Multiple supramassetric dystrophic calcinosis
A 17-year-old boy reported to the department of oral and maxillofacial surgery with a complaint of painless multiple swelling over the right massetric region since 2 years, which was obvious only after clenching. The patient was healthy without any medical and dental abnormalities. He could not recollect any incidence of trauma to the affected site.\nOn examination facial asymmetry with swelling at the right mandibular angle region was evident only on clenching []. Palpation revealed superficial well-circumscribed, well-defined, discrete, painless masses of different sizes (2 × 3 mm, 2 × 2 mm, 1 × 2 mm, 1 × 1 mm, approximately). They were not adherent to the underlying structures and freely movable in all directions. Routine blood investigations were within normal range. Serum calcium and phosphorous were also within normal limits. Panoramic radiograph reveals multiple well-defined radio-opaque masses scattered over the lower border of the right mandibular angle region below the mandibular third molar []. Axial view of CT scan examination revealed a multiple hyperdense masses located in the region of the right mandibular angle over the right masseter muscle [].\nMyositis ossificans, osseous calcified nodules and osseous choriostoma were considered in the differential diagnosis. Intraoral excision was planned under general anesthesia. The incision was placed in the buccal vestibule opposite to the first molar extending along the anterior border of the ramus toward coronoid notch []. Blunt dissection was carried supraperiostally extending toward the masses till it was identified []. The head was fixed in position with proper retraction throughout the procedure which was important. The assistant fixed the masses from outside while dissecting.\nThe whole bunch of nodules was excised []. While dissecting intraorally care was taken to prevent injury to the facial artery and vein. During the procedure, bleeding was encountered due to injury to the facial vein, which was managed using bipolar diathermy. The excised masses were sent for histopathological examination, which was revealed as calcified bodies within the fibrous connective tissue []. Post operative healing was uneventful. Patient was followed up for more than a year without any recurrence.