Administration of local anaesthesia is a very common practice in a dental clinic included in every other treatment and with such a common practice there are chances of things going wrong or complications taking place. One such complication is – Necrosis of the soft tissue at the site of injection called as Anaesthetic Necrosis. The Necrosis is most commonly seen as a result of ischaemia in the localized area of the injection site. The most common cause is due to faulty injection technique and the most common injection technique resulting in Anesthetic Necrosis is the greater palatine nerve block.
Localised ischaemia is caused mainly due to the following reasons – excess anaesthetic solution deposited in the tissue firmly bound to bone as seen in the palate, subperiosteal injection. In some cases the presence of Epinephrine in the LA agent is considered to be the cause of ischaemia and secondary necrosis. Similar type of necrosis has been seen when accidental injection of Sodium Hypochlorite was done.
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Clinical features of Anaesthetic Necrosis:
- Most common location is the Hard Palate ( greater palatine nerve block) at the site of injection
- Well circumscribed area of ulceration is seen
- Deep ulceration
- Delayed healing
- Symptoms seen after several days of administration
- Sequestration of bone at the site of necrosis is rarely seen
As the condition is associated with localized trauma caused due to the Local anesthetic agent there are no systemic symptoms seen in Anesthetic Necrosis and local reversible signs and symptoms are seen.
Treatment of Anaesthetic Necrosis:
There is no need for any treatment unless there is necrosis and sequestration in the ulceration area which is rarely seen. For relief from the pain due to ulceration topical anaesthetic gel can be prescribed making sure that there is no Epinephrine in it. Anesthetic Necrosis can bee avoided or prevented by following the proper injection technique and to prevent sub periosteal injection of anaestheitc agents.