Primary Closure of Deep Penetrating Wounds under Local Anesthesia with Dental Lidocaine HCL 28 Ampules in Maxillofacial Regions -Report of two cases -

치과용 Lidocaine 28 앰플로 국소마취 하에 1차 봉합한 악안면 심부 관통성 열창 -증례 보고-

The wide deep penetrating wound of maxillofacial region should be early closed under emergency general anesthesia for the prevention of complications of bleeding, infection, shock & residual scars. But, if the emergency general anesthesia wound be impossible because of pneumoconiosis, obstructive pulmonary disease & hypovolemic shock, early primary closure should be done under local anesthesia by use of much amount of the anesthetic solution. The maximum dose of dental lidocaine (2% lidocaine with 1 : 100,000 epinephrine) is reported to 7 mg/kg under 500 mg (13.8 ampules) in normal adult. But the maximum permissible dose of dental lidocaine can be changed owing to the general health, rapidity of injection, resorption, distribution & excretion of the drug. The blood level of overdose toxicity is above $4.0{\mu}g/ml$ in central nervous & cardiovascular system. The injection of dental lidocaine 1-4 ampules is attained to the blood level of $1{\mu}g/ml$ in normal healthy adult. The duration of anesthetic action in the dental 2% lidocaine hydrochloride with 1 : 100.000 epinephrine is 45 to 75 minutes and the period to elimination is about 2 to 4 hours. Therefore, authors selected the following anesthetic methods that the first injection of 6 ampules is applied into the deeper periosteal layer for anesthetic action during 1 hour, the second injection into the deeper muscle & fascial layer, the third injection into the superficial muscle and fascial layer, the fourth injection into the proximal skin & subcutaneous tissue and the fifth final injection into the distal skin & subcutaneous tissue. The total 26-28 ampules of dental lidocaine were injected into the wound as the regular time interval during 5-6 hours, but there were no systemic complications, such as, agitation, talkativeness, convulsion and specific change of vital signs and consciousness.