A 21-year-old female, Caucasian, ASA I with no associated comorbidity, university student, presented at the dental service of the Universidad Austral de Chile on January 5, 2014, to get fillings treatment for superficial dental caries in teeth 35 and 36. Her clinical history did not show surgical interventions under general anesthesia. It reported previous dental filling treatments with the use of local anesthetic with no manifestation of any complication. The intraoral examination showed a good rate of oral hygiene, with no presence of gingivitis or any other injury of the delicate tissues. For the treatment, the dentist decided to use the troncular technique to the IAN or the Halstead technique according to the one described by Malamed[] using a carpule syringe with a 27-gauge 0.4 mm × 25 mm needle (Terumo Corporation, Japan) and only one vial of 1.8 ml of articaine hydrochloride 4% with epinephrine 1:100,000 (Nova–FL®, Brazil). The dental crown notch, pterygomandibular raphe, and the occlusal plane of the left mandibular molars were considered for the point of injection. Setting the body of the carpule on the opposite side, the dentist set the tip of the needle to the level of the retromolar space and injected approximately 0.3 ml of anesthetic solution into the mouth nerve and then penetrated with the needle into delicate tissue 25 mm approximately until osseous contact. Blood content was observed in the rest of anesthesia cartridge, verifying the positive aspiration of the intravascular tap [].\nAt the moment of the injection, the patient immediately informed of an itching and burning feeling in the nasal and palatine mucosa, without the pain and dizziness associated with the tap. In the clinical examination, numbness was recorded in the left genial region, endangering the lower eyelid, wing of the nose, and upper lip on the left side of the face. The intraoral examination revealed an ischemia of the left mouth mucosa, end of vestibule of the left upper lip, loose and stuck gum between the maxillary teeth 21 and 28 [], and palatine mucosa from the median raphe to the palatal alveolar processes []. Due to the clinical picture, the intervention was partially suspended. After 5 min, the patient showed dysesthesia of the lower lip, gum and half of the tongue on the left side; she did not have any visual or nasal complications. She did not present any ocular complications such as double vision, blepharoptosis, miosis, anhidrosis, anisocoria, or others.\nAfter 10 min, gradual recovery was observed of the normal skin color and a pale pink at the end of the buccal space and palatine mucosa. Fifteen minutes after administration of the anesthesia, the anesthetic effect on the IAN was verified through a caries probe in the gingival crevice of tooth 36. After the reported complication, the decision was made to treat teeth 35 and 36. Once completed, the patient received some oral instructions about preventive measures to consider with the lip and tongue anesthesia, soft diet, and to return for a check-up 3 days later. In light of the interesting nature of the case, the patient gave her informed consent to study the case and present it in this article.
The patient was a 25-year-old man and ASA class I []. Mandibular inferior alveolar nerve block (Halsted’s technique) and long buccal nerve were used for dental implant insertion in the mandibular right quadrant. Facial blanching and palatal–buccal mucosa whitening occurred.