ABSTRACT
Used routinely by dental practitioners, local anaesthetics are generally a safe and effective means of achieving pain control during invasive dental procedures. Delivery, however, is technique sensitive and the potential for patient complication exists. Although reasonably rare, ocular complications have occurred, often leaving the patient and the clinician in distress. Such reported events have almost always involved tissue responses ipsilateral to the injection site. The current case report presents an unusual event involving involuntary fasciculation or hemifacial spasm and eventual eyelid closure on the contralateral side following a routine inferior alveolar nerve block. Aspects including the patient's history, the observed response, a pathophysiological hypothesis and patient management are discussed.
Subject(s)
Anesthesia, Dental/adverse effects , Anesthetics, Local/adverse effects , Dental Caries/therapy , Hemifacial Spasm/chemically induced , Nerve Block/adverse effects , Trochlear Nerve Diseases/chemically induced , Adolescent , Anesthesia, Dental/methods , Anesthetics, Local/administration & dosage , Diagnosis, Differential , Hemifacial Spasm/diagnosis , Humans , Incisor , Male , Nerve Block/methods , Trochlear Nerve Diseases/diagnosisSubject(s)
Botulinum Toxins, Type A/adverse effects , Eye Movements/drug effects , Trochlear Nerve Diseases/chemically induced , Vision, Binocular/drug effects , Botulinum Toxins, Type A/administration & dosage , Diplopia/etiology , Diplopia/physiopathology , Follow-Up Studies , Humans , Injections, Intramuscular , Male , Middle Aged , Neuromuscular Agents/administration & dosage , Neuromuscular Agents/adverse effects , Oculomotor Muscles/drug effects , Oculomotor Muscles/physiopathology , Rhytidoplasty/adverse effects , Rhytidoplasty/methods , Trochlear Nerve Diseases/complications , Trochlear Nerve Diseases/physiopathologyABSTRACT
Pituitary apoplexy in patients with pituitary macroadenomas can occur either spontaneously or following various interventions. We present a case of a 71-year-old woman who developed third, fourth, and sixth cranial nerve palsies following administration of the four hypothalamic releasing hormones for routine preoperative testing of pituitary function. The MR examination showed interval tumor growth with impression of the floor of the third ventricle. There were also changes in signal intensity characteristics of the mass, suggestive of intratumoral bleeding. A transsphenoidal surgery with subtotal resection of the pituitary adenoma was performed. Microscopical examination revealed large areas of necrosis and blood surrounded by adenomatous tissue. Third, fourth, and sixth cranial nerve palsies completely resolved within 4 months. We conclude that MR imaging is useful in the demonstration of pituitary apoplexy following preoperative stimulation tests, but we suggest that these tests should be abandoned in patients with pituitary macroadenomas.
