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

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