**7. Silicone granuloma**

Silicone granuloma is a foreign body granuloma, which is characterized by the presence of multinuclear Datia cells and macrophages surrounded by lymphocytes and infiltrates of neutrophils. The granulomatous histological lesion caused by silicone varies depending on the type of silicone.

Tissue reactions to silicone gel or liquids are characterized by the formation of silicone granuloma with cystic space containing foreign body [9]. The irregular surface of silicone cannot be phagocytosed completely by macrophage. Datia cells are formed due to "frustrated" macrophages. Microspheres in the size of less than 15

#### **Figure 2.**

*Results of histopathological examination (HE 400× magnification) in one of study subject. There is a Datia cell (arrow), which is phagocytosing silicone (S) and is trying to destroy it into smaller pieces (sk) [1].*

#### **Figure 3.**

*Stadium 1, moderate reaction with a few inflammatory cells. Stadium 2, inflammatory cells with one or two Datia cells. Stadium 3, inflammatory cells with more than two Datia cells and <50% fibrotic area. Stadium 4, inflammatory cells with more than two Datia cells and >50% fibrotic area. Stadium 5, inflammatory cells with one Datia cell and >50% fibrotic area. Stadium 6, <50% fibrotic area with no Datia cell. Stadium 7, >50% fibrotic area with no Datia cell. (cited from A Harlim, et all) [11].*

**7**

**Figure 4.**

*Management of Nasal Silicone Granuloma DOI: http://dx.doi.org/10.5772/intechopen.87188*

encapsulated by fibrotic tissue.

**8. Diagnosis**

the stage (**Figure 4**).

phase with fibrosis, i.e., stages 6 and 7 (**Figure 3**).

can be categorized into seven stages, which are: [11]

Stadium 6, <50% fibrotic area with no Datia cell Stadium 7, >50% fibrotic area with no Datia cell

ated Datia cells present at the central core of granuloma [16].

Stadium 1, moderate reaction with a few inflammatory cells Stadium 2, inflammatory cells with one or two Datia cells

microns will be phagocytosed and transferred to the lymph node, while those with big size and nonabsorbable polymer will be encapsulated by fibrotic tissue [10]. Datia cell is essential in tissue response to silicone as seen in **Figure 2**, in which the Datia cell is phagocytosing the silicone. It appears that although the Datia cell cannot eliminate the silicone, it would produce fragmented silicone into smaller pieces. Within a month, the silicone will be in the size of 20–100 microns [11]. However, it still cannot be completely phagocytosed, and ultimately it will be

In general, silicone granuloma can be categorized into three phases according to the natural history of our immune response, which are mild inflammatory phase, i.e., stage 1; inflammation with datia cells, i.e., stages 2, 3, 4, and 5; and tolerance

According to Harlim in 2018, histopathological features of silicone granuloma

Stadium 3, inflammatory cells with more than two Datia cells and <50% fibrotic area Stadium 4, inflammatory cells with more than two Datia cells and >50% fibrotic area

Stadium 5, inflammatory cells with one Datia cell and >50% fibrotic area

Granuloma is a form of localized nodular inflammation, which is found in tissues [7]. On examination, there is a tumor-like mass or node of granulation tissue with active fibroblast growth and capillaries that contain epithelial-like macrophages surrounded by mononuclear cells, lymphocytes, and sometime multinucle-

On clinical point of view, silicone granuloma is characterized by the presence of complications of silicone. There are usually granuloma nodes, migrating silicone, wider nose, and signs of inflammation such as redness and swelling depending on

*Granuloma due to nasal silicone injection. The photograph shows granuloma node, migrating silicone, wider* 

*nose, and signs of inflammation such as edema and redness.*

#### *Management of Nasal Silicone Granuloma DOI: http://dx.doi.org/10.5772/intechopen.87188*

*Cosmetic Surgery*

**Figure 2.**

*Results of histopathological examination (HE 400× magnification) in one of study subject. There is a Datia cell* 

*Stadium 1, moderate reaction with a few inflammatory cells. Stadium 2, inflammatory cells with one or two Datia cells. Stadium 3, inflammatory cells with more than two Datia cells and <50% fibrotic area. Stadium 4, inflammatory cells with more than two Datia cells and >50% fibrotic area. Stadium 5, inflammatory cells with one Datia cell and >50% fibrotic area. Stadium 6, <50% fibrotic area with no Datia cell. Stadium 7, >50%* 

*fibrotic area with no Datia cell. (cited from A Harlim, et all) [11].*

*(arrow), which is phagocytosing silicone (S) and is trying to destroy it into smaller pieces (sk) [1].*

**6**

**Figure 3.**

microns will be phagocytosed and transferred to the lymph node, while those with big size and nonabsorbable polymer will be encapsulated by fibrotic tissue [10].

Datia cell is essential in tissue response to silicone as seen in **Figure 2**, in which the Datia cell is phagocytosing the silicone. It appears that although the Datia cell cannot eliminate the silicone, it would produce fragmented silicone into smaller pieces. Within a month, the silicone will be in the size of 20–100 microns [11]. However, it still cannot be completely phagocytosed, and ultimately it will be encapsulated by fibrotic tissue.

In general, silicone granuloma can be categorized into three phases according to the natural history of our immune response, which are mild inflammatory phase, i.e., stage 1; inflammation with datia cells, i.e., stages 2, 3, 4, and 5; and tolerance phase with fibrosis, i.e., stages 6 and 7 (**Figure 3**).

According to Harlim in 2018, histopathological features of silicone granuloma can be categorized into seven stages, which are: [11]

Stadium 1, moderate reaction with a few inflammatory cells

Stadium 2, inflammatory cells with one or two Datia cells

Stadium 3, inflammatory cells with more than two Datia cells and <50% fibrotic area Stadium 4, inflammatory cells with more than two Datia cells and >50% fibrotic area Stadium 5, inflammatory cells with one Datia cell and >50% fibrotic area Stadium 6, <50% fibrotic area with no Datia cell Stadium 7, >50% fibrotic area with no Datia cell
