Introduction: Heterotopic ossification (HO) is the formation of ectopic bone within muscle or soft tissue. Traumatic HO (tHO) is the most common form of HO and most frequently occurs after trauma or surgery of the extremities. Current treatment options for HO are prophylactic non-steroidal anti-inflammatory drugs, radiation therapy and surgical resection.

Material and methods: Case report

Results: A 60-year-old male presented to the otorhinolaryngology clinic of BG Klinikum Unfallkrankenhaus Berlin with progressive dyspnea with stridor and dysphagia. One year previously, the patient had suffered injuries in a car accident requiring long-term intubation and tracheostomy. He had been decannulated 4 months earlier. Feeding was provided via a PEG on admission. Examination showed bilateral vocal cord paralysis in median position. Swallowing was impaired by absent larynx elevation. During same-day retracheostomy it was found that the subcutaneous tissue and infrahyoid muscles had undergone heterotopic ossification. Subsequent computed tomography of the neck additionally revealed bilateral ossification of the cricoarytenoid joint and the stylohyoid ligament. Revision to remove ossified tissue fixating larynx and trachea and bilateral resection of the stylohyoid ligament was performed. To minimize the risk of recurrence, a single dose of radiation (7Gy) was administered 24 hours prior to revision. After improvement of swallowing, unilateral arytenoidectomy was carried out to enhance the airway. The patient ist undergoing follow-up.

Conclusion:Heterotopic ossification is a rare and potentially severe complication after tracheostomy and long-term intubation. Progressive dysphagia or bilateral vocal cord paralysis may be indicators.

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