Treatment of Dystrophic Calcification in the Left Strap Muscle
Dystrophic calcification in the strap muscles (including the sternocleidomastoid) is typically managed conservatively with observation unless the calcification causes significant pain, functional impairment, or cosmetic concerns, in which case surgical excision is the definitive treatment. 1, 2
Understanding Dystrophic Calcification
Dystrophic calcification represents calcium phosphate deposition in damaged tissue without systemic calcium imbalance 1. In the head and neck region, this is rare and typically follows:
- Trauma (most common cause) 1, 2
- Infection or inflammation 1
- Prior surgical procedures (such as tracheostomy) 1
The condition is usually asymptomatic and discovered incidentally unless a palpable mass develops 1.
Initial Diagnostic Workup
Before determining treatment, confirm the diagnosis:
- Obtain CT imaging to characterize the calcified mass and rule out other pathology 2
- Perform blood tests including serum calcium, phosphate, parathyroid hormone, and alkaline phosphatase to exclude metabolic calcification 2
- Document detailed trauma history as dystrophic calcification can present 10-64 years after initial injury 3
Normal laboratory values confirm dystrophic (not metabolic) calcification 2.
Treatment Algorithm
Conservative Management (First-Line)
Observation is appropriate when:
- The calcification is asymptomatic 1
- No functional impairment exists (normal neck range of motion, no dysphagia) 1
- No cosmetic concerns from the patient 2
The rationale: Dystrophic calcifications can spontaneously resorb during tissue healing, though they may also persist or progress 4. Many patients require no intervention beyond reassurance 3.
Surgical Excision (Definitive Treatment)
Surgery is indicated when:
- Symptomatic mass causing pain or discomfort 2
- Functional limitation (restricted neck movement, dysphagia if near esophagus) 1
- Cosmetic concerns with visible or palpable deformity 2
- Diagnostic uncertainty requiring tissue confirmation 2
Surgical removal is straightforward with minimal complications when performed for symptomatic lesions 2. Complete excision prevents recurrence 2.
Medical Therapies (Limited Evidence)
While primarily studied in dermatomyositis-associated calcinosis rather than traumatic dystrophic calcification, the following have been attempted with minimal success 5:
- Diltiazem may produce partial response 5
- Bisphosphonates, colchicine, warfarin show minimal improvement 5
- Sodium thiosulfate (calcium chelator) has anecdotal success in severe cases 5
Important caveat: These medications are studied for inflammatory myopathy-related calcinosis, not post-traumatic dystrophic calcification in otherwise healthy muscle. Their efficacy for strap muscle dystrophic calcification is unproven 5.
Experimental Approaches
Research suggests pyrophosphate analogues can prevent dystrophic calcification formation after muscle injury, but this is not yet clinical practice 4. Plasmin activity prevents dystrophic calcification in animal models, but no human therapeutic application exists 4.
Key Clinical Pitfalls
- Do not assume malignancy - dystrophic calcification can mimic soft tissue tumors on examination but has characteristic imaging findings 1, 2
- Do not perform unnecessary surgery for asymptomatic lesions discovered incidentally 3
- Do not confuse with heterotopic ossification - dystrophic calcification lacks organized bone formation unless it progresses to heterotopic ossification 4, 6
- Do not overlook systemic causes - always check calcium metabolism to exclude metastatic calcification 2
Prognosis
Dystrophic calcifications may:
- Resorb spontaneously during tissue healing 4
- Persist indefinitely without symptoms 3
- Rarely progress to heterotopic ossification (organized bone formation) 4, 6
Surgical excision provides definitive resolution when intervention is needed 2.