J Korean Assoc Oral Maxillofac Surg.  2013 Oct;39(5):251-253.

Removal of a broken needle using three-dimensional computed tomography: a case report

• Kim JH
• Moon SY

Abstract

Inferior alveolar nerve block obtained maximum anesthetic effect using a small dose of local anesthetic agent, which also has low a complication incidence. Complications of an inferior alveolar nerve block include direct nerve damage, bleeding, trismus, temporary facial nerve palsy, and etc. Among them, the major iatrogenic complication is dental needle fracture. A fragment that disappears into the soft tissue would be hard to remove, giving rise to a legal problem. A 31-year-old woman was referred for the removal of a broken needle, following an inferior alveolar nerve block. Management involved the removal of the needle under local anesthesia with pre- and peri-operative computed tomography scans.

Keyword

Broken dental needle; Inferior alveolar nerve block; Cone-beam computed tomography; Foreign body migration

MeSH Terms

Adult
Anesthesia, Local
Anesthetics
Cone-Beam Computed Tomography
Facial Nerve
Female
Foreign-Body Migration
Hemorrhage
Humans
Incidence
Mandibular Nerve
Needles*
Paralysis
Trismus
Anesthetics

Figure

• 

  Fig. 1 The broken needle was shown in the left mandibular peri-condylar area in panoramic view.

• 

  Fig. 2 The broken needle was shown in the left mandibular peri-condylar area in three-dimensional computed tomography view.

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  Fig. 3 The broken needle was shown to be positioned in the left mandibular peri-condylar area in three-dimensional computed tomography view with the suture needle for localization during operation.

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  Fig. 4 Panoramic view after the removal of the broken needle.

Reference

1. Säkkinen J, Huppunen M, Suuronen R. Complications following local anaesthesia. Nor Tannlegeforen Tid. 2005; 115:48–52.

2. Augello M, von Jackowski J, Grätz KW, Jacobsen C. Needle breakage during local anesthesia in the oral cavity--a retrospective of the last 50 years with guidelines for treatment and prevention. Clin Oral Investig. 2011; 15:3–8.

3. Amies AB. Broken needles. Aust J Dent. 1951; 55:403–406. PMID: 14895457.

4. Fraser-Moodie W. Location and localisation of metal in the tissues. Br J Oral Surg. 1966; 4:99–105. PMID: 5224633.

5. Zeltser R, Cohen C, Casap N. The implications of a broken needle in the pterygomandibular space: clinical guidelines for prevention and retrieval. Pediatr Dent. 2002; 24:153–156. PMID: 11991319.

6. Faura-Solé M, Sánchez-Garcés MA, Berini-Aytes L, Gay-Escoda C. Broken anesthetic injection needles: report of 5 cases. Quintessence Int. 1999; 30:461–465. PMID: 10635258.

7. Bhatia S, Bounds G. A broken needle in the pterygomandibular space: report of a case and review of the literature. Dent Update. 1998; 25:35–37. PMID: 9709599.

8. Marks RB, Carlton DM, McDonald S. Management of a broken needle in the pterygomandibular space: report of case. J Am Dent Assoc. 1984; 109:263–264. PMID: 6590607.

9. Bedrock RD, Skigen A, Dolwick MF. Retrieval of a broken needle in the pterygomandibular space. J Am Dent Assoc. 1999; 130:685–687. PMID: 10332133.

10. Ethunandan M, Tran AL, Anand R, Bowden J, Seal MT, Brennan PA. Needle breakage following inferior alveolar nerve block: implications and management. Br Dent J. 2007; 202:395–397. PMID: 17435721.