top of page
  • Writer's pictureRealr

Are facial filler microcrystalline porcelain complications caused by dermatologists or dentists?

Hey guys, cervicofacial subcutaneous emphysema is a rare sequela of dental and head and neck surgeries caused by air entering the soft tissues. It is rarely reported in the dermatologic literature. It is important for dermatologists to recognize this complication, as it can occur with dental procedures following skin projects on the head and neck.


Case Details

A 42-year-old woman underwent soft tissue filler injections at a US facility for aging. A total of 3.0 mL of calcium hydroxyapatite (microcrystalline porcelain) was injected into the subperiosteum of the patient's temples, zygomaticomandibular cheeks, mandibular line, and premandibular sulcus on both sides. During the informed consent period and prior to the procedure, the patient was advised to avoid any dental work for 2 weeks before and 2 weeks after the soft tissue filler procedure to prevent biofilm-related infections. The patient waited 15 days after the facial injections before her dentist placed a temporary crown on her upper left tooth.


During dental treatment, the patient felt vague pain and a tingling sensation on the left side of the face. Within minutes, unilateral left-sided facial swelling in the left cheek rapidly worsened and extended to the periorbital region (Figure 1). Her dentist thought she had angioedema due to a potential allergic reaction to the anesthetic she used during crown placement. After an intramuscular injection of 0.3 mg epinephrine (0.3 mL, 1:1000) and 50 mg oral diphenhydramine, her response was inadequate and her symptoms did not improve. Crown placement was discontinued, and the patient was immediately returned to the authors' dermatological clinic for evaluation of a potential soft-tissue infection associated with the filler injection.


Figure 1: Rapid onset of left facial swelling


Physical examination revealed that the patient had no fever and stable vital signs. There was extensive swelling in the left periorbital, zygomatic and mandibular subcutis. Palpation revealed a murmur in the affected area (Figure 2). There was no overlapping erythema, palpable nodules, or skin tenderness. The patient denied shortness of breath, neck pain, chest pain, hoarseness or wheezing. The diagnosis was subcutaneous emphysema in the neck and face, and computed tomography (CT) of the head and neck was required to better determine the degree of involvement and guide the further nursing plan.


Figure 2: papules and swelling in the left periorbital area


The CT film shows extensive soft tissue airways throughout the left face and neck, extending into the thoracic inlet but not significantly into the superior mediastinum. Soft tissue gas extends along the buccal surface and into the left parapharyngeal space. The smallest soft tissue gas crossed the midline into the anterior vascular plane of the anterior neck (Figures 3 and 4).


Imaging findings were consistent with the authors' clinical impression that the cervicofacial subcutaneous emphysema had no sequelae to her airway or involvement of the mediastinum. Amoxicillin/clavulanate 875 mg/125 mg twice daily for 10 consecutive days was used to cover any potential oral flora that may have traveled down along the fascial planes into the critical spaces of the head and neck. The patient was closely monitored through daily visits to the author's clinic. Her condition improved daily, and after 7 days, she was in remission with no adverse sequelae and no change in soft tissue enlargement enhancement.


Figure 3: Head CT showing air in the parapharyngeal fat and areas of hyperdensity in the soft tissue of the premaxilla associated with previous soft tissue filling with hydroxyapatite.


Figure 4: Cervical CT showing air entering the thoracic inlet but not the anterior cervical space connecting the mediastinum


Discussion

Cervicofacial subcutaneous emphysema is a well-recognized clinical condition caused by the introduction of air or gas into soft tissue planes. It is a rare complication of various dental procedures and is more common in head and neck surgery and maxillofacial trauma. Typically, this condition is caused by the use of high-velocity pneumatic instruments in the oral cavity during dental procedures (e.g., surgical extractions, endodontics, and trauma). Surgical procedures, especially those involving third molars, may increase susceptibility to soft tissue emphysema. These high-speed air heads discharge high pressures that can disrupt the oral mucosa and cause air to travel subcutaneously into the fascial planes of the head and neck. Entry of air into the prevertebral and retropharyngeal spaces connected to the mediastinum can lead to very rare but potentially serious and fatal complications such as mediastinitis, airway injury, air embolism, and necrotizing fasciitis of the neck.


With the rise and increasing popularity of several dermatologic procedures, many patients will undergo dermatologic procedures in close proximity to dental procedures, which can be performed with pneumatic instruments. Awareness of this medically induced dental complication is critical in order to distinguish it from complications arising from dermatologic procedures and to allow for proper evaluation and prevention of the rare but potentially life-threatening respiratory sequelae.


Choose REALR Laser & Skincare Medspa, and we provide the most professional and safe medical beauty service.


REALR Laser & Skincare Medspa is a medical beauty skin management center that provides professional and effective problem-solving solutions. Located on the main street of Allston, Greater Boston, Massachusetts.

 

REALR Medical Beauty Center has cooperated closely with more than 100 beauty institutions in recent ten years, and personalized skin care for every beauty lover based on a large number of clinical cases and the real needs of customers. In particular, there are different answers to various skin problems, especially in acne, anti-aging and pigment treatment.

 

At the same time, we are developing a full line of medical beauty products, insisting on combining the scientific skin care concept with international cutting-edge R&D technologies such as cell regeneration technology and bio-bionic technology. After years of exploration, research and practice, we constantly iterate and upgrade the product formula, from taste to skin feeling experience, and repeatedly polish every detail from design to packaging, so as to improve skin problems from the inside out in terms of treatment and maintenance effects of comprehensive skin problems such as whitening and hydrating, acne muscle improvement, sensitive skin improvement, anti-wrinkle and anti-aging repair.

 

REALR introduces the world's most advanced medical technology, only cooperates with the world's top medical manufacturers, and selects the latest, top-notch and safest medical equipment. We are the first Asian medical and beauty institution in Boston to introduce the fifth generation of Hot Maggie Thermage FLX, and we are officially certified as a diamond member of Hot Maggie FLX. At the same time, we are also the only Asian medical and beauty institution with Fotona Eurostar equipment in Boston, which is strongly recommended by the medical and beauty industry leaders such as Fotona Eurostar. REALR also has the official certification of M22 Photorejuvenation, Ultherapy Ultrasonic Knife, PicoWay and other projects.

 

REALR has accumulated rich clinical experience of Asian guests and has its own medical research department. We introduce the most advanced medical technology in the world and regularly organize medical teams to participate in cutting-edge medical and aesthetic education projects around the world. We only cooperate with the world's top medical manufacturers and choose the latest, top-notch and safest medical equipment.



9 views0 comments

Comments

Rated 0 out of 5 stars.
No ratings yet

Add a rating
bottom of page