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Pharmacology · single question

What is the MAIN cause of tissue necrosis after local anesthetic injection on the palate?

  1. Allergic reaction to the anesthetic
  2. Bacterial infection from the injection
  3. Vasoconstrictor-induced ischemia
  4. Direct tissue toxicity from the anesthetic
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Correct answer: C. Vasoconstrictor-induced ischemia

Tissue necrosis after palatal injection of local anesthetic is caused by ISCHEMIA from the vasoconstrictor (epinephrine). The palatal mucosa is tightly bound to underlying bone with minimal ability to expand or dissipate the vasoconstriction. Epinephrine causes intense local vasoconstriction, reducing blood flow to the mucosa. If prolonged or concentrated, this results in tissue ischemia and necrosis. The palate is the MOST COMMON site for this complication.
  • A. Incorrect. Allergic reactions cause urticaria, angioedema, anaphylaxis — not localized palatal tissue necrosis.
  • B. Incorrect. Bacterial infection from injection (if it occurs) would present as abscess days later — not immediate tissue necrosis.
  • C. CORRECT. Vasoconstrictor-induced ischemia is the primary mechanism — epinephrine dramatically reduces blood flow to the tightly bound palatal mucosa, causing ischemic necrosis.
  • D. Incorrect. Direct anesthetic toxicity is systemic (CNS/cardiac) — not the cause of localized palatal tissue necrosis.

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