Granulomatous Foreign-Body Reaction Involving Oral and Perioral Tissues After Injection of Biomaterials: A Series of 7 Cases and Review of the Literature
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.
⁎Resident and Doctoral Student in Oral and Maxillofacial Pathology, Department of Diagnostic Sciences and Pathology, University of Maryland Dental School, Baltimore, MD
†Assistant Professor, Department of Oral Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
‡Assistant Professor, Department of Diagnostic Sciences and Pathology, University of Maryland Dental School, Baltimore, MD
§Professor, Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
‖Professor and Program Director, Department of Diagnostic Sciences and Pathology, University of Maryland Dental School, Baltimore, MD
¶Professor, Institute of Dental Research, Oral Pathology Laboratory, Faculty of Dentistry, Central University of Venezuela, Ciudad Universitaria, Caracas, Venezuela
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
B.C.J. gratefully acknowledges National Counsel of Technological and Scientific Development-Brazil doctorate scholarship 201590/2006-9.
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