title: Granulomatous foreign-body reaction involving oral and perioral tissues after injection of biomaterials: a series of 7 cases and review of the literature.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Diagnostic Sciences and Pathology, University of Maryland Dental School, Baltimore, MD 21201, USA. bjham001@UMaryland.edu
authors.forename: Bruno C
authors.initials: BC
authors.lastname: Jham
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Nikitakis
authors.forename: Mark A
authors.initials: MA
authors.lastname: Scheper
authors.forename: John C
authors.initials: JC
authors.lastname: Papadimitriou
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Levy
authors.forename: Helen
authors.initials: H
authors.lastname: Rivera
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000009:adverse effects*; D001704:Biopolymers / Q000009:adverse effects*; D046289:Body Modification, Non-Therapeutic / Q000009:adverse effects*; D003094:Collagen / Q000009:adverse effects; D003357:Cosmetic Techniques / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D015745:Granuloma, Foreign-Body / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008046:Lip; D008048:Lip Neoplasms / Q000175:diagnosis; D008067:Lipoma / Q000175:diagnosis; D008875:Middle Aged; D009061:Mouth Mucosa; D015626:Tissue Expansion / Q000009:adverse effects*
chemical_list: D001672:Biocompatible Materials; D001704:Biopolymers; D003094:Collagen