriarty
authors: Joel A
authors: JA
authors: Sercarz
authors: Vishad
authors: V
authors: Nabili
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005360:Fibula / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D009055:Mouth / Q000601:surgery; D009333:Neck / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009999:Ossification, Heterotopic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply; D014057:Tomography, X-Ray Computed / Q000379:methods