title: Granulomatous foreign body reaction to dermal cosmetic fillers with intraoral migration.
abstract: OBJECTIVE
  We report intraoral granulomatous foreign body reactions in patients treated with calcium hydroxylapatite (CHA) or poly-l-lactic acid (PLA).
  
  
  METHODS
  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.
authors: 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.
authors: Shokoufeh
authors: S
authors: Shahrabi-Farahani
authors: 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.
authors: Mark A
authors: MA
authors: Lerman
authors: Associate Professor, Boston University School of Dental Medicine, Boston, MA, USA; Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA.
authors: Vikki
authors: V
authors: Noonan
authors: Co-Director and Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA.
authors: Sadru
authors: S
authors: Kabani
authors: 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.
authors: Sook-Bin
authors: SB
authors: Woo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000009:adverse effects*; D017886:Durapatite / Q000009:adverse effects*; D005260:Female; D005548:Foreign-Body Migration / Q000473:pathology*; D005549:Foreign-Body Reaction / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007271:Injections, Intradermal; D019344:Lactic Acid / Q000009:adverse effects*; D008875:Middle Aged; D009055:Mouth / Q000473:pathology*; D011091:Polyesters; D011108:Polymers / Q000009:adverse effects*
chemical_list: D001672:Biocompatible Materials; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide); D017886:Durapatite