Acta Otorrinolaringológica Española 73 (2022) 336---338

www.elsevier.es/otorrino

IMAGES IN OTORHINOLARYINGOLOGY

Left lower hemilabium necrosis as a complication of

infiltration under local anesthesia
Necrosis de hemilabio inferior izquierdo como complicación de infiltración
con anestesia local
María Teresa Cervilla Martín,∗ María Romero Marchante, Rafael Sanz Trenado,
Marta García Jimenez

Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario de Cáceres, Cáceres, Spain

Introduction of the left lower hemilabium, following a dental procedure

The infiltration of local anaesthesia (LA) is a widely used
procedure, due to its safety and efficacy, for procedures
requiring short-term pain control in oral surgery. Although
infrequent, side effects, either local or systemic, may
occur. Examples include: rapid diffusion of anaesthetic,
intravascular injection, cardiovascular reactions, central
nervous system reactions, allergic reactions, etc. Some of
the complications include: sudden unilateral deafness, cra-
nial nerve palsies, skin complications.1
Below we describe a case of a cutaneomucosal
complication, which we suspect was a consequence of post-
infiltration LA vasospasm.
Clinical case study
A 9-year-old female patient, whose parents consulted due
to the appearance of a mucosal lesion on the inner surface
∗ Corresponding author.
E-mail address: mariateresa.cervilla@salud-juntaex.es
(M.T. Cervilla Martín).
(filling) performed by her dentist 4 days earlier.
In the initial ENT assessment, a whitish lesion with an
indurated appearance was observed on the left lower lip,
with a doubtful area of central fluctuation, affecting both
the mucosa of the inner side of the lip and the vermilion,
which was almost entirely covered by a large hard, dehy-
drated crust with a necrotic appearance (Fig. 1).
The procedure from which the clinic symptoms developed
consisted of a dental filling. It was performed under local
anaesthesia: infiltration of a 1.8 ml lidocaine carpule.
She was admitted for intravenous treatment with methyl-
prednisolone and Augmentine® according to weight, as well
as analgesia and serotherapy. She was also treated with nasal
Bactroban® and nitroglycerin ointment, both for topical use
on the mucosal lesion.
After 4 days of hospitalisation, the patient showed a
clear improvement in the lesion and was discharged with
oral Augmentine® for 7 days, and application of topical
Bactroban® nasal and Aloclair® Plus gel on the lesion (Fig. 2).
She was reviewed 3 days later and the lesion was found to
be completely healed (Fig. 3).

https://doi.org/10.1016/j.otoeng.2022.02.006
2173-5735/© 2022 Sociedad Española de Otorrinolaringologı́a y Cirugı́a de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights
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