Neurological complications following extrusion of sodium hypochlorite solution during root canal treatment

Abstract

*Neurological sequelae can follow inadvertent hypochlorite extrusion. *Early recognition may avert a potentially more serious outcome. *Active hospital treatment including intravenous steroids and antibiotics is recommended.

Accidental injection of sodium hypochlorite instead of local anesthetic in a patient scheduled for endodontic procedure

“…[6][7][8] Motor deficit observed by some authors did not occur here. 6,7 The depression is suggestive of the subcutaneous tissue loss and scar contracture. Use of local anesthesia and hypochlorite is almost simultaneous during endodontic treatment and there is a real possibility that the clinician mistakes one for another.…”

“…In some cases, there may be accidental injection of the solution. Corticosteroids may be useful due to their marked anti-inflammatory property and have been used, [5][6][7] but in none of the cases have they been injected directly at the site. The effect of submucosal injection of dexamethasone has been demonstrated to reduce the postoperative discomfort after third molar surgery.…”

Facial atrophy following accidental subcutaneous extrusion of sodium hypochlorite

“…4 Nerve damage to the branches of the facial and trigeminal nerve have been described. [4][5][6] Patients being treated under local anaesthesia they may not experience pain immediately. The patient described above developed a swelling associated with severe pain in the cheek.…”

Before you reach for the bleach...

“…5 All our patients developed paraesthesia and two developed persistent neuropathic pain which required tricyclic medication. Chemical damage to motor nerves, principally the facial nerve, 6 can result in weakness as in case 1. This may lead to incompetency of the lips and dribbling of fluids and saliva.…”