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Clinical Note |

Imaging of Silastic Cheek Implant Penetration Into the Maxillary Sinus

Daniel T. Ginat, MD, MS; Charles J. Schatz, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(2):199-201. doi:10.1001/jamaoto.2013.1618.
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Published online

Importance Silastic implants are popular for cosmetic cheek augmentation. We describe the computed tomographic (CT) and magnetic resonance imaging (MRI) findings in 5 cases (4 patients) with penetration of the medial aspect of Silastic cheek implants through the anterior maxillary sinus wall.

Observations Three cases demonstrated associated sinus mucosal thickening, and 3 cases demonstrated infection surrounding the implant. In 3 cases, the implants migrated into the maxillary sinus, and in 1 case the implant also eroded through the nasoantral wall and extended into the nasal cavity.

Conclusions and Relevance Maxillary sinus penetration is a potential complication of Silastic cheek implants. The extent of this complication can be characterized by CT and MRI.

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Figures

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Figure 1. Axial computed tomographic scan showing a full-width defect of the anterior maxillary sinus adjacent to the medial edge of the right cheek implant (arrow). There is no associated mucosal thickening or infection around the implant. Note the normal contralateral anterior maxillary sinus wall and overlying cheek implant (arrowhead).

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Figure 2. Axial computed tomographic scan showing a fluid collection that displaces the left cheek implant from the underlying bone (arrow). The medial edge of the left cheek implant has penetrated the full width of the anterior wall of the maxilla and migrated slightly into the sinus. There is considerable left maxillary sinus mucosal thickening. The right cheek implant has also penetrated the anterior wall of the maxillary sinus. There is mild mucosal thickening within the right maxillary sinus but not adjacent to the implant.

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Figure 3. Axial computed tomographic scan showing migration of the right cheek implant, which has created a wide defect in the anterior wall of the maxillary sinus (arrow). There is a mild degree of mucosal thickening surrounding the medial portion of the implant, and there is a small amount of fluid surrounding the right cheek implant within the subcutaneous tissues.

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Figure 4. Axial fat-saturated postcontrast T1-weighted magnetic resonance images (MRIs) at 2 different levels (A and B). The MRIs show penetration of the left cheek implant into the maxillary antrum and into the left nasal cavity through the nasoantral wall (arrow). There is linear enhancement within the subcutaneous tissues surrounding the left cheek implant (arrowheads). The right cheek implant was unremarkable.

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