Review Anatomy of sodium hypochlorite accidents involving facial ecchymosis—A review Wan-chun Zhu a,1 , Jacqueline Gyamfi b,1 , Li-na Niu c , G. John Schoeffel d, **, Si-ying Liu e , Filippo Santarcangelo f , Sara Khan b , Kelvin C.-Y. Tay g , David H. Pashley h , Franklin R. Tay b, * a Department of Stomatology, North Sichuan Medical College, Nanchong, China b Department of Endodontics, Georgia Regents University, Augusta, GA, USA c Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi’an, China d Retired Endodontist, P.O. Box 370, Dana Point, CA, USA e School and Hospital of Stomatology, Wuhan University, Wuhan, China f Private Practice Limiting to Endodontics, Bari, Italy g General Dental Practitioner, Halifax, Nova Scotia, Canada h Department of Oral Biology, Georgia Regents University, Augusta, GA, USA j o u r n a l o f d e n t i s t r y 4 1 ( 2 0 1 3 ) 9 3 5 – 9 4 8 a r t i c l e i n f o Article history: Received 30 June 2013 Received in revised form 12 August 2013 Accepted 17 August 2013 Keywords: Central venous pressure Ecchymosis Facial vein Intraosseous space Positive fluid pressure Root canal treatment Sodium hypochlorite a b s t r a c t Objectives: Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. Methods: To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. Results: By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non- collapsible venous sinusoids within the cancellous bone is presented. Conclusions: Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal de ´ bridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system. # 2013 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Endodontics, College of Dental Medicine, Georgia Regents University, Augusta, GA 30912-1129, USA. Tel.: +1 706 7212152; fax: +1 706 7218184. ** Corresponding author at: P.O. Box 370, Dana Point, CA, USA. E-mail addresses: [email protected](G.J. Schoeffel), [email protected], [email protected](F.R. Tay). 1 These authors contributed equally to this work. Available online at www.sciencedirect.com ScienceDirect journal homepage: www.intl.elsevierhealth.com/journals/jden 0300-5712/$ – see front matter # 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jdent.2013.08.012
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Review
Anatomy of sodium hypochlorite accidentsinvolving facial ecchymosis—A review
Wan-chun Zhu a,1, Jacqueline Gyamfi b,1, Li-na Niu c, G. John Schoeffel d,**,Si-ying Liu e, Filippo Santarcangelo f, Sara Khan b, Kelvin C.-Y. Tay g,David H. Pashley h, Franklin R. Tay b,*aDepartment of Stomatology, North Sichuan Medical College, Nanchong, ChinabDepartment of Endodontics, Georgia Regents University, Augusta, GA, USAcDepartment of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi’an, ChinadRetired Endodontist, P.O. Box 370, Dana Point, CA, USAeSchool and Hospital of Stomatology, Wuhan University, Wuhan, Chinaf Private Practice Limiting to Endodontics, Bari, ItalygGeneral Dental Practitioner, Halifax, Nova Scotia, CanadahDepartment of Oral Biology, Georgia Regents University, Augusta, GA, USA
j o u r n a l o f d e n t i s t r y 4 1 ( 2 0 1 3 ) 9 3 5 – 9 4 8
a r t i c l e i n f o
Article history:
Received 30 June 2013
Received in revised form
12 August 2013
Accepted 17 August 2013
Keywords:
Central venous pressure
Ecchymosis
Facial vein
Intraosseous space
Positive fluid pressure
Root canal treatment
Sodium hypochlorite
a b s t r a c t
Objectives: Root canal treatment forms an essential part of general dental practice. Sodium
hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to
Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively
rare and are seldom life-threatening, they do create substantial morbidity when they occur.
Methods: To date, NaOCl accidents have only been published as isolated case reports.
Although previous studies have attempted to summarise the symptoms involved in these
case reports, there was no endeavour to analyse the distribution of soft tissue distribution in
those reports. In this review, the anatomy of a classical NaOCl accident that involves facial
swelling and ecchymosis is discussed.
Results: By summarising the facial manifestations presented in previous case reports, a novel
hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-
collapsible venous sinusoids within the cancellous bone is presented.
Conclusions: Understanding the mechanism involved in precipitating a classic NaOCl accident
will enable the profession to make the best decision regarding the choice of irrigant delivery
techniques in root canal debridement, and for manufacturers to design and improve their
irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.
# 2013 Elsevier Ltd. All rights reserved.
* Corresponding author at: Department of Endodontics, College of Dental Medicine, Georgia Regents University, Augusta, GA 30912-1129,USA. Tel.: +1 706 7212152; fax: +1 706 7218184.** Corresponding author at: P.O. Box 370, Dana Point, CA, USA.
These authors contributed equally to this work.0300-5712/$ – see front matter # 2013 Elsevier Ltd. All rights reserved.http://dx.doi.org/10.1016/j.jdent.2013.08.012
j o u r n a l o f d e n t i s t r y 4 1 ( 2 0 1 3 ) 9 3 5 – 9 4 8946
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