Case presentation

R3
00239860 0 /73
CC: multiple neck mass- 10
PI
Liquid silicone injection for soft tissue
augmentation in the face and neck by a
unregistered nurse about 15 years ago.
serial microdroplet puncture technique.
Weekly injection

5
.
DM / HTN / Tbc( - / - / - )
OPHx. ( + )
15
2010
5
Drug Hx ( - )
ROS
Throat discomfort (+) sore throat (-) dyspnea (-)
dysphagia (-) odynophagia (-) voice change (-)

H/L (-/-) otalgia (-/-) otorrhea (-/-)
vertigo (-) tinnitus (-/-) earfullness (-/-)

nasal obstruction (-/-) rhinorrhea (-/-) PND (-)
sneezing (-) snoring (-) hyposmia (-) anosmia (-)
Physical examination
Both TM: free
Nasal cavity and nasopharynx: free
Oral cavity and oropharynx: free
Larynx and hypopharynx: free
Neck: cheek ,
hard non-tenderous mass, subcutaneous
nodule-like mass

, shiny surface
Problem list
Silicone injection
5
Multiple neck mass
Subcutaneous nodules
Erythematous skin color
Multiple neck Op wound
Scleroderma in extremities
Impression
r/o silicone granuloma
r/o paraffinoma
r/o Talc granuloma
r/o cervical lymphadenitis
r/o malignancy
r/o recurrent facial erysipelas,
Tb, lepromatous leprosy.

Silicone injection by
untrained practitioner
5

Multiple neck mass
Subcutaneous nodules
Erythematous skin color
Multiple neck Op wound
Scleroderma in
exteremities
Diagnostic plan
Pharynx ECT
General lab
Fine needle aspiration( giant
multinucleated cellularity phagocytising
foreign material, foreign body materials)
Therapeutic plan
Medical treatment
Intralesional steroids and systemic steroids.
Minocycline+ low-dose prednisone or celecoxib
Imiquimod cream
Topical tacrolimus
Etarnacepts
Isotretinoin
Allopurinol
Laser treatment.
Surgical treatment
Surgical excision


Selective neck dissection [Lt 3,4, 5 & Rt 4,
5
No definitive PostOp complication of
neck surgery.
Numerous round to ovoid empty cavities of varying sizes are
visible. Fibrosis, histiocytes, and lymphocytes are present between
cavities (hematoxylin-eosin stain; original magnification, 100).
200
POD #2 month
POD #2 month
POD #2 month
Excepts for cases with suspicion of
malignancy, given the high number of
cases where excision is not satisfactory
Surgical approaches should be restricted
to those patients with marked aesthetic
alterations, and always providing
adequated information about a potential
recurrence of the lesion