Needle breakage: incidence and prevention

Device Failure During Injection Medialization Laryngoplasty

OBJECTIVES

Injection medialization laryngoplasty is a commonly performed procedure for the management of glottic insufficiency. Among complications of this procedure is device failure, for which the literature is scarce. Our goal was to determine the prevalence of needle failure during injection laryngoplasty among members of the American Bronchoesophagological Association (ABEA).

METHODS

A questionnaire was designed and subsequently sent to members of ABEA via electronic mail. Responses were analyzed using descriptive statistics.

RESULTS

Twenty-four members (6.7%) completed the survey. Eighty three percent reported experience with needle failure; 59% of these were needle clogging, 22% needle twisting, and 19% needle tip fracture. Fifty-four percent of respondents reported needle failure during a percutaneous approach, and 48% reported using calcium hydroxyapatite during device failure. Twenty percent reported having to abort the procedure due to device failure. Twenty five percent of respondents experienced needle tip fracture that led to an airway or esophageal foreign body.

CONCLUSIONS

Needle failure during injection laryngoplasty was reported by most respondents. Most commonly this was due to clogging or twisting which was managed by replacing the needle but in 25% of cases was due to a broken tip that results in an aerodigestive tract foreign body and aborting of the procedure in most cases.

Needle-free Mental Incisive Nerve Block:In vitro, Cadaveric, and Pilot Clinical Studies

The present study aimed to optimize Needle-Free Liquid Jet Injection (NFLJI) for Mental Incisive Nerve Blocks (MINB) and evaluate its clinical safety and feasibility. A MINB protocol was developed and optimized by series of NFLJI experiments in soft tissue phantoms and cadavers, then validated in two pilot Randomized Controlled Trials (RCT). The NFLJI penetration depth was found to be directly proportional to the supply pressure and volume. High-pressure NFLJIs (620 kPa or above) created maximum force and total work significantly greater than needle injections. Low-pressure NFLJIs (413 kPa), however, produced results similar to those of needle injections. Additionally, high-pressure NFLJIs created jet impingement pressure and maximum jet penetration pressure higher than low-pressure NFLJIs. Pilot RCTs revealed that high-pressure NFLJI caused a high risk of discomfort (60%) and paresthesia (20%); meanwhile, low-pressure NFLJI was less likely to cause complications (0%). The preliminary success rates of MINB from cadavers using NFLJIs and needles were 83.3% and 87.5%. In comparison, those from RCTs are 60% and 70%, respectively. To conclude, NFLJI supply pressure can be adjusted to achieve effective MINB with minimal complications. Furthermore, the cadaver study and pilot RCTs confirmed the feasibility for further non-inferiority RCT.

Needle-free injection: Dental infiltration anesthesia

This study aimed to develop an optimal Needle-Free Liquid Jet Injection (NFLJI) technique for dental infiltration anesthesia and evaluate its clinical safety and feasibility. The fluid dynamics of NFLJI in the dentoalveolar region were investigated using soft tissue phantoms supported by rigid glass. NFLJIs were performed at different incident angles and recorded using a high-speed camera. Accordingly, an optimal NFLJI for infiltration anesthesia was developed and validated on cadavers, then assessed in two pilot Randomized Controlled Trials (RCT): one for validating the safety of optimal NFLJI technique, the other for evaluating its feasibility and safety. High-speed videos showed that perpendicular NFLJIs induced significantly more regurgitation than oblique NFLJIs, which was confirmed in cadavers. Clinical trials revealed that perpendicular NFLJIs induced a high risk of bleeding (83.3%) and laceration (83.3%), whereas oblique NFLJIs induced a low risk of bleeding (33.3%) and laceration (16.7%). Moreover, the preliminary success rates of oblique NFLJIs and needle injections were both 83.3%. The recruitment took 3-5 weeks with a rate of 100%. Oblique NFLJIs could be a promising approach for dental infiltration anesthesia, causing minimal drug regurgitation with a relatively low risk of complication. The pilot RCTs confirmed the feasibility for conducting a non-inferiority RCT.

Do length and gauge of dental needle affect success in performing an inferior alveolar nerve block during extraction of adult mandibular molars? A prospective, randomized observer-blind, clinical trial

OBJECTIVE

Association between length and gauge of dental needle and success rate and pain perception during an inferior alveolar nerve block (IANB) has not been investigated using a randomized clinical trial (RCT). This RCT aimed to compare the success rate of IANB and perceived pain using 27- or 30-gauge needles for the extraction of adult mandibular molars.

MATERIAL AND METHOD

A prospective RCT was conducted on two hundred and twelve adult patients requiring extraction of mandibular molars using standard methods as described by Malamed with 1.8 ml of 2% lidocaine with 1:80,000 adrenaline. One hundred six patients received IANB using 27-gauge needles (32 mm × 0.2 mm) and one hundred six patients received IANB using 30-gauge needles (25 mm × 0.15 mm). Predictor variables were 27-gauge and short and 30-gauge. Outcome variables were the success rate of IANB and pain perception during injection using a visual analogue scale.

RESULTS

There was a highly significantly increase in the success of IANB using 27-gauge needle (95.28%) versus 30-gauge needle (41.51%) (P = 0.001). There was a significant increase in pain perception for patients who received IANB by shorter and thinner needle (30-gauge) when compared to the long and thicker needle (27-gauge).

CONCLUSION

This RCT demonstrated that 27-gauge needle seems to be associated with a higher success rate of IANB and lower pain perception during injection when compared to 30-gauge needle in the extraction of adult mandibular molars when compared to 30-gauge needles.

CLINICAL RELEVANCE

For adult patients, when thickness of soft tissue to be penetrated is essential to achieve bony contact, long or large gauge dental needle is preferred to get a higher success rate of IANB with less pain perception during injection.

Fractured Needle Removal With a 3-Dimensionally Printed Surgical Guide: A Case Report and Literature Review

Needle breakage is a rare complication of inferior alveolar nerve block anesthesia. This study proposes a new localization technique. We used a three-dimensionally printed surgical guide, supported by the lower dental arch to minimize the required surgical access. With this approach, the procedure could be performed with procedural sedation anesthesia.

Cone-beam computed tomography of mandibular foramen and lingula for mandibular anesthesia

Purpose

The positions of the mandibular foramen (MnF) and the lingula affect the success rate of inferior alveolar nerve block. The objective of this study was to investigate aspects of the MnF and the lingula relevant for mandibular block anesthesia using cone-beam computed tomography (CBCT).

Materials and Methods

Fifty CBCT scans were collected from a picture archiving and communications system. All scans were taken using an Alphard Vega 3030 (Asahi Roentgen Co. Ltd., Kyoto, Japan). Fifty-eight MnFs of 30 subjects were included in the study. The position of the MnF, the size of the MnF, the position of the lingula, the size of the lingula, and the shape of the lingula were measured and recorded. All data were statistically analyzed at a significance level of P<0.05.

Results

The position of MnF was 0.1 mm and 0.8 mm below the occlusal plane in males and females, respectively. The horizontal position of the MnF was slightly anterior to the center of the ramus in males and in the center in females (P<0.05). The vertical position of the MnF was lower in females than in males (P<0.05). The MnF was an oval shape with a longer anteroposterior dimension. The height of the lingula was 9.3 mm in males and 8.2 mm in females. The nodular type was the most common shape of the lingula, followed by the triangular, truncated, and assimilated types.

Conclusion

CBCT provided useful information about the MnF and lingula. This information could improve the success rate of mandibular blocks.

Avaliação da deformação de agulhas gengivais e análise fractal

Resumo Introdução A fratura da agulha na anestesia odontológica é rara, mas sua ocorrência tem sérias complicações e deve ser evitada. Objetivo O objetivo deste estudo foi avaliar a deformação de agulhas dentárias após a aplicação de forças de compressão. Material e método Agulhas das marcas Dencojet e Septoject XL nos calibres 27G e 30G (quatro grupos) foram dobradas em dois sentidos opostos em máquina de ensaio mecânico DL200 - EMIC, com base na ISO 7885:2010. A resistência à compressão das agulhas foi medida em cada dobra. Ao final, foi realizada inspeção visual em uma lupa EK3ST em aumento de 40×, para análise da integridade das agulhas. Resultado As agulhas de calibre 30G não apresentaram diferenças significativas entre elas. As agulhas de maior calibre (27G) apresentaram diferenças no primeiro (p = 0,0001) e no segundo dobramento (p = 0,0016). As agulhas Septoject XL 27G demonstraram ser muito menos flexíveis, fornecendo valores mais altos de resistência à dobra. No grupo Septoject XL 30G, 70% das agulhas fraturaram próximo ao canhão. Todas as amostras do grupo Septoject XL 27G apresentaram fraturas após a segunda dobra. Conclusão Todas as agulhas gengivais testadas apresentaram comportamento aceitável, mesmo quando submetidas a situações críticas. As agulhas Dencojet 27G demonstraram ser mais flexíveis quando dobradas. Todas as agulhas Septoject XL 27G fraturaram após a segunda dobra. Não é aconselhável dobrar as agulhas dentárias.

Telescopic Dental Needles versus Conventional Dental Needles: Comparison of Pain and Anxiety in Adult Dental Patients of Kerman University of Medical Sciences-A Randomized Clinical Trial

INTRODUCTION

Pain felt during dental injections is dependent on dental anxiety. Patients feel increased pain if anxiety in the treatment environment is high, and therefore it is important to reduce anxiety during treatment to reduce pain. The purpose of this study was to compare pain and anxiety levels experienced during injections using a newly invented telescopic-coated dental needle that covers the conventional needle and also has the capability of applying topical anesthesia through its unique design with the conventional dental injection needle.

METHODS

Dental injection anxiety questionnaires were completed by 60 adult patients who were randomly assigned to either the telescopic (a newly invented telescopic-coated dental needle that covers the needles) or the conventional group. Patients also completed visual analog scales to rate their pain perception during injection, their overall experience, and their future anticipated anxiety. Wilcoxon, Mann-Whitney, and Student t tests were used for statistical analysis. Statistical significance was defined as P < .05.

RESULTS

A total of 25 men and 35 women with an age range of 19-55 years (mean age of 38.7 ± 2.31 years) participated in this study. Pain levels reported during the injection using the telescopic-coated needle (4.13 ± 1.37) were significantly lower than those using the conventional needle (5.63 ± 1.57), with statistically significant differences between the 2 groups (P < .05). Patients experienced significantly lower overall postinjection anxiety (P < .05) and had more positive overall experience ratings with the telescopic-coated needles.

CONCLUSIONS

A new telescopic-coated dental needle was superior to a conventional injection system in pain perception and in reducing postinjection dental anxiety.

A novel case of a broken dental anesthetic needle transecting the right internal carotid artery

BACKGROUND AND OVERVIEW

Although dental anesthetic needle fractures remain an uncommon occurrence, there is a lack of consensus on the management of the treatment of this complication. Complications could include trismus, dysphagia, or infection that may lead to more deleterious results.

CASE DESCRIPTION

In this case study, a 47-year-old man underwent a routine dental extraction at a private office. During administration of the inferior alveolar nerve block, a dental anesthetic needle fractured. The general dental practitioner dismissed the patient and reassured him that no retrieval of the needle was needed. Several weeks later, the patient sought care for severe, acute pain and dysphagia. Traditional retrieval techniques were unsuccessful, and the authors consulted the neurosurgery team. The patient underwent endovascular surgery with digital subtraction angiography for retrieval of the needle from the right internal carotid artery.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Most authors in the literature agree that proper technique and equipment are paramount in avoiding fractures of dental anesthetic needles. Although needle fracture is a rare complication, immediate referral and retrieval of the broken needle by an appropriately trained surgeon is essential for optimal outcomes. This case demonstrates an example of a broken needle that migrated and transected the internal carotid artery at the jugular foramen. All dental practitioners must be cognizant of the potentially serious complications associated with a retained broken needle.

The surgical retrieval of a broken dental needle: A case report

One complication related to local anesthesia in the dental clinic is a broken needle. Although rare, a broken needle may be difficult to retrieve. Dental radiographs and 3D CT have been used in the past to confirm the location of a broken needle. We present the case of a broken needle, which was successfully removed using a careful, microscopic approach.

Local anesthesia part 2: technical considerations

An earlier paper by Becker and Reed provided an in-depth review of the pharmacology of local anesthetics. This continuing education article will discuss the importance to the safe and effective delivery of these drugs, including needle gauge, traditional and alternative injection techniques, and methods to make injections more comfortable to patients.