Reactive Palatal Fibrosis Following Facial Dermal Filler Injection and Anfiye Inhalation: A Case Mimicking OSMF

Anfiye is a traditional herbal remedy commonly used in Iran and several Arabic countries for the treatment of sinusitis and nasal congestion. It is typically administered as a nasally inhaled powder. Various formulations exist under the name Anfiye; however, the most widely used preparation contains root powder of Gypsophila struthium and seeds of Nigella sativa. Inhalation of Anfiye induces sneezing, which in turn helps alleviate nasal congestion and rhinorrhea, thereby contributing to the management of sinusitis. Modifying facial soft tissues volume and contours through dermal injection of botulinum toxin, injectable fillers such as hyaluronic acid, and bovine collagen is a common esthetic procedure these days. Although they may be successfully utilized, there may be possible side effects such as allergic reactions, inflammation, foreign body granuloma formation, and skin necrosis due to incorrect injection techniques. Also, it is a relatively expensive esthetic treatment. In this case report, we present a 41-year-old Iranian woman who developed swelling in the right portion of the palate following injection of facial dermal filler and use of Anfiye for treating sinusitis. An excisional biopsy was performed, and histopathological analysis revealed marked submucosal fibrosis with features reminiscent of oral submucous fibrosis (OSMF). However, the absence of hallmark clinical criteria-namely palpable fibrotic bands, progressive reduction in tissue elasticity, and trismus or limited mouth opening-alongside the patient's denial of areca nut use and spontaneous healing of the lesion after biopsy suggests that the presentation is more consistent with reactive palatal fibrosis secondary to facial filler injection and Anfiye inhalation. This report aims to highlight Anfiye or dermal fillers as potential etiological factors in the development of reactive fibrosis, which can be misdiagnosed as OSMF.