上唇永久性填充并发症的组织学、临床评估和治疗:随访 16 年的病例报告

IF 3.4 Q2 BIOCHEMISTRY & MOLECULAR BIOLOGY
Samuel Fiuza, Tiago Marques, Irving Padin, Maria Teresa Carvalho, Nélio Veiga, Juliana Campos Hasse Fernandes, G. Fernandes, P. Couto
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引用次数: 0

摘要

旨在改变面部美学,尤其是嘴唇外观的物质和医疗程序的使用大幅增加。聚二甲基硅氧烷(又称液态硅氧烷)等永久性填充剂被广泛使用,但它们在面部美容方面的应用目前已经过时。硅酮属于这种聚合物家族;其粘度由聚合度决定。液态注射用硅胶无味、无色、不挥发,手感油腻。这种物质在室温下储存不会发生变化,也不会致癌或致畸。然而,长期并发症仍然是一个现实问题,因为它们可能在应用后几十年才出现。因此,本病例报告旨在介绍使用液态硅胶治疗 16 年后出现的并发症。本病例报告涉及一名 52 岁的男性,他在 16 年前接受了双侧上唇永久性填充术,术后出现了并发症,并进行了手术切除和组织学分析。患者于 2022 年 4 月首次到葡萄牙维塞乌天主教大学牙科诊所就诊,当时他对上唇的外观和形状不满意。他不吸烟,也没有糖尿病,但患有高血压和高胆固醇血症,并服用了洛沙坦、氢氯噻嗪和匹伐他汀等药物。口外检查未发现任何相关结果;他有磨牙症,牙周状况良好。患者上唇有一个无症状的双侧肿块,触诊困难,是由于 2006 年为增加唇部容积而进行的永久性唇部填充造成的,并伴有非相关性的全身性福尔蒂斯颗粒。患者选择的治疗方案是观察或分两次手术完全切除肿物。然后,在右侧嘴唇局部麻醉下进行了第一次手术,使用 2% 的利多卡因和 1:100,000 的肾上腺素,用霰粒肿钳夹住霰粒肿,用二极管激光控制出血,然后进行简单缝合。在这一过程中,活检了三个碎片:一个长方体,大小为 1 × 1 × 0.8 厘米;一个不规则的碎片,由两个碎片组成,其中一个碎片的一端彼此相连,大小为 1.6 × 0.5 × 0.4 厘米,另一个为 2.5 × 0.6 × 0.5 厘米。所有材料的宏观外观相似,呈白色,表面不规则,有弹性,切面呈白色,或略带束状。患者接受了泰诺 500 毫克的药物治疗,每天三次,连续两天。间隔 20 天后,按照同样的手术技巧和用药方法,拆除了第一次手术的缝合线以及左侧上唇的异物。从组织学角度看,可以发现一种慢性炎症、淋巴浆细胞性和肉芽肿反应,并伴有异物巨细胞反应,这与硅胶反应引起的非极性外源性物质有关。最常见的并发症是肉芽肿出现和材料移位。病例报告显示,这些肉芽肿的特点是硅胶周围出现慢性低度炎症。这些肉芽肿的病因不明,但很可能是多因素造成的,包括持续的创伤、摩擦或刺激、先天性因素、感染、免疫机制以及遗传和分子变异,而且可能与注射材料的不纯密切相关。本病例为医疗专业人员提供了一个机会,使他们能够提高对用于填充唇部的硅胶材料的长期不良影响的认识,从而使其应用更具可预见性和自觉性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Histological, Clinical Assessment, and Treatment of a Permanent Filler Complication in the Upper Lip: A Case Report with 16-Year Follow-Up
There is a considerable increase in the use of substances and medical procedures aimed at changing the esthetics of the face, particularly the appearance of the lips. Permanent fillers such as polydimethylsiloxane, also called liquid silicone, are widely used, but their application for facial esthetics is currently obsolete. Silicone belongs to this polymer family; its viscosity is determined by its degree of polymerization. Liquid injectable silicone is odorless, colorless, non-volatile, and oily to the touch. The substance is not altered by storage at room temperature and is not carcinogenic or teratogenic. However, the long-term complications remain a reality, as they can occur decades after the application. Thus, the goal of this case report was to present a complication after 16 years of treatment using liquid silicone. This case report involved a 52-year-old male with a complication of bilateral permanent filler in the upper lip performed 16 years ago, its surgical removal, and histological analysis. The patient had the first appointment at the University Dental Clinic—Universidade Católica Portuguesa (Viseu, Portugal) in April 2022, dissatisfied with his upper lip’s esthetic appearance and shape. He was not a smoker or diabetic but had hypertension and hypercholesterolemia and was medicated with Losartan, Hydrochlorothiazide, and Pitavastatin. No relevant findings were observed in the extraoral examination; he had bruxism and a good periodontal condition. The patient had an asymptomatic bilateral mass, hard to palpation, located on the upper lip due to permanent lip filling performed to increase its volume in 2006 associated with non-related generalized granules of Fordyce. The treatment options presented just observation or complete material removal in two surgical steps, which was the patient’s choice. Then, the first surgical procedure was performed under local anesthesia on the right side of the lip, one carpule of Lidocaine 2% with adrenaline 1:100,000, with a chalazion clamp, a diode laser for hemorrhagic control, and a simple suture. In this procedure, three fragments were biopsied: a cuboid measuring 1 × 1 × 0.8 cm and an irregular one consisting of two fragments that at one end of the piece were in continuity with each other, one measuring 1.6 × 0.5 × 0.4 cm and the other 2.5 × 0.6 × 0.5 cm. A similar macroscopic appearance in all the material, white in color, irregular surface, elastic, white section surface, or slightly fasciculate. The patient was medicated with Tylenol 500 mg thrice a day for two days. With 20-day intervals, the sutures from the first surgery were removed, as well as the foreign body from the upper lip on the left side, following the same surgical technique and medication. Histologically, it was possible to identify a chronic inflammatory, lymphoplasmacytic, and granulomatous reaction, with foreign body giant cells’ reaction, in relation to non-polarizable exogenous material due to the reaction to silicone. The most common complications are granulomas’ appearance and material displacement. The case report shows these granulomas are characterized as chronic low-caliber inflammation around the silicone. They have an unknown etiology but are probably multifactorial, from continuous trauma, friction or irritation, iatrogenic factors, infection, immunological mechanisms, and genetic and molecular variations, and can be highly related to the impurity of the injected material. This case brings the opportunity for health professionals to increase awareness of the long-term adverse effects of the silicone material used to fill the lip in order to make its application more predictable and conscious.
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来源期刊
Cosmetics
Cosmetics Medicine-Surgery
CiteScore
5.20
自引率
12.10%
发文量
108
审稿时长
8 weeks
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