title: Embolia cutis medicamentosa (Nicolau syndrome) after endodontic treatment: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Calcium hydroxide paste is appropriate for the medicamentous treatment of root canals, but is not suitable to stanch bleeding from periapical arteries.
authors.affiliation: Department of Maxillofacial Surgery, University Hospital Giessen, Giessen, Germany. jan-falco.wilbrand@uniklinikum-giessen.de
authors.forename: Jan-Falco
authors.initials: JF
authors.lastname: Wilbrand
authors.forename: Martina
authors.initials: M
authors.lastname: Wilbrand
authors.forename: Heidrun
authors.initials: H
authors.lastname: Schaaf
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Howaldt
authors.forename: Christoph-Yves
authors.initials: CY
authors.lastname: Malik
authors.forename: Philipp
authors.initials: P
authors.lastname: Streckbein
mesh_terms: D000328:Adult; D002126:Calcium Hydroxide / Q000009:adverse effects*; D002680:Chin / Q000294:innervation; D004617:Embolism / Q000139:chemically induced*; D005148:Facial Dermatoses / Q000139:chemically induced*; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000209:etiology; D006801:Humans; D006987:Hypesthesia / Q000139:chemically induced; D007049:Iatrogenic Disease; D008297:Male; D008334:Mandible / Q000098:blood supply; D008437:Maxilla / Q000098:blood supply; D009336:Necrosis; D009915:Orbit / Q000294:innervation; D035583:Rare Diseases; D012387:Root Canal Filling Materials / Q000009:adverse effects*; D017445:Skin Diseases, Vascular / Q000139:chemically induced*; D013927:Thrombosis / Q000139:chemically induced; D014057:Tomography, X-Ray Computed
chemical_list: D012387:Root Canal Filling Materials; D002126:Calcium Hydroxide