Foreign Body Granulomas Caused by Polymethylmethacrylate Microspheres

Reisberger, Eva-Maria; Landthaler, Míchael; Wiest, Luitgard; Schröder, Josef; Stolz, Wilhelm

doi:10.1001/archderm.139.1.17

Cited by 111 publications

(102 citation statements)

References 22 publications

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“…This was the cause for the high (2.5 percent) rate, until 1994, of foreign body granulomas. [77][78][79] When the dry sieving process was changed to wet sieving in 1994, the number of nanoparticles in Artecoll was reduced drastically and the rate of granulomas dropped below 0.2 percent between 1995 and 2002. 10 In January of 2003, the U.S. Food and Drug Administration began requiring even stricter controls on the purity of the microspheres for U.S. clinical testing.…”

Section: Polymethylmethacrylate Microspheres (Arteplast/artecoll)mentioning

confidence: 99%

Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes

Lemperle

Gauthier-Hazan

Wolters

et al. 2009

Plastic and Reconstructive Surgery

223

243

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Summary Genuine granuloma formation following implantation of injectable dermal fillers is a rare complication, with incidences ranging from one in 100 patients (1 percent) to one in 5000 (0.02 percent). Foreign body granulomas occur several months to years after injection at all implantation sites at the same time. Without treatment, they may grow to the size of beans, remain virtually unchanged for some years, and then resolve spontaneously. Three clinical and histologic types of foreign body granulomas can be distinguished: 1. Cystic granulomas (synonyms: inflammatory, palisading, collagenolytic): these are caused mainly by injected biological gels such as collagens and hyaluronic acids. Their clinical signs are fluctuation (sterile abscess), extreme redness, and induration. Cystic granulomas are small and superficial, occur within the first year, and disappear spontaneously within another year. They are surrounded by a significant number of giant cells. 2. Edematous granulomas (synonym: lipogranuloma): these are caused by artificial fluids such as silicone and polyacrylamides. They appear suddenly years after injection with extensive swelling and are surrounded and infiltrated by mononuclear and inflammatory cells. 3. Sclerosing granulomas (synonyms: sarcoidal and xanthelasmic): these are caused by particulate injectables composed of polymethylmethacrylate, polylactic acid, hydroxyethylmethacrylate, calcium-hydroxylapatite, or dextran microspheres. Sclerosing granulomas occur generally 6 months to 3 years after implantation and are visible, often bluish confined nodules. Histologically, the implant is infiltrated by many macrophages and giant cells, fibroblasts, and collagen fibers but few inflammatory cells. Permanent implants are not characterized by a higher rate of foreign body granuloma per se than temporary implants; however, their clinical appearance is more pronounced and their persistence longer if not treated adequately. (Plast.

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Section: Polymethylmethacrylate Microspheres (Arteplast/artecoll)mentioning

confidence: 99%

Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes

Lemperle

Gauthier-Hazan

Wolters

et al. 2009

Plastic and Reconstructive Surgery

223

243

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“…However, it is unclear whether this acute inflammatory process is directly associated with PMMA implantation, as granulomatous foreign-body reactions may occur up to 6 years after the subcutaneous implantation of PMMA [22,35].…”

Section: Discussionmentioning

confidence: 99%

“…Because of its small number of side effects and its lasting results, PMMA is believed to be a good solution for dermal filling. However, with the popularization of its use reports of complications following PMMA implantation have increased significantly [20][21][22][23][24][25][26][27][28][29]. Therefore, understanding the tissue alterations caused by PMMA implantation is essential for discover the causes of complications inherent to this filling procedure.…”

Section: Introductionmentioning

confidence: 99%

Potential of Migration and Tissue Reactions to Intraperitoneally Implanted Polymethyl Methacrylate in Wistar Rats

Fc¹,

Acl²,

A³

2016

J Clin Exp Dermatol Res

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Objective: This study aimed to evaluate the performance of polymethyl methacrylate (PMMA) when implanted into the peritoneal cavities of Wistar rats, specifically its potential for migration to the examined organs and possible tissue reactions at the implantation site.Methods: Adult male Wistar rats (290-400 g) were distributed randomly into 2 groups: P4 (n=20), to which 0.4 mL of PMMA was administered; and P2 (n= 0), to which was 2 mL of PMMA were administered. These groups were subsequently divided into 4 subgroups according to the day on which euthanasia occurred (day 1, 7, 14, or 28). Results:The changes in animal weight prior to PMMA implantation and after euthanasia were compared. No nodules or signs of PMMA implantation or any other macroscopic alterations were observed in the spleen, kidneys, lungs, or liver. However, mild-to-moderate inflammatory infiltration in which macrophages, lymphocytes, and neutrophils predominated was observed in at least 1 of the 4 organs examined from each animal during the experimental time points. Mild inflammatory responses were observed that were rich in histiocytes and giant cells and featured increased numbers of blood vessels and fibroblasts in the pericapsular regions of the studied organs. In 29 cases, a greyish material compatible with PMMA was identified. There was no migration of PMMA into the parenchyma of the examined organs. The changes in the tissues were the same regardless of the volume of implanted PMMA. Following staining with HE, the PMMA particles in the tissues were a grayish color, measuring approximately 30-40 µm in size, and were found to have stimulated histiocytic reactions in 29 examined organs. Conclusions:The results showed that the most affected tissues were the visceral peritoneum of the spleen and the kidneys from group P2. Our study may contribute to add a new proof of testing implants.

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“…These occurrences were overcome in time using bioengineering to synthesize the HA (3-s5,12,15,17,84) . Other currently used filler materials still cause diverse, significant adverse reactions (1,5,17,(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96)(97)(98)(99)(100) , therefore, it is not advisable to combine HA with other materials, or brand names that are not subject to stringent quality controls (1,4-5,84,87,93) .…”

Section: A B C Dmentioning

confidence: 99%

Estudio clínico de eficacia, duración y efectos adversos del implante de ácido hialurónico en área buco-maxilo-facial

Scardovi

Goglian

Gendra

et al. 2017

Odontoestomatología

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Foreign Body Granulomas Caused by Polymethylmethacrylate Microspheres

Cited by 111 publications

References 22 publications

Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes

Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes

Potential of Migration and Tissue Reactions to Intraperitoneally Implanted Polymethyl Methacrylate in Wistar Rats

Estudio clínico de eficacia, duración y efectos adversos del implante de ácido hialurónico en área buco-maxilo-facial

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