Embolia Cutis Medicamentosa (Nicolau Syndrome) after Endodontic Treatment: A Case Report

Embolia medicamentosa (Nicolau síndrome) é um evento iatrogênico raro que ocorre por necrose tecidual após a aplicação intramuscular ou intra-articular de suspensões de cristais. Clinicamente, apresenta-se como uma descoloração da pele, dor local, e sinais de inflamação. Este artigo apresenta caso de síndrome de Nicolau após a aplicação de pasta de hidróxido de cálcio no canal da raiz distal do dente 18.  

Embolia cutis medicamentosa (Nicolau syndrome) after endodontic treatment: a case report. 

Wilbrand JF, Wilbrand M, Schaaf H, Howaldt HP, Malik CY, Streckbein P.

University Hospital Giessen, Giessen, Germany.jan-falco.wilbrand@uniklinikum-giessen.de

Embolia cutis medicamentosa (Nicolau syndrome) is a rare iatrogenic event of tissue necrosis after intramuscular or intraarticular application of cristalloid suspensions. Clinically, it presents as a livid discoloration of the skin, local pain, and signs of inflammation.This article presents the first case of Nicolau syndrome after the endodontic application of calcium hydroxide paste into the distal root canal of tooth 18. The patient presented to the Department for Maxillofacial Surgery and hospitalized for several days.The application of calcium hydroxide paste led to a thrombosis of the inferior alveolar artery and various branches of the maxillary artery. A definite necrosis of the left-side infraorbital skin area and concomitant hypaesthesia of the infraorbital nerve and of the mental nerve were observed. Calcium hydroxide paste is appropriate for the medicamentous treatment of root canals, but is not suitable to stanch bleeding from periapical arteries.

J Endod. 2011 Jun;37(6):875-7. Epub 2011 Mar 3.