Cleft lip and palate: recommendations for dental anesthetic procedure\nbased on anatomic evidences
A 13-year-old female patient with a complete bilateral CLP was seen at the Outpatient\nClinic of the Department of Oral and Maxillofacial Surgery, Prosthodontics and\nTraumatology of the Dental School, University of São Paulo, after referral from an\northodontist for extraction of residual roots located in the margins of the right\nalveolar cleft and premaxilla, and over-retained primary canine and supernumerary\ntooth located in the left maxillary segment. All teeth had poor bone insertion or\nroot malformation ().\nFor anesthesia of teeth located on the margin of the right cleft, topical anesthetic\ngel with 20% benzocaine (Benzotop, DFL) was applied at the bottom of the vestibule,\nin the right maxillary segment and premaxillary areas. The first puncture, using 2%\nlidocaine with epinephrine 1:100.000 (Alphacaine, DFL), was made in the premolar\nregion, avoiding the introduction of the needle in the area near the nose, which is\noften very painful (). A second\npuncture was made in the right maxillary segment close to the buccal aspect of the\ncleft and, in the third puncture, the tooth located on the right margin of the\npremaxilla was anesthetized, with the needle inserted at 45º toward the tooth apex\n(). Infiltrations along the mucosa\nin the buccal () and palatal aspects\n() of the right maxillary segment\nand premaxillary region ( and , respectively) were made to promote greater\nlocal anesthesia and hemostasia during the surgical procedure.\nOn the left side, the anesthetic technique was very similar to the procedure\nperformed on the right cleft, i.e., first infiltration away from the cleft site\n(), second and third infiltrations\nin the cleft area inclined 45º towards the tooth apex () and anesthesia of the buccal () and palatal mucosa\n(). After anesthesia, tooth\nextraction was conducted in a conventional manner (, and ).