Rare Cutaneous Ischaemia and Pain during Infiltrative Anaesthesia for Dental Surgery: Case Reports and Literature Review

Abstract

Local Anaesthetics (LA) is commonly used for surgical and dental procedures. Complications related to local anaesthesia can be divided into local, systemic and immediate complications. Immediate complications include positive blood aspiration, blanching of the tissue, pain, facial paralysis and burning sensation on impingement of the nerve. Blanching develops from decreased blood flow to the tissues as a result of blood vessels narrowed by adrenaline. The precise cause of this complication is unknown; however, it may be derived because of intraarticular injection, anatomical variation, rapid injection of local anaesthetic solution, retrograde flow of the solution, misdirection of the needle and neuronal basis. This report of 2 cases describes patients with ischemic areas on their faces resulting from maxillary and mandibular buccal infiltrative anaesthesia techniques. After the skin ischemia associated with the severe and instant pain occurs, the patient should be calmed and informed about the reversibility of the situation. It also includes information about the diagnosis, management, literature review and proposes some mechanisms for cutaneous ischemia and pain.

Keywords

• immediate complication
• local anaesthetics
• skin blanching