# Heterotopic ossification of the fibula flap pedicle causing trismus in a pediatric maxillary reconstruction

## TL;DR

A 13-year-old boy developed abnormal bone growth after a facial reconstruction surgery, leading to jaw stiffness that required further surgery.

## Contribution

This case highlights a rare complication in pediatric patients undergoing fibula flap reconstruction and emphasizes the need for long-term monitoring.

## Key findings

- Heterotopic ossification occurred along the fibula flap pedicle in a pediatric patient.
- The complication caused severe trismus requiring surgical intervention.
- Long-term surveillance and periosteal management are critical in such cases.

## Abstract

We present the case of a 13-year-old boy who developed heterotopic ossification along the pedicle of a fibula osteocutaneous free flap used for complex midface reconstruction following a ballistic injury. While rare in pediatric patients, this complication resulted in severe trismus, which required surgical excision of the pedicle. This case highlights the importance of long-term surveillance and periosteal management strategies in children undergoing fibula flap reconstruction of the maxilla.