Which of your patients may have presented with this unusual facial swelling?

This is an interesting case report of a 45 year-old female who presented to her dental practice with a painless buccal swelling on the right-hand side of her face that resembled a facial cellulitis. It had apparently happened before; several years previously she had experienced two episodes of swelling in the same region, which had been some three years apart and which had regressed spontaneously. When the present swelling persisted, she had sought care.

There was no obvious dental cause for the swelling. A thorough history revealed that the patient had had bilateral injections of a cosmetic filler to enhance the malar regions of her face. These had been done by an unlicensed practitioner and she was not aware of the nature of the material injected.

The swelling responded to antibiotic and steroid therapy and it was decided that removal of the cosmetic filler was not indicated.

The authors discuss the possible pathology, which is far from clear, and the clinical indications, but the paper is published primarily as a caution to the dental practitioner that, with the increasing use of such materials, similar presentations may be seen in general practice with orofacial swellings initiated by non-biodegradable silicone materials. An interesting differential diagnosis!