A Case of Broken Local Anesthetic Needle in the Pterygomandibular Space; Diagnostic Approaches and Surgical Management

Needle fracture during dental local anesthetic injections is a rare but significant, potentially serious complication. Various approaches for the location and removal of broken needles have been described; however, there are several difficulties and concerns related to the potential complications an...

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Bibliographic Details
Published in:Diagnostics (Basel) 2023-09, Vol.13 (19), p.3050
Main Authors: Malkawi, Ziad, Alayeh, Alaa, Alshawa, Abedalaziz, Shaban, Ola, Al Saraireh, Omar, Malkawi, Hashem, Babkair, Hamzah, Abdouh, Ismail, Dar-Odeh, Najla
Format: Article
Language:English
Subjects:
Blood vessels
broken needle
CBCT
dental anesthesia
Dissection
General anesthesia
inferior alveolar nerve block
Interesting Images
pterygomandibular space
Radiography
Surgeons
Sutures
Veins & arteries
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Summary:Needle fracture during dental local anesthetic injections is a rare but significant, potentially serious complication. Various approaches for the location and removal of broken needles have been described; however, there are several difficulties and concerns related to the potential complications and critical anatomic challenges peculiar to the head and neck region. In this case, we describe the diagnostic approaches utilized in locating a broken needle that migrated in the pterygomandibular space following gag reflex, and sudden head movement of a middle-aged male patient. A meticulous diagnostic approach was employed to locate the needle utilizing CBCT scan, CT scan with contrast, and C-arm X-ray machine. The needle was successfully retrieved using an angled hemostat inserted through an oral incision, guided by a C-arm X-ray machine and ENT endoscopic instruments. While careful planning could prevent many complications that may arise during oral surgical procedures, inadvertent events leading to serious complications should be addressed using the appropriate and timely diagnostic techniques pre-and intra-operatively.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics13193050