Local facial atrophy and permanent anesthesia of right upper lip following subcutaneous extrusion of chlorhexidine digluconate

Abstract Endodontic therapy is a well-established treatment modality with a high success rate [ 1 ]. The aim of endodontic therapy is to prevent or treat periapical inflammatory lesions [ 2 ] by removal of connective tissue and microorganisms found in infected root canal [ 3 ]. In addition, it seeks an effective seal in order to prevent recolonization of the root canal system with bacteria [ 4 ]. Irrigation plays a major role in successful endodontic therapy, and it is used to remove debris from the root canal, eliminate microorganisms, and serve as a lubricant during instrumentation. Therefore, an “ideal” irrigation solution should be efficient as an antimicrobial agent but not toxic to the surrounding tissues [ 5 ]. Sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA) and in the recent years chlorhexidine (CHX) gluconate are commonly used root canal irrigants [ 6 ]. Negative adverse effects and complications following accidental extrusion of irrigation solutions are well known in the literature for NaOCl [ 7 , 8 ], hydrogen peroxide [ 9 , 10 ] and sulfuric acid [ 11 ]. CHX has been advocated to be antimicrobial effective without having the inflammatory disadvantages of NaOCl [ 12 , 13 ]. To our knowledge, there have been no reports of severe tissue damage caused by 2% CHX digluconate during the course of endodontic therapy. Unique to this case report is also the unusual form of harm persistence in the aftermath of injury.