• Journal of Chest Surgery
• /
• v.56 no.1
• /
• pp.53-55
• /
• 2023

Silicone granulomas are rare, benign lesions that may occur after breast augmentation. Occasionally, a careful differential diagnosis is necessary because lymphadenopathy or malignancy is suspected based on an imaging study. A 56-year-old woman who visited the hospital due to a lung nodule in the left upper lobe (LUL) underwent a staging work-up with the suspicion of lung cancer. Positron emission tomography/computed tomography and chest computed tomography revealed the LUL nodule and a lesion in the left internal mammary chain (IMC), suggesting lymphadenopathy. Diagnostic wedge resection was performed, followed by curative surgery. The final biopsy result confirmed that the LUL nodule was pathologic stage IB adenocarcinoma; unexpectedly, the lesion in the left IMC was a silicone granuloma.

• Investigative Magnetic Resonance Imaging
• /
• v.22 no.2
• /
• pp.110-112
• /
• 2018

We report the case of a patient who presented with rupture of a silicone breast implant showing acute and chronic inflammation. Magnetic resonance imaging (MRI) showed silicone foci outside the implant shell and inside the pectoralis muscles that represented intra- and extracapsular ruptures of the implant and silicone granuloma. There were distinct fluid-fluid levels of various signal intensities and no signs of implant collapse such as 'linguine sign.' Rather, we detected enlargement of both the implant shell and the breast.

• Archives of Plastic Surgery
• /
• v.42 no.2
• /
• pp.232-239
• /
• 2015

A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.

• Archives of Plastic Surgery
• /
• v.35 no.5
• /
• pp.611-614
• /
• 2008

Purpose: Infection, foreign body reaction and decreased volume of implant are common complications after augmentation rhinoplasty with $Gore-tex^{(R)}$ implant. The author experienced two cases of recurrent foreign body granuloma in the patients who underwent $Gore-tex^{(R)}$ removal because of infection after augmentation rhinoplasty. and treated them with complete removal of$Gore-tex^{(R)}$. Methods: Case 1: A 49 year-old female visited our clinic for recurrent foreign body reaction on nasal dorsum and tip area. The patient underwent augmentation rhinoplasty with $Gore-tex^{(R)}$ 3 years ago and implant was removed due to infection 9 months ago. Excision of the granuloma was performed and a piece of foreign body suspicious to be a $Gore-tex^{(R)}$ implant debris was detected under the subcutaneous pocket. The implant fragments were removed and nasalis muscle rotation flap was performed to cover the lesion. The specimen was proved to be $Gore-tex^{(R)}$ in histological study. Case 2: A 31 year-old-male with recurrent foreign body granuloma on the nasal tip area visited our clinic. 10 years ago, the patient had augmentation rhinoplasty with silicone implant and then, he underwent revisional rhinoplasty five times including nasal implant removal, which was performed 9 months ago. The authors excised the granuloma and found a small sized foreign body suspicious to be a $Gore-tex^{(R)}$ implant debris under the granuloma. The foreign body was excised and identified to be $Gore-tex^{(R)}$ in histological study. Results: In both cases, the lesions were healed without any complications and there were no evidences of recurrence up to 6 months of follow-up. Conclusion: The $Gore-tex^{(R)}$ is known to be weak against mechanical force. These properties of $Gore-tex^{(R)}$ make it difficult to remove the implant completely. In the patient who have infection after augmentation rhinoplasty with $Gore-tex^{(R)}$, the operator should take care to perform the complete removal without remaining fragment of the implant.

• Archives of Craniofacial Surgery
• /
• v.22 no.1
• /
• pp.26-32
• /
• 2021

Background: Various substances are currently being used for cosmetic or postsurgical reconstruction reasons. Injecting of various materials into the face may provoke inflammatory or granulomatous reactions, infection and tissue necrosis. Among these reactions are foreign body granulomas. This study aims to describe the clinical characteristics of and therapeutic approaches used in patients with facial foreign body granulomas caused by the injection of various substances. Methods: From 2007 to 2020, a total of 64 patients visited our hospital due to inflammatory signs, palpable masses or surface irregularities. We reviewed patient characteristics, type of injected material, medical history and treatment outcomes. The treatment results were scored with patient satisfaction and statistical analysis of the treatment period was performed. Results: Most patients underwent conservative treatment followed by surgical treatment because of persistent symptoms; one patient did not require surgery. All patients reported good treatment results and satisfaction. The earlier the surgical treatment was performed, the shorter the treatment period and the higher patient satisfaction scoring. Conclusion: Granulomatous changes to the face are an emerging concern in various cosmetic procedures and surgeries, including fillers, silicone implants and autologous fat injections. Our findings strongly suggest that patient symptoms require accurate diagnosis and surgical treatment.

• Korean Journal of Bronchoesophagology
• /
• v.14 no.2
• /
• pp.10-16
• /
• 2008

Surgical resection and reanastomosis has been the treatment of choice in patients with tracheobronchial stenosis. Recent development of bronchoscopic intervention has been replacing the role of surgery in these patients. After summarizing the upto date data of bronchoscopic intervention, the proper management of tracheobronchial stenosis will be presented. Bronchoscopic intervention would be much effective when performed under rigid bron- choscopy, due to the stable patients' condition and endoscopic view. The usual method of intervention includes ballooning, Nd-YAG laser resection, bougienation, mechanical airway dilatation, stenting and photodynamic therapy. Silicone stents are very effective in patients with tracheobronchial stenosis to maintain airway patency. Bronchoscopic intervention provided immediate symptomatic relief and improved lung function in most of patients. After airway stabilization, stents were removed successfully in 2/3 of the patients at a 12-18 months post-insertion. Less than 5% of patients eventually needs surgical management. Acute complications, including excessive bleeding, pneumothorax, and pneumomediastinum develops in less than 5% of patients but managed without mortality. Stent-related late complications, such as, migration, granuloma formation, mucostasis, and restenosis are relatively high but usually controlled by follow-up bronchoscopy. In conclusion, bronchoscopic intervention, including silicone stenting could be a useful and safe method for treating tracheobronchial stenosis.

• Archives of Plastic Surgery
• /
• v.37 no.3
• /
• pp.233-238
• /
• 2010

Purpose: As the use of soft tissue fillers becomes more popular, complications such as foreign body granuloma (FBG) are increasing. We report 120 cases of facial FBG and review the available literatures. Methods: 120 patients of facial FBG in our clinic from Mar. 2003 to Feb. 2008 were complied and analyzed. A retrospective chart review was done and patient satisfaction was evaluated with a questionnaire using 5 score scale. Patients with severe inflammation sign or bizarre deformity underwent surgical excision and those with minimal symptoms or a history of hyaluronic acid injection received injection therapy using hyaluronidase. Results: 100 females and 20 males were observed. The average age was 43.7 years (from 16 to 74). 84 patients received surgical therapy and 36, injection therapy. Deformity of facial contour, foreign body sensation and inflammation sign were the three main chief complaints. 84 patients did not know what the injection materials were. The known materials are as follows: collagen, hyaluronic acid, silicone oil, paraffin. 92 cases were performed by unlicensed practitioners, 29 by physicians. Anatomical site most frequently affected by the foreign body granuloma was the cheek (25.8%), followed by forehead (19.2%), lips (15.8%), nose (9.2%), mentum (8.3%), eyelid and eyebrow (4.3%) and temple (0.8%). In 21 patients (17.5%), FBGs were found on multiple sites. Patients with inflammation sign got the highest satisfaction ($3.19{\pm}0.73$) (p=0.001) among 3 chief complaints. And patient satisfaction was statistically higher in surgical therapy group ($3.43{\pm}0.72$) than in injection therapy group ($2.97{\pm}0.88$) (p=0.003). Conclusion: We suggest that it may be beneficial to tailor the type of treatment for FBG relying on wound state and patient's chief complaints. In surgical therapy, resolute approach is necessary to correct facial deformity definitely and to minimize inflammation. Injection therapy could be another option for those with minimal symptoms or a history of hyaluronic acid injection. To prevent foreign body granuloma, not only plastic surgeons but also other physicians should inject soft tissue fillers with great caution and we should warn the public of disastrous consequences associated with illegal medical practice.

• Archives of Plastic Surgery
• /
• v.42 no.6
• /
• pp.783-787
• /
• 2015

This procedure was developed for preservation of the rectus muscle components and deep inferior epigastric vessel after deep inferior epigastric perforator (DIEP) flap harvesting. A 53-year-old woman with granuloma caused by silicone injection underwent bilateral nipple-sparing mastectomies and immediate reconstruction with "mini-flow-through" DIEP flaps. The flaps were dissected based on the single largest perforator with a short segment of the lateral branch of the deep inferior epigastric vessel that was transected as a free flap for breast reconstruction. The short segments of the donor deep inferior epigastric vessel branch are primarily end-to-end anastomosed to each other. A short T-shaped pedicle mini-flow-through DIEP flap is interposed in the incised recipient's internal mammary vessels with two arterial and four concomitant venous anastomoses. Although it requires multiple vascular anastomoses and a short pedicle for the flap setting, the mini-flow-through DIEP flap provides a large pedicle caliber, enabling safer microsurgical anastomosis and well-vascularized tissue for creating a natural breast without consuming time or compromising the rectus muscle components and vascular flow of both the deep inferior epigastric and internal mammary vessels.

• Archives of Plastic Surgery
• /
• v.51 no.1
• /
• pp.20-26
• /
• 2024

The etiology and pathophysiology of delayed inflammatory reactions caused by hyaluronic acid fillers have not yet been elucidated. Previous studies have suggested that the etiology can be attributed to the hyaluronic acid filler itself, patient's immunological status, infection, and injection technique. Hyaluronic acid fillers are composed of high-molecular weight hyaluronic acids that are chemically cross-linked using substances such as 1,4-butanediol diglycidyl ether (BDDE). The mechanism by which BDDE cross-links the two hyaluronic acid disaccharides is still unclear and it may exist as a fully reacted cross-linker, pendant cross-linker, deactivated cross-linker, and residual cross-linker. The hyaluronic acid filler also contains impurities such as silicone oil and aluminum during the manufacturing process. Impurities can induce a foreign body reaction when the hyaluronic acid filler is injected into the body. Aseptic hyaluronic acid filler injections should be performed while considering the possibility of biofilm formation or delayed inflammatory reaction. Delayed inflammatory reactions tend to occur when patients experience flu-like illnesses; thus, the patient's immunological status plays an important role in delayed inflammatory reactions. Large-bolus hyaluronic acid filler injections can induce foreign body reactions and carry a relatively high risk of granuloma formation.

• Archives of Reconstructive Microsurgery
• /
• v.20 no.1
• /
• pp.32-37
• /
• 2011

Purpose: Canalicular laceration is relatively common due to its exposed, vulnerable location in case of facial trauma. Conjunctivodacryocystorhinostomy has been the standard treatment for canalicular obstruction secondary to unrepaired canalicular laceration. In spite of a high rate of relieving tear-duct obstruction, this method is noted to be associated with low rate of patient satisfaction and a number of complications. The goal of this study is to report the good results of delayed lacrimal stent implantation with Mini Monoka$^{(R)}$ for patients whose canaliculi were not repaired by initial surgery. Methods: From May of 2005 to February of 2007, four patients who underwent delayed lacrimal stent implantation using Mini Monoka$^{(R)}$ in canalicular laceration were retrospectively reviewed. First, the previous scar incision was made over the lower lid and we identified the cut end of proximal lacerated canaliculus. The Mini Monoka$^{(R)}$ was passed through the punctum to the cut end of the proximal lacerated canaliculus. We identified the cut end of the distal lacerated canaliculus, whose cut end has rolled white edges after careful excision of the scarred lid tissue. We then passed Mini Monoka$^{(R)}$ through the lacerated inferior canaliculus. Using an operating microscope, we placed three interrupted sutures of 8-0 Ethilon to join the canalicular ends. Silicone stent was left in place for 6 months. The mean age of the patients was 48.5 years (range, 35 to 59 years). The time interval from initial trauma to delayed lacrimal stent implantation was between 3 and 31 days. Follow-up periods ranged from 12 and 20 months. Results: The results of reconstruction were classified into normal, fair and poor. Patent lacrimal drainage systems were achieved in three of the four cases. In one case, epiphora was encountered. No cases of stent displacement, conjunctivitis or granuloma formation were encountered. Conclusion: Even though canalicular reconstruction was delayed for a long time, attempting canalicular reconstruction would be acceptable before considering secondary operations like dacryocystorhinostomy and conjunctivodacryocystorhinostomy.