Rare Ocular and Cutaneous Complication of Inferior Alveolar Nerve Block

One of the most common procedures in dentistry/ oral and maxillofacial surgery is the administration of local anesthetics. Local anesthetics administrated carefully and within recommended dosage limits have established an enviable record of safety. Although life threatening systemic reactions do occur, most adverse effects or complications are local and temporary. Localized responses to anesthetic injections are fairly common. Immediate local complications of local anesthesia include hematoma formation, tissue blanching, facial paralysis, amaurosis, diplopia, needle breakage, positive blood aspiration, and burning sensation on impingement of the nerve. However, some side effects are less frequent, and rarely reported complications can be bizarre and difficult to explain. Some blanching of the mucous membrane is to be expected after submucosal administration of solutions containing vasoconstrictors. Infrequently, the skin over the injection site may also lose color. This effect is entirely harmless and disappears as the drug is absorbed into the systemic circulation. Momentary blanching of peripheral tissues supplied by an artery may be elicited by contraction of the blood vessel in reaction to needle impact or by mechanical stimulation of sympathetic vasoconstrictor fibers supplying the area. Also, even when clinicians use the utmost care, by aspirating before the injection and noting anatomic landmarks, intra-arterial injections can occur during regional nerve blocks. Unintended intravascular injections from inferior alveolar nerve blocks result in frustrating local complications. Ocular complications such as temporary blindness, ophthalmoplegia, diplopia, hysterical blindness, myosis, amaurosis, and ptosis were also reported after mandibular or Gow-gates block injection of local anesthesia. Although blanching, ischemia, and ocular complications are reported as rare local complications of local anesthesia, there are very few articles documenting patients and clinical photographs. Including the very recent ones, some textbooks do not even mention these complications. In this case report, 2 facial blanching and ocular symptoms immediately after local anesthesia administration are presented.