Neck mass secondary to pedicle ossification after oromandibular reconstruction

Educational Objective: At the conclusion of this presentation the participants should be able to describe this newly described phenomenon associated with fibula free flap oromandibular reconstruction. Objectives: 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. Study Design: Retrospective review at a university medical center. Methods: Patient database of 520 consecutive fibula free flaps between 1995-2010 were reviewed to identify patients who had postoperative 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, 43/66 (65%) showed heterotopic ossification of the fibula periosteum. Clinically, 14/520 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, while 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.