A 25-year-old woman visited our hospital for left mandibular third molar extraction. She had no notable medical history. Before surgery, she complained of gastrointestinal discomfort after taking prophylactic antibiotics and anti-inflammatory drugs, but her symptoms had improved. To extract the third molar, IANBA was performed on the left side. For local anesthesia, 1.8 cm3 of lidocaine with epinephrine in a 1:80000 ratio (Huons Lidocaine HCL and Epinephrine Inj. [1:80,000], Huons co. LTD, Sungnam, Republic of Korea) was used. Immediately after anesthetic injection in the left mandibular foramen area, the left side of the patient's face turned pale white, and she complained of pain and discomfort in the left facial area (). Aspiration was not performed during injection.\nThereafter, she complained of pain and discomfort extending from the middle left facial region to the left orbital region, including the eye. After evaluating facial nerve function, we confirmed that the symptoms were not related to any complication caused by anesthetic injection into the facial nerve. Although the patient chiefly complained of eye discomfort, she showed no signs such as the inability to close the eye or weakness of the frontalis associated with facial nerve paralysis (). The patient was observed in a supine position. Signs indicating blanching were observed from the outside of the nose, upper lip, central facial region, and the left zygomatic area. The patient complained of discomfort accompanying pain in the region with blanching, especially around the eye. The symptoms had occurred immediately after anesthetic injection and became severe within 1–2 min. The symptoms remained stable, but they improved after more than 10 min (). The patient's pain symptoms also improved, but the ischemic sign in the left facial region did not improve completely, especially in the lateral nasal area.\nAs the patient did not complain of severe symptoms and showed improvement, her current condition was explained to her, and surgical extraction of the left mandibular third molar was performed. After extraction, her progress was monitored until her symptoms completely improved approximately 40 min after the initial facial blanching sign. She was informed again that it was a complication of anesthesia. We decided to conduct additional examinations and treatment if the symptoms reappeared after discharge. No notable additional symptoms were observed.
The patient was a 28-year-old woman without any systemic disease. She attended for the removal of mandibular right wisdom tooth. On the basis of palpitation report, plain mepivacaine had been used. Gow-Gates injection was used for this purpose, and immediately after injection, blanching occurred in the infraorbital, buccal, and palatal regions [].