Distal Internal Maxillary Artery Occlusion with Palatal Necrosis following Cheek Injection with Calcium Hydroxylapatite

Abstract

Summary: Accidental intravascular injection of cosmetic fillers resulting in dermal infarction represents one of the most feared complications in aesthetic medicine. Despite the infrequency of these injuries, the rapid rise in filler use has caused a sudden increase in the incidence of filler-induced skin necrosis. Because the complex vascular anatomy of the face subserves a wide range of cutaneous and mucosal tissues, it has been surmised that occult injuries affecting the oronasal cavities could occur as a result of accidental intravascular injection of dermal fillers. We report an instance of ischemic skin injury of the infraorbital territory of the face with hemi-palatal mucosal necrosis secondary to vascular occlusion with calcium hydroxylapatite.

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions

“…Each domain angiosome is subdivided into five mucocutaneous segments for a maximum bilateral score of 10 for each domain. From Soares et al [ 29 ], with permission.…”

“…The clinical scope of injuries resulting from FIVO is ample owing to the numerous arterial and venous conduits of the face, which enable the dissemination of embolized fragments to local and distant targets. Consequently, published reports of FIVO injuries have encompassed vision loss, ophthalmoplegia, cerebral infarction, skin necrosis, pulmonary embolism, cerebral sinus thrombosis, and even death [ 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Nevertheless, the exact magnitude of the problem has been difficult to quantify owing to intrinsic limitations in the U.S. Federal Manufacturer and User Facility Device Experience (MAUDE) database, a passive reporting system prone to under-reporting and information deficiencies [ 35 ].…”