Shokoufeh Shahrabi-Farahani1, Mark A Lerman2, Vikki Noonan3, Sadru Kabani4, Sook-Bin Woo5. 1. Assistant Professor, Department of Diagnostic Sciences and Oral Medicine, Division of Oral and Maxillofacial Pathology, UTHSC College of Dentistry, Memphis, TN, USA. Electronic address: shokoufeh_sf@post.harvard.edu. 2. Assistant Clinical Professor, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA. 3. Associate Professor, Boston University School of Dental Medicine, Boston, MA, USA; Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA. 4. Co-Director and Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA. 5. Associate Professor, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; Chief of Clinical Affairs, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Co-Director and Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA.
Abstract
OBJECTIVE: We report intraoral granulomatous foreign body reactions in patients treated with calcium hydroxylapatite (CHA) or poly-l-lactic acid (PLA). STUDY DESIGN: Clinical and histopathologic data were obtained from 25 patients who developed orofacial nodules or swelling after dermal filler injections. RESULTS: All 25 patients were women aged 35 to 78 years (median, 55 years). All had a history of injection of CHA (n = 13) or PLA (n = 12) to the lips, nasolabial area, or mental area. Two patients developed cutaneous nodules at the sites of injections; all others presented with intraoral nodules (labial/buccal or vestibular mucosa) distant from the site of injections, suggestive of filler migration. Five of 21 cases presented with pain. Histopathologically, CHA presented as a diffuse mass of mauve-gray or beige, nonrefractile spherules, and PLA as rice- or spindle-shaped, geometric, refractile bodies within circumscribed nodules. CONCLUSIONS: Cutaneous injections of CHA and PLA fillers may induce granulomatous reactions presenting as intraoral nodules distant from the injection sites.
OBJECTIVE: We report intraoral granulomatous foreign body reactions in patients treated with calcium hydroxylapatite (CHA) or poly-l-lactic acid (PLA). STUDY DESIGN: Clinical and histopathologic data were obtained from 25 patients who developed orofacial nodules or swelling after dermal filler injections. RESULTS: All 25 patients were women aged 35 to 78 years (median, 55 years). All had a history of injection of CHA (n = 13) or PLA (n = 12) to the lips, nasolabial area, or mental area. Two patients developed cutaneous nodules at the sites of injections; all others presented with intraoral nodules (labial/buccal or vestibular mucosa) distant from the site of injections, suggestive of filler migration. Five of 21 cases presented with pain. Histopathologically, CHA presented as a diffuse mass of mauve-gray or beige, nonrefractile spherules, and PLA as rice- or spindle-shaped, geometric, refractile bodies within circumscribed nodules. CONCLUSIONS: Cutaneous injections of CHA and PLA fillers may induce granulomatous reactions presenting as intraoral nodules distant from the injection sites.
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