A complication of LA

Today I perfomed a buccal infiltration of the 18 and the patient had a sharp reaction and after the LA complained of a tingling sensation below his right eye. I observed a blanching below his eye of irregular shape about 6-7cm in size. This was a phenomenon of the needle tip coming into contact with the sympathetic nerve plexus surrounding the maxillary artery causing a chain reaction spanning down the length of the artery causing vasoconstriction. This presents as blanching of the tissues suppled by the infraorbital artery of the ipsilateral side due to local vasoconstriction of the blood vessels. This will last as long as the LA is effective in the area.

What to do?
Assure the patient that it is normal and will wear off over time. You can show it to them in the mirror if they'd like. Say people wouldn't normally notice it but it will wear off as the LA wears off. Monitor their condition to see if there are any changes in vision or heart rate which would indicate injection intravascularly. aspirate in more posterior infiltrations.