Removal of a fractured needle during inferior alveolar nerve block: two case reports

The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.

Uso de fluoroscopia e tomografia computadorizada para remoção de agulha fraturada / Use of fluoroscopy and computed tomography for removal of broken needle

A anestesia local é fundamental no controle da dor em procedimentos odontológicos, porém a maioria das emergências ambulatoriais ocorrem durante ou imediatamente após a injeção do anestésico local. Dentre estes, podemos citar a fratura da agulha, que, apesar de incomum, pode ocorrer devido a uma técnica anestésica equivocada, ao uso de material de baixa qualidade ou à falta de colaboração do paciente. Após a fratura, o fragmento pode se mover através dos tecidos, necessitando de uma avaliação cuidadosa de um cirurgião buco-maxilo-facial antes da tentativa de recuperação desta. Várias técnicas de localização são descritas na literatura, como a tomografia computadorizada, panorâmica, detectores de metais, as radiografias convencionais e fluoroscopia transoperatória. O objetivo deste trabalho é apresentar uma breve revisão de literatura e relatar um caso de fratura de agulha em que a utilização da tomografia computadorizada de feixe cônico como um exame pré-operatório foi associada com fluoroscopia transoperatória para identificação e retirada de corpo estranho.

Local anesthesia is fundamental in pain control in dental procedures. Most emergencies in outpatient departments, however, occur during or immediately after the injection of local anesthetic. Among these we may mention needle fracture which, although uncommon, can occur because of an erroneous anesthetic technique, use of low-grade material or lack of cooperation on the part of the patient. After fracture, the fragment may move through the tissues, requiring careful evaluation by a maxillofacial surgeon before an attempt is made to recover it. Several location techniques are described in the literature, such as panoramic, computed tomography, metal detectors, conventional radiographs and intraoperative fluoroscopy. The aim of the present study is to review the literature and report a case of needle fracture in which the use of cone beam computed tomography as a preoperative examination was associated with fluoroscopy, perioperatively, for identification and removal of any foreign bodies.