Sodium Hypochlorite-induced Facial Hematoma Following Root Canal Treatment

Abstract

This case report highlights a rare complication of root canal treatment involving the inadvertent extrusion of sodium hypochlorite solution, resulting in a sodium hypochlorite-induced facial hematoma. A 44-year-old female patient presented significant right hemifacial swelling and ecchymosis following root canal therapy. Computed tomography imaging confirmed a hematoma involving the facial region without active signs of bleeding. Sodium hypochlorite, a potent cytotoxic agent commonly used in root canal procedures, was identified as the causative agent. Treatment consisted of prednisone, antibiotics, and NSAIDs, resulting in gradual improvement over a month. The cytotoxic properties of sodium hypochlorite, its variable concentrations, and risk factors associated with facial hematomas are discussed. It is essential to emphasize the rarity of such hematomas and highlight the need for precise technique, vigilant monitoring, and interdisciplinary collaboration to mitigate risks and prioritize patient safety.

Keywords: Case Report; Facial Hematoma; Root Canal Treatment; Sodium Hypochlorite.

Figure 1.

Clinical images of the patient's face at presentation exhibiting significant right-sided hemifacial edema and ecchymosis consistent with a facial hematoma. The edema is characterized by a notable swelling, extending from the submandibular region to the periorbital tissues, predominantly affecting the right side of the face. The ecchymosis, evident as purplish discoloration, further emphasizes the extent of soft tissue damage

Figure 2

A) Axial and B) Coronal computed tomography (CT) scan performed in the emergency setting highlights a substantial increase in density of the right hemifacial soft tissues, showing a diffuse reticular pattern of increased fat density. A more concentrated area of higher density is observed in the right zygomatic and paramandibular regions compatible with a hematoma; C) Additionally, two gas bubbles, indicative of emphysema, are seen within the right retromaxillary buccal fat, further emphasizing the involvement of this region (A and B, red arrow). On the angiographic CT image, no contrast extravasation was observed, suggesting the absence of active bleeding at the time of examination

Figure 3.

A) Sagital and B) axial CT image with bone algorithm reconstruction captures the region of tooth number 16, revealing significant post-intervention changes consistent with the root canal treatment that the tooth underwent. Within the tooth structure, a well-defined radiolucent center is observed, indicating the presence of the root canal space (A and B, red arrow)