Article Figures & Data
Figures
- Fig 1.
Axial contrast-enhanced neck CT scans and 3D reformat performed in a 59-year-old-man who underwent fibular free flap reconstruction for osteomyelitis complicating segmental mandibulectomy (patient 3). Imaging performed at 1 month (A), 2 months (B), and 12 months (C) shows progressive ossification in the left neck from linear segmental densities to a linear attenuation to a linear structure with features characteristic of bone (arrows). The new bone is of greater attenuation than enhancing vessels and is less attenuated than adjacent vascular clips. D, 3D reformation from a CT scan at 9 months when the pedicle ossification (arrows) was first mentioned in the imaging report.
- Fig 2.
Different patterns of heterotopic ossification. Axial contrast-enhanced CT (A) in a 77-year-old man (patient 4) 5 months after FFF reconstruction shows multiple linear densities (white arrows); we classify this pattern as multisegmented ossification. Note that pedicle ossification is clearly denser than the adjacent enhancing flap vessels (black arrow). Coronal face CT (B) in a 72-year-old man (patient 9) 5 months after reconstruction shows vertical linear ossification (white arrow) with a more superior triangular bonelike component (black arrow). Sagittal reformat from neck CT (C) in a 51-year-old man (patient 6) 10 months after reconstruction for recurrent HNSCC shows curved bonelike ossification (arrows). 3D reformat (D) in a 37-year-old man (patient 2) 9 months after reconstruction following resection of a maxillary osteoblastic osteosarcoma shows a linear bonelike structure (arrows).
- Fig 3.
Axial nonenhanced CT in a 73-year-old man 3 weeks after FFF reconstruction shows tram-track vascular calcification in the wall of the peroneal artery (arrows), a pattern typical of atherosclerosis. This appears distinctly different from the attenuated, linear, continuous, or multisegmented patterns that were observed in patients with periosteal ossification. Pedicle ossification is not evident on this scan, and the patient had no further CT or PET/CT follow-up at our institution.
- Fig 4.
Operative and histopathology images from same patient as in Fig 1 (patient 3). Intraoperative photograph (A) at 13 months following fibula microvascular transfer demonstrates pronounced heterotopic calcification of the fibula periosteum (arrows). Also note surgical clips (curved arrow) that were placed on side branches during the fibula transfer. Histologic section of this resected bone (B) with hematoxylin and eosin stain at magnification of 200X shows mature lamellar bone without marrow elements. This bone is microscopically indistinguishable from native bone, such as the hyoid.
