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

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.