This is a repository copy of The role, efficacy and outcome measures for teriparatide use in the management of medication-related osteonecrosis of the jaw.
Nodular eruption after botulinum neurotoxin type-A (BoNT-A) treatment is exceedingly rare, and the pathogenesis is poorly understood. This case series reports three patients that developed nodular eruptions following administration of Botox® (onabotulinum neurotoxin type A (ONA) injections). These patients had undergone multiple treatments before and after development of the eruptions which were uneventful. In addition to this, we have reviewed the published literature regarding this condition and have compared and contrasted the similarities and differences with regards to the clinical presentation and treatment with our patient cohort. This case series aims to raise awareness of this rare condition, its importance in relation to patient consent and provides a simplified management approach based on our experience. Further evaluation is needed to determine treatment consensus but conducting such research may prove to be challenging due to this condition being an infrequent encounter.
Administration of hyaluronic acid (HA) filler for aesthetic lip augmentation is a routine and common procedure with a low rate of adverse reactions. This case report documents an extremely rare complication of lip augmentation with HA leading to the development of lymphangiomas.
Lymphangiomas are uncommon hamartomas of the lymphatic system. Although usually congenital, they can be acquired due to trauma, inflammation, or lymphatic blockage. They may be in the deep or superficial tissues, with superficial forms being either lymphangioma circumscriptum or acquired lymphangioma, also referred to as lymphangiectasia. Acquired lymphangiomas are typically formed by blockage of lymphatic drainage leading to dilation of the lymphatic channels. The diagnosis in our case report is acquired lymphangioma.
A 27-year-old female presented with a two-year history of linear swellings in her upper lip. These lumps followed the line where HA filler had been injected four years earlier. Hyaluronidase had previously been used unsuccessfully to remove these lumps. The patient was treated with surgery to excise the lesions. Five masses were excised, and histopathological analysis displayed the presence of variably ectatic lacunae, lined by cells with CD34 expression, a lymph-vascular-endothelial marker. There were also scattered macrophages with CD68 expression in the interstices. These are typical features of a lymphangioma. The patient was satisfied with the excellent aesthetic and functional outcome.
To our knowledge this is the first case of a lymphangioma following HA lip augmentation. Although rare, this complication can have aesthetic implications for the patient which may require further treatment or surgery to correct.
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