Buccal Space Collection of Ozonized Sunflower Oil Following Off-Label Injection: A Case Report

Ozonized sunflower oil is increasingly employed in the management of oral conditions due to its antimicrobial and immunostimulating properties. While topical use is generally considered safe, off-label applications, such as intrasulcular or periapical injections, may pose unexpected clinical risks. The aim of the present report was to describe an unusual complication due to an improper use of ozonated oil and its management.

We, herein, report the case of a 67-year-old female presenting with facial swelling unresponsive to antibiotics and corticosteroids. Initial evaluation suggested an odontogenic abscess; however, ultrasonography revealed an irregular, avascular intramuscular collection with a surrounding hypoechoic halo. The patient disclosed prior treatment involving ozonized sunflower oil, raising suspicion of an inadvertent submucosal injection. Surgical drainage yielded brownish fluid, with microbiological analysis proving negative. A second aspiration was required due to residual swelling. The patient reported near-complete symptom resolution following the second intervention. This case highlighted the potential adverse outcomes of non-topical administration of ozonized oil, which is non-resorbable and may induce a foreign body inflammatory response. Ultrasonography played a key role in differential diagnosis and guided therapeutic intervention, which was successfully managed with needle aspiration.

Off-label injections of ozonized oil should be avoided. Ultrasound assessment is instrumental in diagnosis, and needle-driven aspiration may offer an effective, minimally invasive treatment.