Case Report: Unusual Presentation of Myositis Ossificans of the Elbow in a Child Who Underwent Excessive Postoperative Rehabilitation Exercise

Traumatic myositis ossificans (MO) is an unusual complication after muscle injury and is predominantly seen in young adults and adolescents. Pediatric MO cases are even rarer. We report an 8-year-old girl who was diagnosed with a lateral humeral condyle fracture. She was treated surgically, and her elbow joint was fixed with plaster. Rehabilitation exercise was administered 1 month after the operation. Due to the wrong exercise method, a palpable bony mass appeared around the elbow 1 month later. The clinical radiological diagnosis showed MO, and conservative treatment was administered. After 3 years of follow-up, the affected limb functioned well, with no sign of recurrence. Here, we report this long-term follow-up case of MO resulting from excessive rehabilitation exercise.

Spontaneous regression of solitary osteochondromas in children: An option to consider in clinical practice

Osteochondromas are neoplasm that belong to the family of cartilaginous histogenesis tumors and represent 90% of all forms of exostoses. As most osteochondromas are asymptomatic, underdiagnosis is frequent. Symptomatic forms usually manifest before the age of 20 years, and the most common symptoms are pain and the detection of a bony mass. Herein, we report four cases of spontaneous regression of solitary osteochondromas in the light of literature. We consider that orthopedic surgeons should take into account the possibility of spontaneous regression of these tumors, before recommending surgery. Symptoms are usually mild and we recommend following these patients with X-ray and physical examination annually.

Case report of a large rhinolith cast – A frequently missed diagnosis

Background: Rhinoliths are calcified or mineralized concretions that are deposited around a nucleus and are usually unilateral. They are rare with an estimated incidence of 1:10000 of all ENT outpatient cases. This may be an underestimation as many cases remain asymptomatic since the process may take years to develop. Case Report: We report a case of unilateral nasal obstruction since childhood in an adult male where the diagnosis remained obscured until thorough assessment was done. According to the anterior rhinoscopic and nasoendoscopic examination, there was an irregular bony mass occupying the left nasal cavity from the floor to the middle meatus. The diagnosis of rhinolith was confirmed by nasoendoscopy and non-contrast CT (NCCT) scan, and it was removed piecemeal from the nose. Conclusion: This case underlines the importance of a detailed clinical and endoscopic examination of the nose in adult cases with unilateral nasal obstruction. It also highlights the potential for misdiagnosis of such cases at the hands of general practitioners or physicians and the importance of early referral to an otolaryngologist in case of treatment failure by established protocols.

Tophaceous gout in the sternoclavicular joint

Gouty arthritis commonly occurs in peripheral synovial joints and involvement in the thoracic cage is extremely rare. We report a case of a 52-year-old presenting with a painful bony mass in her sternal notch. Imaging demonstrated a lobulated calcified and necrotic lesion causing mass effect on adjacent structures. Excision biopsy confirmed a benign cystic lesion with amorphous material containing needle-shaped refractile crystals suggestive of uric acid. Tophaceous gout was diagnosed. Presence of a periarticular mass with characteristics of gout should warrant investigation with biopsy and imaging. This can prevent misdiagnosis of malignancy and avoid unnecessary surgery in asymptomatic lesions.

Spontaneous Intraparenchymal Tension Pneumocephalus

Tension pneumocephalus is a treatable emergency that is usually caused by trauma or surgery. We present a rare case of spontaneous tension pneumocephalus. A 64-year-old woman presented with a severe aggravating headache. Computed tomography revealed a large air collection in the brain parenchyma of the right frontal lobe, both lateral ventricles, and the subarachnoid space. Emergent craniotomy was performed because her headache got progressively worse. We found that an abnormal bony protrusion connected the frontal sinus mucosa and the intraparenchymal pneumocephalus. After removal of the bony mass and repair of the defect, the patient immediately recovered and there was no recurrence.

Solitary osteochondroma of dorsal spine causing canal stenosis with myelopathy – A case report with review of literature

Background: Osteochondroma is a common benign tumor arising from the long bones. It rarely arises in the spine, where it can cause mild symptoms such as backache all the way up to compressive myelopathy. Malignant transformation has also been reported. Here, the authors present a 52-year-old male with myelopathy attributed to a rare thoracic solitary osteochondroma. Case Description: A 52-year-old male presented back pain radiating into both lower extremities with paresthesia to the toes of 1 year’s duration. On examination, he exhibited hyperactive bilateral lower extremity reflexes with bilateral Babinski signs, and focal sensory changes to pin, and touch appreciation in the left L5S1 distributions. Computed tomography and magnetic resonance imaging showed an abnormal bony mass arising from the posterior arch of T10 with protrusion into the spinal canal resulting in marked canal/cord compression. Surgery included a D10 laminectomy with en bloc resection of the lesion. Postoperatively, the patient’s symptoms resolved. Histologically, the lesion was an osteochondroma. Conclusion: When patients present with myelopathy, one should include osteochondromas among the differential diagnostic possibilities.

Osteonecrosis of Bilateral Mandibular Tori After Direct Laryngoscopy

A 36-year-old man underwent direct laryngoscopy with routine general anesthesia for a knee procedure. Several days later, he experienced pain involving an ulceration along the medial aspect of the right mandible in the floor of the mouth. This evolved to a painful bony mass, and subsequently, a bony sequestrum was spontaneously shed. The initially misdiagnosed pathologic process occurred several more times on both sides of the mouth. A computed tomography scan eventually revealed large bilateral mandibular tori, a feature that likely predisposed the patient to this course of events. Pain in the floor of the mouth after airway manipulation should be carefully evaluated and the possibility of osteonecrosis considered.

Ventral scapular osteochondroma excision through ‘triangle of auscultation’: A case series

Introduction: Surgical intervention through the ‘triangle of auscultation’ is less morbid to patients, as it is devoid of muscles and provides an easy access to tumours arising on the ventral aspect of scapula especially near inferior angle. Method: Three patients presented to us with pseudo-winging of scapula and an audible thud on abduction of the arm. A bony mass, painful in two and painless in one patient, was palpable along the anterior aspect of the inferior angle of scapula. A clinical diagnosis of osteochondroma was made which was corroborated by X-rays and computed tomography (CT) imaging. Ventral scapular osteochondroma excision is challenging due to multiple muscle attachments, requiring extensive soft tissue dissection and muscular release. Numerous blood vessels and nerves in the vicinity may also add to the degree of difficulty. This necessitates the need of a minimally invasive and muscle-sparing procedure. We hereby describe a novel surgical approach to the ventral aspect of scapula through the triangle of auscultation for excision of scapular osteochondroma. Results: Pseudo-winging disappeared following surgery. Snapping of the scapula resolved with early, full shoulder range of motion. Quick disabilities of arm, shoulder and hand (DASH) score improved from mean 20.2 preoperatively to 0 postoperatively at 3 months in all the patients. Conclusion: The approach is simple with minimal blood loss as it does not involve splitting or cutting of trapezius, rhomboid major or subscapularis muscles.

Ossification of the yellow ligament in the cervical spine – an unusual location

Ossification of the yellow ligament (OYL) or ligamentum flavum, usually occurs in the thoracic spine. Focal OYL occurring in the cervical spine is considered rare and is sparsely reported in the literature. We came across a 30-year-old male patient with progressive left upper limb and bilateral lower limb weakness over a period of 3 months, associated with an unsteady gait. Clinical examination revealed bilateral generalized hyper-reflexia in both upper and lower limbs, inverted supinator jerk, Hoffman’s sign and clonus. Myelopathy due to cord compression was suspected and further investigations were done. MRI and CT scans revealed a bony mass in relation to the C6 spinous process projecting anterosuperiorly and narrowing the cervical spinal canal causing cord signal changes from C4 to C6 levels. In view of the deteriorating neurological status, immediate surgery in the form of decompression and posterior stabilization from C4-C6 was performed. Patient gradually recovered after surgery and attained full functional status. We report this case considering the unusual location of OYL and its successful management.