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Pandey AK, Sharma S, Gupta P, Kumar P, Chaudhry K. Medial Pterygoid Abscess Masquerading as a Temporomandibular Joint Disorder: A Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:2828-2832. [PMID: 38883550 PMCID: PMC11169312 DOI: 10.1007/s12070-024-04518-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/08/2024] [Indexed: 06/18/2024] Open
Abstract
A patient presenting with a history of restricted mouth opening and deflection of the mandible after a prolonged dental procedure raises a suspicion of temporomandibular joint disorder (TMD) due to its estimated high prevalence of 29%. Muscle relaxants and routine active physiotherapy established normal range of movement and pain reduction was achieved through TENS therapy and analgesics. However, the non-subsidence of deflection prompted an initial suspicion of TMD which was overturned by MRI. The MRI evaluation revealed left side medial pterygoid abscess. It is imperative to understand that despite strong history and relevant clinical features, for the definitive diagnosis radiographic evaluation is highly contributory. Misdiagnosing TMD due to its similar presentation can have significant implications for the patient's well-being and quality of life. The clinical features of medial pterygoid abscess including restricted mouth opening and pain can be similar to that of TMD. These abscesses are most commonly caused by odontogenic infections but can also occur as a result of septic inferior alveolar nerve block techniques. Limited literature reports of pterygoid space abscess have been described, but intramuscular and medial pterygoid abscess is an absolute rarity. Causal relationship to septic inferior alveolar nerve block further makes this case report an interesting read.
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Affiliation(s)
- Akhilesh Kumar Pandey
- Oral and Maxillofacial Surgery (Department of Dentistry), All India Institute of Medical Sciences-Jodhpur, OPD block, 2A, 211, Jodhpur, Rajasthan 3420005 India
| | - Smily Sharma
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences-Jodhpur, Jodhpur, Rajasthan 3420005 India
| | - Palak Gupta
- Otorhinolaryngology, All India Institute of Medical Sciences-Jodhpur, Jodhpur, Rajasthan 3420005 India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences-Jodhpur, Jodhpur, Rajasthan 3420005 India
| | - Kirti Chaudhry
- Oral and Maxillofacial Surgery (Department of Dentistry), All India Institute of Medical Sciences-Jodhpur, OPD block, 2A, 211, Jodhpur, Rajasthan 3420005 India
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Almadhoon HW, ABUIRIBAN ROAAWALEED, ALMASSRI HUTHYFA, AL-HAMED FAEZSALEH. EFFICACY OF 4% ARTICAINE BUCCAL INFILTRATION VERSUS INFERIOR ALVEOLAR NERVE BLOCK FOR MANDIBULAR MOLARS WITH SYMPTOMATIC IRREVERSIBLE PULPITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2022; 22:101712. [DOI: 10.1016/j.jebdp.2022.101712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/18/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
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Aquilanti L, Mascitti M, Togni L, Contaldo M, Rappelli G, Santarelli A. A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031627. [PMID: 35162650 PMCID: PMC8835670 DOI: 10.3390/ijerph19031627] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients' reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.
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Affiliation(s)
- Luca Aquilanti
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
| | - Marco Mascitti
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
- Correspondence: ; Tel.: +39-071-2206-226
| | - Lucrezia Togni
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Via Armanni, 5, 80138 Naples, Italy;
| | - Giorgio Rappelli
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
- Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Via Tronto 10/A, 60126 Ancona, Italy
| | - Andrea Santarelli
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
- Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Via Tronto 10/A, 60126 Ancona, Italy
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Allegra S, Church R, Sudireddy V. A Rare Case of Cranial Nerve VII Neuropraxia Associated with Alveolar Nerve Blocks. Clin Pract Cases Emerg Med 2021; 5:273-274. [PMID: 34437027 PMCID: PMC8143834 DOI: 10.5811/cpcem.2021.4.51264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/01/2021] [Indexed: 11/11/2022] Open
Abstract
CASE PRESENTATION A 26-year-old male presented to our emergency department for six days of right-sided facial myasthenia and parasthesias following a dental procedure using anesthetic nerve blocks. DISCUSSION Iatrogenic cranial nerve VII neuropraxia, a peripheral nerve injury, is an uncommon complication of alveolar nerve blocks with few documented cases specifically due to dental anesthesia. Treatment usually involves use of oral corticosteroid and/or antiviral medications along with close follow-up in clinic with a neurologist and/or otolaryngologist.
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Affiliation(s)
- Stephen Allegra
- University of Massachusetts Memorial Medical Center, Department of Emergency Medicine, Worcester, Massachusetts
| | - Richard Church
- University of Massachusetts Memorial Medical Center, Department of Emergency Medicine, Worcester, Massachusetts
| | - Veera Sudireddy
- University of Massachusetts Memorial Medical Center, Department of Emergency Medicine, Worcester, Massachusetts
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Demir E, Ataoglu H. Clinical evaluation of efficacy of transcortical anesthesia for the extraction of impacted mandibular third molars: a randomized controlled trial. J Dent Anesth Pain Med 2020; 20:9-17. [PMID: 32158955 PMCID: PMC7054070 DOI: 10.17245/jdapm.2020.20.1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery. Methods This prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer. Results Thirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013). Conclusion The IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.
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Affiliation(s)
- Esin Demir
- Department of Oral and Maxillofacial Surgery, Selçuk University Faculty of Dentistry, Konya, Turkey
| | - Hanife Ataoglu
- Department of Oral and Maxillofacial Surgery, Selçuk University Faculty of Dentistry, Konya, Turkey
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Jang HY, Han SJ. Measurement of mandibular lingula location using cone-beam computed tomography and internal oblique ridge-guided inferior alveolar nerve block. J Korean Assoc Oral Maxillofac Surg 2019; 45:158-166. [PMID: 31334104 PMCID: PMC6620308 DOI: 10.5125/jkaoms.2019.45.3.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives Inferior alveolar nerve block (IANB) is the most frequently used treatment for mandibular molars. Successful IANB requires insertion of the dental needle near the mandibular foramen. In this study, we aimed to analyze the anatomic location of the mandibular lingula and evaluate the effects of internal oblique ridge (IOR)-guided IANB. Materials and Methods The location of the mandibular lingula was measured using cone-beam computed tomography images of the mandibles obtained from 125 patients. We measured the distances from the occlusal plane to the lingula and from the IOR to the lingula in 250 mandibular rami. Based on the mean of these distances, alternative anesthesia was carried out on 300 patients, and the success rate of the technique was evaluated. Results The mean vertical distance was 8.85±2.59 mm, and the mean horizontal distance was 14.68±1.44 mm. The vertical (P<0.001) and the horizontal (P<0.05) distances showed significant differences between the sex groups. The success rate of the IOR-guided technique was 97.3%. Conclusion IANB-based location of mandibular lingula showed a high success rate. From this study, we concluded that analysis of the anatomic locations for mandibular lingula and IOR-guided IANB are useful for restorative and surgical dental procedures of the mandibular molars.
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Affiliation(s)
- Ho-Yeol Jang
- Department of Oral and Maxillofacial Surgery, Konyang University Hospital, Daejeon, Korea
| | - Seung-Jung Han
- Medical & Scientific Affairs Team, CGBio Research Center, Seongnam, Korea
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Majerowski J, Xu YG. Acute, Temporary, Unilateral Facial Nerve Palsy After Dermatologic Surgery: A Report of 3 Cases. J Cutan Med Surg 2017; 21:445-448. [PMID: 28514867 DOI: 10.1177/1203475417711155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Facial nerve dysfunction can be functionally and cosmetically debilitating and is commonly associated with high anxiety for patients. We report 3 cases of temporary, unilateral facial nerve palsy following dermatologic surgery under local anaesthesia over the preauricular cheek and mandibular angle, which, to our knowledge, has not been reported in the literature. Given its frightening presentation mimicking a stroke, it is essential for dermatologists to become aware of this complication to inform their patients more thoroughly. Thus, when performing facial surgery over these regions, we recommend that dermatologists include this rare complication and its good prognosis in the consenting process to minimise anxiety for those who experience it intra- or postoperatively.
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Affiliation(s)
- Jacquelyn Majerowski
- 1 Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yaohui G Xu
- 1 Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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AlHindi M, Rashed B, AlOtaibi N. Failure rate of inferior alveolar nerve block among dental students and interns. Saudi Med J 2017; 37:84-9. [PMID: 26739980 PMCID: PMC4724685 DOI: 10.15537/smj.2016.1.13278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To report the failure rate of inferior alveolar nerve block (IANB) among dental students and interns, causes of failure, investigate awareness of different IANB techniques, and to report IANB-associated complications. METHODS A 3-page questionnaire containing 13 questions was distributed to a random sample of 350 third to fifth years students and interns at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia on January 2011. It included demographic questions (age, gender, and academic level) and questions on IANB failure frequency and reasons, actions taken to overcome the failure, and awareness of different anesthetic techniques, supplementary techniques, and complications. RESULTS Of the 250 distributed questionnaires, 238 were returned (68% response rate). Most (85.7%) of surveyed sample had experienced IANB failure once or twice. The participants attributed the failures most commonly (66.45%) to anatomical variations. The most common alternative technique used was intraligamentary injection (57.1%), although 42.8% of the sample never attempted any alternatives. Large portion of the samples stated that they either lacked both knowledge of and training for other techniques (44.9%), or that they had knowledge of them but not enough training to perform them (45.8%). CONCLUSION To decrease IANB failure rates for dental students and interns, knowledge of landmarks, anatomical variation and their training in alternatives to IANB, such as the Gow-Gates and Akinosi techniques, both theoretically and clinically in the dental curriculum should be enhanced.
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Affiliation(s)
- Maryam AlHindi
- Department of Oral and Maxillofacial Surgery, King Khalid University Hospital, Faculty of College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Gaudin RA, Remenschneider AK, Phillips K, Knipfer C, Smeets R, Heiland M, Hadlock TA. Facial palsy after dental procedures – Is viral reactivation responsible? J Craniomaxillofac Surg 2017; 45:71-75. [DOI: 10.1016/j.jcms.2016.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022] Open
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Patient’s pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block. Clin Oral Investig 2016; 20:2241-2250. [DOI: 10.1007/s00784-016-1712-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
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Ramdasi RV, Rangarajan V, Mahore A. Lower motor neuron facial palsy after ventriculoperitoneal shunt surgery. BMJ Case Rep 2015; 2015:bcr-2014-206938. [PMID: 25920734 DOI: 10.1136/bcr-2014-206938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 40-year-old woman underwent marsupialisation of a symptomatic retrocerebellar cyst. She developed pseudomeningocoele after the procedure. CT of the brain showed hydrocephalus. Therefore, a right-sided ventriculoperitoneal shunt procedure was performed. Unfortunately, the patient developed lower motor neuron-type facial paralysis immediately after the surgery. We localised the site of injury in the distal fallopian canal probably during tunnelling of the subcutaneous tract for passage of the shunt. We discuss the steps to be followed to avoid such mishaps with a brief review of the literature.
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Affiliation(s)
| | | | - Amit Mahore
- Department of Neurosurgery, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
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Abstract
The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose between these modifications. Some operators may encounter difficulty in identifying the anatomical landmarks which are useful in applying the inferior alveolar nerve block and rely instead on assumptions as to where the needle should be positioned. Such assumptions can lead to failure and the failure rate of inferior alveolar nerve block has been reported to be 20-25% which is considered very high. In this basic review, the anatomical details of the inferior alveolar nerve will be given together with a description of its both conventional and modified blocking techniques; in addition, an overview of the complications which may result from the application of this important technique will be mentioned.
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Affiliation(s)
- Hesham Khalil
- Department of Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Wallner J, Reinbacher KE, Pau M, Feichtinger M. Intermuscular pterygoid-temporal abscess following inferior alveolar nerve block anesthesia-A computer tomography based navigated surgical intervention: Case report and review. Ann Maxillofac Surg 2014; 4:110-4. [PMID: 24987612 PMCID: PMC4073452 DOI: 10.4103/2231-0746.133090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Inferior alveolar nerve block (IANB) anesthesia is a common local anesthetic procedure. Although IANB anesthesia is known for its safety, complications can still occur. Today immediately or delayed occurring disorders following IANB anesthesia and their treatment are well-recognized. We present a case of a patient who developed a symptomatic abscess in the pterygoid region as a result of several inferior alveolar nerve injections. Clinical symptoms included diffuse pain, reduced mouth opening and jaw's hypomobility and were persistent under a first step conservative treatment. Since image-based navigated interventions have gained in importance and are used for various procedures a navigated surgical intervention was initiated as a second step therapy. Thus precise, atraumatic surgical intervention was performed by an optical tracking system in a difficult anatomical region. A symptomatic abscess was treated by a computed tomography-based navigated surgical intervention at our department. Advantages and disadvantages of this treatment strategy are evaluated.
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Affiliation(s)
- Jürgen Wallner
- Department of Maxillofacial Surgery, Medical University of Graz, Graz, Austria
| | | | - Mauro Pau
- Department of Maxillofacial Surgery, Medical University of Graz, Graz, Austria
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Tzermpos FH, Cocos A, Kleftogiannis M, Zarakas M, Iatrou I. Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia. Anesth Prog 2012; 59:22-7. [PMID: 22428971 DOI: 10.2344/11-03.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution.
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