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J Am Dent Assoc, Vol 139, No 12, 1625-1630.
© 2008 American Dental Association
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CLINICAL PRACTICE

Necrosis of the skin of the chin

A possible complication of inferior alveolar nerve block injection



Eulàlia Torrente-Castells, DDS, Jordi Gargallo-Albiol, DDS, PhD, Alfonso Rodríguez-Baeza, MD, PhD, Leonardo Berini-Aytés, DDS, MD, PhD and Cosme Gay-Escoda, DDS, MD, PhD

Background. The literature describes different local complications derived from a local anesthetic. The authors present a report of a case of such a complication—a complication of which they have identified only one other similar case in the literature.

Case Description. A 10-year-old girl received an inferior alveolar nerve block injection for a dental restoration on the right side. After the procedure, she developed pallor of the right side of the lower lip and chin that subsequently evolved into a surface ulceration. The lesion suddenly healed 15 days later. The authors ruled out self-inflicted injury, intra-operative injury and skin infection as causes.

Conclusions and Clinical Implications. On the basis of the clinical manifestations and affected anatomical structures, the authors postulated skin necrosis secondary to vascular spasm of the terminal branches of the inferior alveolar artery. Even when clinicians use the utmost care, this kind of complication can occur as a result of an inferior alveolar nerve block injection. The practitioner should diagnose the problem appropriately and reassure the patient.

Key Words: Inferior alveolar artery; skin necrosis; inferior alveolar nerve block

Abbreviations: IAN: Inferior alveolar nerve.




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