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Neurogenic Heterotopic Ossification within the Temporomandibular Joint in a Stroke Patient

Keywords: Heterotopic ossification , Temporomandibular joint , Stroke , Bruxism

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A 50 year-old male with a history of atrial fibrillation onCoumadin developed an acute infarct of the right MiddleCerebral Artery (MCA) involving the frontal and temporallobes. The patient developed cerebral edema with amidline shift and hemorrhagic conversion. Aventriculostomy was performed followed by an emergentfrontotemporal decompressive craniotomy. The patientdeveloped uncal herniation and underwent a redofrontotemporal craniectomy with right temporallobectomy and decompression of midbrain withevacuation of the basal ganglia hematoma. On admissionto an inpatient rehabilitation unit, approximately 20 monthsafter onset of injury, the patient was found to have diffusespasticity with multiple severe contractures, limited rangeof motion, hemifacial spasms, bruxism and cervicalmuscle dystonia. Patient had limited opening of his mouthboth actively and passively, work up revealed matureheterotopic ossification (HO) of the lefttemporomandibular joint (TMJ) at the condyloid processat the level of the condyloid head and neck of themandible.


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