Thanasarnaksorn Wilai, Thanyavuthi Apichaya, Prasertvit Piyatida, Rattanakuntee Siwakorn, Jitaree Benrita, Suwanchinda Atchima
Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Doctor Younger Clinic, Bangkok, Thailand.
J Cosmet Dermatol. 2023 Mar;22(3):784-791. doi: 10.1111/jocd.15475. Epub 2023 Jan 26.
Even though the chin is considered a safe injection area for facial filler augmentation, tongue necrosis is a rare complication in this area.
Our aim was to present case series of rare complications from chin filler augmentation with possible pathophysiology and management.
From our thorough literature search found only one case report of tongue necrosis from chin filler augmentation. We present case series of unilateral tongue necrosis from vascular occlusion following hyaluronic acid injection in the chin, which was successfully treated with a high-dose hyaluronidase injection resulting in complete recovery in all patients.
Variation in vascular anastomosis leads to a possible cause of vascular occlusion. The lingual artery is the primary arterial supply for the tongue, which is an exclusive target for embolism. Two main responsible arteries and branches are the deep lingual and sublingual arteries. The submental artery variation was previously described as the cause of this event. We proposed potential pathophysiology of the occlusion, not only the variation of vasculature but bone. The midline lingual foramen, an anatomical bone variation on the surface of the midline inferior jaw, was found to be another possible cause. This foramen contains a branch of the submental and sublingual artery, which includes the perforating artery, median perforating artery, or both. Filler injection with a sharp needle on the bone can potentially increase the risk of this vascular incident. A high dose of hyaluronidase administered with multiplane injections was accomplished with complete recovery.
Tongue necrosis from vascular complications after hyaluronic acid filler injection can occur. Not only vessels but bone variation pathology were possible causes.
尽管下巴被认为是面部填充剂隆下巴的安全注射区域，但舌部坏死是该区域一种罕见的并发症。
我们的目的是呈现下巴填充剂隆下巴罕见并发症的病例系列，并探讨可能的病理生理学及处理方法。
通过全面的文献检索，仅发现一例下巴填充剂隆下巴导致舌部坏死的病例报告。我们呈现了一系列因下巴注射透明质酸后血管阻塞导致单侧舌部坏死的病例，所有患者通过高剂量透明质酸酶注射成功治疗并完全康复。
血管吻合的变异是导致血管阻塞的一个可能原因。舌动脉是舌头的主要动脉供血，是栓塞的唯一目标。两个主要的责任动脉及其分支是舌深动脉和舌下动脉。颏下动脉变异先前被描述为该事件的原因。我们提出了阻塞的潜在病理生理学，不仅涉及脉管系统的变异，还包括骨骼。中线舌孔是下颌中线表面的一种解剖学骨骼变异，被发现是另一个可能原因。该孔包含颏下动脉和舌下动脉的一个分支，其中包括穿支动脉、正中穿支动脉或两者皆有。在骨骼上用尖锐针头注射填充剂可能会增加这种血管事件的风险。通过多平面注射给予高剂量透明质酸酶后患者完全康复。
透明质酸填充剂注射后血管并发症导致的舌部坏死可能会发生。脉管系统变异和骨骼变异病理都是可能的原因。
