Case reports: Palatal mucosal necrosis after administration of a palatal infiltration

Efficacy of concentrated growth factor in the surgical treatment of postanaesthetic palatal necrosis

BACKGROUND

Although uncommon, adverse local and systemic reactions to local anesthetic administration can occurred. The postanesthetic necrosis is a rare complication which usually involved the palatal region. The wound healing is a complex process regulated by a range of growth factors. Concentrated growth factor (CGF) is the latest generation of autologous platelet concentrate which has been widely used in the repair and regeneration of oral soft and hard tissue. The study aims to analyses the clinical benefit of CGF in the treatment of postanesthetic necrosis of the hard palate.

METHODS

The study included all patients referred to the Department of Maxillo-Facial Surgery, Marche University General Hospital, between 2020 and 2022, for aseptic ulcer of the hard palate due to local anesthetic administration. For each patient, the surgical debridement of the necrotic tissue and a peripheral blood sample were performed. The CGF was obtained by a centrifuge device and sutured in the affected site. The greasy gauze, placed to prevent the matrix detachment, was removed seven days post-operative.

RESULTS

Seven patients (M:F=4:3, mean age 48.6±5.1 years) were enrolled in the study. After 7 days post-operative, no infection, discomfort, or dysphagia were reported. Moreover, 4 patients (57%) showed a total re-epithelialization, while 3 patients (43%) with larger defects, displayed a partial re-epithelialization. A complete recovery occurred in all cases 15 days after surgery.

CONCLUSIONS

CFG represents a promising potential preparation for the oral mucosa wound healing able to promote the granular tissue formation and the mucosa re-epithelialization.

Postanaesthetic Aseptic Palatal Necrosis - A Case Report

Rationale:

In dentistry, the most common procedure to be applied is administration of a local anaesthetic agent. It is impossible to practice dentistry without local anaesthesia. In the oral cavity, the palatal mucosa is tightly adherent to the palatal bone and there is little space for anaesthetic solution to be deposited. If local anaesthetic is forcefully injected by the syringe, it creates pressure on blood vessels and causes palatal necrosis.

Patient Concern:

Here, we present a case report of a 25-year-old male patient who reported to us with chief complaint of an ulcer on the palate.

Diagnosis:

Patient was diagnosed with postanaesthetic aseptic palatal necrosis.

Intervention:

The patient was managed conservatively using copious irrigation and a palatal acrylic splint.

Outcome:

On the 6^th month follow-up, the lesion was completely replaced by healthy mucosa.

Take-away Lessons:

We should avoid forceful injection of local anaesthetic agent to prevent further postoperative complications.

Canalis Sinuosus Damage after Immediate Dental Implant Placement in the Esthetic Zone

Dental implant failure in the anterior maxilla can be caused by the range of the features. One of them is neighboring neurovascular structure damage, such as the canalis sinuosus (CS), that carries the superior anterior alveolar nerve. The aim of the report is to demonstrate clinical symptomatology and radiographic signs of CS damage in a 45-year-old female patient who underwent upper left lateral incisor extraction and immediate implant placement and implant removal in 16 days secondary to pain and paresthesia in the maxillary left region.

Palatal Perforation: A Rare Complication of Postanesthetic Necrosis

The everyday practice of dentistry relies heavily on achieving adequate local anesthesia. Even though the safety record of local anesthetic agents is high, complications do occur. Palate is a favorable site for soft-tissue lesions. Various factors such as direct effects of the drug, blanching of the tissues during injection, relatively poor blood supply, and reactivation of the latent forms of herpes can all promote to tissue ischemia and a lesion in the palate. Among various complications, anesthetic necrotic ulcer is a rare and uncommon condition occurring mostly in the hard palate possibly after a local anesthetic infiltration. The ulceration is often deep and shows spontaneous but delayed healing. If proper treatment is not instituted on time, the necrosis can reach deep into the bone causing sequestrum formation and ultimately leading to palatal perforation. Here, we report a case of palatal perforation in a male patient followed by surgical interventions and follow-up.