额面部美容填充治疗致眼睑肉芽肿样肿物的临床特征分析

Clinic feature of eyelid granulomatous mass following forehead and face augmentation surgery

目的探讨行额面部美容填充治疗后眼睑肉芽肿样肿物患者的临床特征。设计回顾性病例系列。研究对象2019-2020年北京同仁医院眼科门诊因面部填充治疗致眼睑肉芽肿样肿物患者16例22眼。方法回顾患者的症状、体征、影像学检查以及病情转归。主要指标临床表现、眼眶及头颅CT、MRI表现以及治疗情况。结果16例患者均为女性,平均年龄(36.43±5.65)岁。3例(18.7%)仅进行了面部玻尿酸或肉毒素填充注射;13例(81.3%)曾行面部自体脂肪填充治疗,其中1例同时行前额肉毒素注射,4例在面部自体脂肪填充治疗后曾行双眼重睑术。从手术到出现肿物的时间间隔6~72个月,平均(19.50±19.70)个月。6例(37.5%)表现双侧眼睑肿物,10例(62.5%)为单侧眼睑肿物。2例(12.5%)眼睑肿胀;13例(81.2%)肿物位于上睑,2例(12.5%)位于下睑,1例(6.3%)上下睑均出现。所有患者均在无意间发现眼睑多发皮下肿物,有一定活动性、界清、质硬、局部无红肿和压痛。MRI显示,12例(75.0%)14眼肿物在T1WI表现为长或等信号,12例(75.0%)17眼肿物在T2WI上表现为长信号;增强后不均匀强化。16例均保守观察,随访半年肿物大小无明显变化。结论面部美容填充治疗可导致眼睑肉芽肿样肿物,其特征为眼睑皮下一个或多个无痛性、界清的肿物。结合患者的面部填充治疗史、临床表现和影像学特征可确定诊断。

Objective To summary the clinic feature and treatment of eyelid granulomatous mass following forehead and face augmentation surgery.Design Retrospective case series.Participants 16 patients(22 eyes)with periorbital lumps following forehead and face augmentation surgery from 2019 to 2020 in Beijing Tongren Hospital.Methods Clinical manifestation,physical signs,ophthalmic imaging and treatment were reviewed.Main Outcome Measures Manifestation,neuroimaging features and outcome.Results All patients were female.Age ranged from 26 to 46 years with an average of 36.43±5.65 years old.3 patients(18.7%)merely received facial creotoxin or hyaluronic acid injection.13(81.2%)patients received facial fat injection with 1 patient among them received forehead creotoxin injection,and 4 of them received double eyelid surgery after facial fat injection.The average duration between last surgery and onset of symptom was 19.50±19.70 months,with a median of 12 months.6(37.5%)of them had bilateral lumps and 10(62.5%)had unilateral lumps.2(12.5%)of them had eyelid swelling.Lumps located in upper eyelid in 13 cases(81.2%),and located in lower eyelid in 2 patients(12.5%).Lumps located both upper and lower eyelid in1 patient(6.3%).All the patients were found the lumps unintentionally.MRI demonstrated a mass with hypointense or hyperintense signal(12 patients with 14 eyes)in T1WI and hyperintense signal(12 patients with 17 eyes)in T2WI.Contrast-enhanced MRI showed heterogeneous enhancement.All 16 following patients rejected to receive any treatment and their lumps showed no change during 6 mouths follow up.Conclusion As a rare complication,the clinic manifestation of eyelid granulomatous mass following forehead and face plastic surgery remain quite stable and have a high chance to be misdiagnosed.Radiologic feature combined with the history of facial augmentation surgery would be helpful for diagnosis.