MRI helps identify adverse Effects due to Hyaluronic Acid Filler- case report

"What is interesting about this case is that the same filler therapy in one session led to three different complications in a patient with an inconspicuous general medical history," wrote the group, led by Dr Philipp Becker from the department of oral and maxillofacial surgery at the Federal Armed Forces Hospital, Rübenacherstr in Germany.

Case Description:

The authors delineated the case of a 62-year-old healthy woman who went to the oral and maxillofacial surgery clinic after developing a hard, tender swelling near the right jaw angle. Three months earlier, her cheekbones and each side of her jaw had been injected with a hyaluronic acid filler. After a few days of soft tissue augmentation, the woman was presented with an inflammatory swelling over the left zygomatic arch which was treated with antibiotics. Shortly thereafter, a similar finding appeared on the left corner of the jaw. It was also improved after incision, drainage and several days of antiseptic irrigation. After the inflammation subsided, a few weeks later, she was again presented with a renewed inflammatory swelling in the area of the right angle of the jaw, which did not improve despite surgical drainage with oral antibiotic therapy and injections with hyaluronidase.

She was then admitted to Becker and colleagues clinic. During admission, she had an approximately 2 cm large, rough, painful swelling with restricted mouth opening (interincisal distance 15 mm).

Ultrasound revealed an approximately 20 × 15 mm encapsulated mass, which matched a granulomatous melted inflammation. To reduce the inflammation, the physicians administered intravenous ampicillin/sulbactam due to the closeness of the mass to the facial nerve, and an MRI scan was performed. The MRI findings showed a polylobulated lesion that measured 13 x 10 x 15 mm in the right masseter muscle. The findings were compatible with an inflammatory nodule which was then punctured and aspirated. They found no pus, secretions or blood in the aspiration. So the physicians diagnosed the accumulation of the injected mass for hyaluronic acid filler and not for an abscess. Due to the localization and extent of the findings, the physicians decided to continue the conservative intravenous antibiotic therapy, whereby the clinical symptoms regressed.

The authors concluded, "In the case of unsuccessful long-term antibiosis and unsuccessful hyaluronidase therapy, surgical resection would have been the last option if the symptoms persist."

They further added, "Proper medical training, knowledge of the patient and an experienced handling of the therapeutics used are basic requirements for success with the lowest possible complication rate of aesthetic medicine."

For further information:

DOI: https://doi.org/10.1016/j.adoms.2021.100034