Home | About us | Editorial board | Ahead of print | Current issue | Archives | Search | Submit article | Instructions | Subscribe | Advertise | Contact us |  Login 
National Journal of Maxillofacial Surgery
 
Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 195
 


 
Table of Contents
CASE REPORT
Year : 2016  |  Volume : 7  |  Issue : 1  |  Page : 86-88  

Postanesthetic ulceration of palate: A rare complication


1 Department of Oral Medicine and Radiology, Sudha Rustagi Dental College and Hospital, Faridabad, Haryana, India
2 Department of Prosthodontics, Sudha Rustagi Dental College and Hospital, Faridabad, Haryana, India
3 Department of Orthodontics, Krishna Dental College, Ghaziabad, Uttar Pradesh, India

Date of Web Publication19-Dec-2016

Correspondence Address:
Ramesh Gupta
A-49 Kalkaji, New. Delhi - 110 019
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-5950.196142

Rights and Permissions
   Abstract 

The routine dental practice involves various dental procedures which needs the application of local anesthetics. Generally, there are very few complications associated with these procedures. Complications such as tissue necrosis can occur following the rapid injection of local anesthetic solutions. Palate is a favorable site for soft tissue lesions, various factors such as direct effects of the drug, blanching of the tissues during injection, a relatively poor blood supply, and reactivation of the latent forms of herpes can all promote to tissue ischemia and a lesion in the palate.

Keywords: Anesthesia, necrosis, palate, ulcer


How to cite this article:
Gupta R, Garg M, Pawah S, Gupta A. Postanesthetic ulceration of palate: A rare complication. Natl J Maxillofac Surg 2016;7:86-8

How to cite this URL:
Gupta R, Garg M, Pawah S, Gupta A. Postanesthetic ulceration of palate: A rare complication. Natl J Maxillofac Surg [serial online] 2016 [cited 2017 Apr 26];7:86-8. Available from: http://www.njms.in/text.asp?2016/7/1/86/196142


   Introduction Top


The regular dental practice involves various dental procedures which needs the application of local anesthetics. It is mainly given as local infiltration or nerve blocks.[1] In local infiltration, anesthetic solutions are injected close to the apex of the involved tooth structures. Generally, there are very few complications associated with this procedure; however, possible complication may include infection, trismus, prolonged pain, needle breakage, paresthesia, hematoma, edema, facial nerve paralysis, sloughing of tissues, and postanesthetic intraoral lesions.[1],[2],[3] Palate is a favorable site for soft tissue lesions and the various contributory factors such as the direct effects of the drug being administered, blanching of the tissues during injection, a relatively poor blood supply, and reactivation of the latent forms of a disease such as herpes can all promote to the tissue ischemia and a lesion.[1],[2],[3] In this paper, we have presented two cases that developed ulceration of palate after administration of local anesthetic containing a vasoconstrictor along with its management.


   Case Reports Top


Case report 1

A 50-year-old male patient reported to the dental clinic with a chief complaint of an ulcer in the mouth since 4–5 days. The dental history revealed that he had undergone extraction with reference to 24 tooth under local anesthesia containing 2% lidocaine with adrenaline 1:100,000. A local infiltration was given in palate with reference 24 tooth region, after which patient reported an ulcer at the site of injection on the next day. No history of allergy to local anesthetics was elicited from previous dental treatments. The patient was overall in good health; on intraoral examination, a single crescent-shaped ulcer in the palate measuring 2 cm × 1.5 cm was present. It was extending mesiodistally from 23 to 25 and mediolaterally 7–8 mm inferior to palatal gingival margin to almost mid-palatine raphe. The floor of the ulcer was covered with grayish whitish necrotic slough with sloping edge and erythematous margins; on palpation, all inspectory findings were confirmed the ulcer was slightly tender on palpation with no indurations present [Figure 1].
Figure 1: Ulcer on the hard palate with reference to 24 regions

Click here to view


Case report 2

A 42-year-old male patient reported to the dental clinic with a chief complaint of pain in the palate since 2 days; his history revealed that he had received a palatal injection 3 days back of 2% lidocaine with 1:100,000 epinephrine in the area of the upper right first molar. The patient was overall in good health but with poor oral hygiene. No sign of allergy to local anesthetics was reported in the previous dental treatments On Intraoral examination, on inspection, a single irregular-shaped ulcer in relation 26 and 27 teeth measuring 2 cm × 2 cm on the palate was present the surrounding margins of ulcer was sloping and erythematous. The center of ulcer was covered by a whitish yellow necrotic slough. On palpation, all inspectory findings were confirmed the ulcer was slightly painful with no indurations present [Figure 2].
Figure 2: Ulcer on the hard palate with reference to 26, 27 regions

Click here to view


A sensitivity test was done in both cases to rule out the delayed type of hypersensitivity reaction to the anesthetic solutions. It came out to be negative. Hematological investigation result showed both the patients were nondiabetic, so fungal infection (mucormycosis) was ruled out. In both cases, one thing was common both the patients have undertaken dental treatment in the same village of Mathura city (India) by unqualified dental professionals.

A combination of an anesthetic-antiseptic solution together with an oral analgesic was prescribed. After 1 week, almost complete healing of the ulcer was seen in [Figure 3] and [Figure 4].
Figure 3: Healing of the ulcer after 1 week

Click here to view
Figure 4: Healing of the ulcer after 2 weeks

Click here to view



   Discussion Top


Local anesthetic solutions which have been used in modern day practice are relatively nonirritating to tissues; however, ulceration and necrosis have been documented after the administration of local anesthetic.[4],[5] Allergic reactions are usually rare but if they occur they are mostly due to pharmacological effects of the agents used.[1] Complications such as tissue necrosis can occur following the rapid injection of local anesthetic solutions, particularly those containing a vasoconstrictor. They reduce the supply of oxygen to the injected tissue thereby promote the buildup of acidic by-products.[1],[5],[6]

Hypersensitivity reaction may develop almost immediately after administration of local anesthetic agents, whereas most dermatological reactions take several hours to manifest.[3]

Application of a topical anesthetic agent for a longer duration may result in desquamation of epithelial tissue. Sterile abscess on the hard palate can be formed due to ischemia caused by the use of vasoconstrictor-containing local anesthetic. Postanesthetic intraoral lesions can also be formed on the hard palate due to reactivation of recurrent aphthous stomatitis and herpes simplex.[1],[5],[7]

Management of such lesion formed after the administration of local anesthetic is usually conservative. It is mainly consists of reassuring the patient, prescribing analgesics, and combination of topical antiseptic and anesthetic preparations. Healing generally occurs within 8 to 10 days after the onset of the lesion. Rarely surgical intervention is necessary when ulcer does not heal. An oral protective emollient orabase paste can also be prescribed. The following measures can minimize such palatal lesions using topical anesthetic preparation according to the manufacturer's specifications. Moreover, it should be applied for 1–2 min to maximize the effectiveness and minimize toxicity.[1],[8]

Repeated palatal injection and solutions containing relatively high concentrations of epinephrine (i.e., 1:50,000; 1:30,000) should be avoided.[1]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Malamed SF. Handbook of Local Anesthesia. 5th ed. St. Louis: The C.V. Mosby Co.; 2004.  Back to cited text no. 1
    
2.
Carroll MJ. Tissue necrosis following a buccal infiltration. Br Dent J 1980;149:209-10.  Back to cited text no. 2
    
3.
Becker DE, Reed KL. Local anesthetics: Review of pharmacological considerations. Anesth Prog 2012;59:90-101.  Back to cited text no. 3
    
4.
Jastak JT, Yagiela JA. Regional Anesthesia of the Oral Cavity. St. Louis: The C.V. Mosby Co.; 1981.  Back to cited text no. 4
    
5.
Neville BW, Damm DD, Allen CM, Bouquot JE. Text Book of Oral and Maxillofacial Pathology. 3rd ed. Philadelphia: WB Saunders Co.; 2008.  Back to cited text no. 5
    
6.
Klingenstroem P, Westermark L. Local tissue-oxygen tension after adrenaline, noradrenaline and octapressin in local anaesthesia. Acta Anaesthesiol Scand 1964;8:261-6.  Back to cited text no. 6
    
7.
Giunta J, Tsamsouris A, Cataldo E, Rao S, Schreier E. Postanesthetic necrotic defect. Oral Surg Oral Med Oral Pathol 1975;40:590-3.  Back to cited text no. 7
    
8.
Schaffer J, Calman HI, Levy B. Changes in the palate color and form. Dent Radiogr Photogr 1966;39:3-6.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Reports
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed164    
    Printed1    
    Emailed0    
    PDF Downloaded62    
    Comments [Add]    

Recommend this journal