Granulomatous Foreign-Body Reaction Involving Oral and Perioral Tissues After Injection of Biomaterials: A Series of 7 Cases and Review of the Literature

Jham, Bruno C.; Nikitakis, Nikolaos G.; Scheper, Mark A.; Papadimitriou, John C.; Levy, Bernard A.; Rivera, Helen

doi:10.1016/j.joms.2008.01.052

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 2 , Pages 280-285, February 2009

Granulomatous Foreign-Body Reaction Involving Oral and Perioral Tissues After Injection of Biomaterials: A Series of 7 Cases and Review of the Literature

Bruno C. Jham, DDS, MS
- Resident and Doctoral Student in Oral and Maxillofacial Pathology, Department of Diagnostic Sciences and Pathology, University of Maryland Dental School, Baltimore, MD
- Address correspondence and reprint requests to Dr Jham: Department of Diagnostic Sciences and Pathology, University of Maryland Dental School, 650 West Baltimore St, Floor 7 North, Baltimore MD, 21201
Nikolaos G. Nikitakis, DDS, PhD
- Assistant Professor, Department of Oral Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
Mark A. Scheper, DDS, PhD
- Assistant Professor, Department of Diagnostic Sciences and Pathology, University of Maryland Dental School, Baltimore, MD
John C. Papadimitriou, MD, PhD
- Professor, Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
Bernard A. Levy, DDS, MSD
- Professor and Program Director, Department of Diagnostic Sciences and Pathology, University of Maryland Dental School, Baltimore, MD
Helen Rivera, DDS, MS
- Professor, Institute of Dental Research, Oral Pathology Laboratory, Faculty of Dentistry, Central University of Venezuela, Ciudad Universitaria, Caracas, Venezuela

Purpose

Injectable implants used for soft-tissue augmentation may lead to a granulomatous foreign-body reaction. The aim of this report is to present 7 new cases of foreign-body granulomas involving the oral and perioral tissues, after injection of biomaterials to achieve soft-tissue augmentation. In addition, the clinical and epidemiological profile of this condition is summarized, based on a review of the English-language literature of all previously described cases.

Patients and Methods

We report on 7 new cases of granulomatous foreign-body reaction involving the oral and perioral tissues after the injection of biomaterials. A comprehensive literature review is also presented.

Results

The literature search revealed 49 cases of this condition affecting the oral and perioral tissues. Our 7 patients were female, with a mean age of 52.8 years (range, 34 to 70 years). The lower lip was affected in 4 cases, 1 case was located in the upper lip, 1 case in the buccal mucosa, while 1 case involved 2 different sites (upper lip and buccal mucosa). Histopathologic examination revealed numerous cells with clear, often multiple, cytoplasmic vacuoles, bearing a resemblance to lipoblasts. Immunohistochemistry revealed diffuse positivity for the histiocytic marker CD68.

Conclusions

The diagnosis of granulomatous foreign-body reactions may be challenging because of their microscopic resemblance to liposarcoma, and because of the occasional reluctance of patients to report the previously performed esthetic procedure. A clinical history, histopathologic examination, and immunohistochemical analysis (as needed) are essential in achieving an accurate diagnosis.