Overview of dermatological ozone applications and A rare complication of dermal ozone treatment: Isolated orbital emphysema with cutaneous injection

Öz

Background: Ozone treatment that effects immune system has become more popular as a supplemental or alternative therapy due to development of sensitive medical ozone generators, starting formal ozone training programs and some established general application protocols.  Although, ozone treatment is a safe method, especially in dermal injections, inexperienced practitioners can cause various complications. In this report, we discussed a rare complication of ozone treatment titled isolated orbital emphysema with dermal injection and a short overview of dermatological ozone applications.

Case: A 35 years old male volunteer without any systematic disease was applied subcutaneous ozone injection at a concentration of 10 µg/ml to induce collagen synthesis for thin wrinkles on the forehead, while he was getting the ozone therapy course as a trainee. During the injection to the right of glabella, 3 ml of ozone gas at a concentration of 10 µg/ml was injected while it was supposed to be 0.5 ml. Due to periorbital anatomical structure, the subcutaneous air intrusion towards the right eye occurred, leading to immediate emphysematous swelling in the right eye lid and orbital region, and ptosis in the eye lid. Understanding the injection was subcutaneous, direct massaging towards inside out around the eye was performed to collect the gas to the periphery. When the patient's condition was assessed, no pain, blurred vision and other symptoms were noted, except feeling of pressure. However, on the same day we administer oral high dose vitamin C and multi-mineral combination to increase the patient's antioxidant resistance. Also, oral hydration and keeping warm of the periocular area recommended. It was determined that no developing any visual complaints during 48 and 72 hour follow-up.

In this case, we believe that intervention with manual massage around the eye, using ozone gas at low concentration and the injected amount of gas is not relatively extreme lead to the absence of complications.

Conclusion: Although, ozone is very reliable and the therapeutic index is quite broad, the ozone gas application to critical anatomical localizations such as the orbital region we believe that these kinds of interventions should not be done except experienced practitioners who are dominant in the anatomical structure and practice the application technique well.

Anahtar Kelimeler

• ozone,dermal ozone,ozone treatment,complication

Dermatolojik ozon uygulamalarına bakış ve Nadir bir dermal ozon tedavisi komplikasyonu olgusu: Dermal enjeksiyonla oluşan izole orbital amfizem

Öz

Amaç: İmmün sistemi etkileyen bir yöntem olan ozon tedavisi, hassas medikal ozon jeneratörlerinin gelişmesi, ozon uygulama için çeşitli eğitim programlarının düzenlenmeye başlanması ve bazı genel uygulama protokollerinin oluşturulmayla etkin bir şekilde tamamlayıcı veya alternatif bir tedavi olarak kullanılması yaygınlaşmaktadır. Her ne kadar oldukça güvenli bir yöntem olsa da özellikle dermal enjeksiyonlarda deneyimsiz uygulayıcılar çeşitli komplikasyonlara yol açabilmektedir. Bu olgu sunumunda dermal enjeksiyonla oluşan izole orbital amfizem olgusu paylaşılmakta ve kısaca dermatolojik ozon uygulamalarına değinilmektedir.

Olgu: 35 yaşında herhangi bir sistemik hastalığı olmayan erkek gönüllüye, kursiyer olarak katıldığı ozon terapi kursunda alın bölgesindeki ince kırışıklar için kollojen sentezinin indüksiyonu amacıyla subkutan 10 μg/ml dozunda ozon enjeksiyonunun yapılması istenir. Fakat uygulayıcının glabellanın sağ kısmına doğru yaptığı enjeksiyon sırasında intradermal 0.5 ml yapması gereken bölgeye subkutan yaklaşık 3 ml, 10 μg/ml konsantrasyonda ozon gazı enjekte edilir. Periorbital anatomik yapı nedeniyle subkutan havanın hastanın sağ gözüne doğru ilerlemesi sonucu sağ göz kapağı ve orbital bölge dakikalar içerisinde amfizematöz şişliğe uğradı ve göz kapağında hafif pitoz meydana geldi. Enjeksiyonun subkutan yapıldığının anlaşılması ile gaz toplanmasını perifere toplamak için derhal göz etrafına içerden dışarı doğru masaj yapıldı. Hastanın görme durumu değerlendirildiğinde bası hissi dışında herhangi bir şikayetinin olmadığı, ağrı, bulanık görme veya diğer semptomların gelişmediği tespit edildi. Buna rağmen hastanın antioksidan direncini artırmak için aynı gün oral yüksek doz C vitamini ve multiminarel kombine preparat başlandı. Oral hidrasyon ve lezyona uğrayan bölgenin sıcak tutulması önerildi. Hastanın 48 ve 72 saatlik takibinde görme ile ilgili herhangi bir şikâyet gelişmediği tespit edildi. Bu vakada neyse ki düşük konsantrasyonda ozon gazı kullanılmasının, enjekte edilen miktarın görece olarak aşırı olmamasının ve göz etrafına manuel masaj ile müdahale edilmesinin ciddi bir komplikasyon gelişmesine engel olduğu kanaatindeyiz.

Sonuç: Her ne kadar ozon oldukça güvenilir ve terapotik indeksi geniş bir etken madde olsa da orbital bölge gibi kritik anatomik lokalizasyonlara ozon gazı uygulamasında anatomik yapıya hâkimiyeti olan, uygulama tekniğini iyi gerçekleştiren deneyimli uygulayıcılar dışında bu tür müdahalelerin yapılmaması gerektiği kanaatindeyiz.

Anahtar Kelimeler

• ozone treatment,complication,Isolated orbital emphysema

Kaynakça

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