Retrieval of a Broken Dental Needle Close to the Facial Artery After Cervical Migration

Observational and descriptive analysis of broken dental needles: a case series

PURPOSE

To discuss potential causes of broken dental needles during dental anesthesia and features of this complication, including the anatomical location of fragments in tissues, symptoms, complications, and therapeutic approaches.

METHODS

Twelve cases of broken dental needles occurring during dental anesthesia and subsequently referred to Hospital de Base do Distrito Federal, Brazil, between 1992 and 2019 were selected. In addition, similar cases reported in the literature over the past 50 years were reviewed.

RESULTS

Needle fractures occur most frequently during inferior alveolar nerve blocks and in younger patients. The leading cause is unexpected patient movement during the anesthetic procedure. The needle fragment is most commonly found in the pterygomandibular space or the deep spaces of the head and neck region. Needle migration is a particular concern; although rare, it is unpredictable and potentially life-threatening.

CONCLUSIONS

Needle fracture is an intraoperative complication which has the potential to cause severe patient damage. It is essential that practitioners have knowledge of this possible complication and understand the technical considerations for its prevention. The existing literature and the results of this case series analysis suggest that removal of the fractured needle fragment should be attempted as soon as possible.

Removal of a suture needle: a case report

Background

Foreign bodies may be embedded or left behind in the oral cavity during oral surgical procedure. The loss of instruments such as impression material, surgical gauze, and broken injection needles are commonly reported in the dental field. These complications are generally symptomatic and show signs of inflammation, pain, and purulent discharge. Accidental breakage of suture needles is a rare but potentially dangerous event.

Case presentation

In this report, we present one case of lost suture needle during the procedure of flap operation at local dental clinic and its successful removal under local/general anesthesia administration via CBCT with a help of two reference needles to localize the 6-0 nylon needle and consulting with the clinician.

Conclusion

CT scanning taken while mouth-closing may not be accurate with regard to real location measurement performed while mouth-opening. If so, other up-to-date radiographic devices and methods to retrieve a needle are recommended.

Migration of Broken Dental Needle Through the Internal Jugular Vein in the Parapharyngeal Space

Accidental broken dental needles during dental blocks have become a rare occurrence but still occur. Although the treatment for such occurrence is controversial, an increasing body of literature demonstrates that migration of such needles is possible. In this case, we report on a 48-year-old male with migration of a broken dental needle from an inferior alveolar block. Over the course of 2 years, we demonstrated radiological documentation of the course of migration with penetration of the internal jugular vein at the jugular foramen which was subsequently successfully retrieved through a transcervical approach without neurovascular injury. This case is unique given the location of migration to the skull base as well as radiologically documented time course. Furthermore, it highlights the need for prompt retrieval of broken dental needles given the high potential of migration and injury to neurovascular structures.

Physical, chemical, mechanical, and micromorphological characterization of dental needles

Background

In anesthetic techniques, touching bones can cause needle bending. Theoretically, a needle should support such deflection without fracturing. However, it is possible that a needle may fracture depending on the quality and type of needle used. This study evaluated the physical, chemical, and micromorphological characteristics of long and short dental anesthetic needles, as well as the mechanical properties of flexural load and bending resistance when needles are subjected to different bending angles.

Methods

Long and short needles (30G, Jets, Misawa, Selekto, Terumo, Unoject and 27G, Dencojet, Injex, Jets, Misawa, Procare, Setoject XL, Terumo) were evaluated. Scanning electron microscopy was used to evaluate the needle bevels and energy-dispersive X-ray spectroscopy was used for the chemical analysis of needle compositions. Flexural loading and bending strength assessments were performed using a universal testing machine by bending the needles (n = 5) to angles of 30°, 60°, or 90°, or until fracture occurred.

Results

The Injex 27G, Jets 27G, and Septoject XL 27G needles were all less than 30 mm in length. There were small percentage variations in the chemical compositions of the needles. Superior smoothness was observed for the Unoject 30G needle, which exhibited the highest fracture resistance at 60°. The Jets 30G needle exhibited greater resistance to fractures at 90°. The Procare 27G needle exhibited the highest load resistance to bending, followed by the Septoject XL 27G needle, and both needles were tied for the lowest fracture resistance. No needle fractured when bent to 30° or at less than three bends to 60° or 90°.

Conclusions

Greater needle resistance to bending increases the probability of early fracturing. Thinner and shorter needles are more resistant than longer and thicker needles. Performing a single bend does not result in any significant risk of fracture or obliterate the lumen, allowing for the continued passage of anesthetic liquid.

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.

[Needle fractures during mandibular block: prevention and emergency care algorithm]

Cases of dental needle fracture during mandibular block were studied in the last 10 years. Despite dental anesthesia development, the cases of needle fracture occur regularly in the world practice. Some of these complications has iatrogenic nature while others may be attributed to independent reasons like patients' sharp movement and needle manufacturing defect. In most of the cases the needle migrates to surrounding anatomical spaces making operative removing a challenging task. Subsequent surgical removing of a foreign body has severe consequences to patient in the form of a large operating injury, long-term disability and functional limitations. The article presents an algorithm for prevention and emergency care for a patient with dental needle fracture during mandibular block.

Displacement of a Broken Dental Injection Needle Into the Perivertebral Space

Dental injection needle breakage is an uncommon problem in dental practice. Displacement of the broken fragment into anatomical spaces is, on the other hand, a serious complication that occurs most commonly during inferior alveolar nerve blocks as a result of material wear, incorrect application of the anesthesia technique, or sudden movement of the patient during injection. Further complications such as infection, trismus, and nerve paralysis may exacerbate the condition and, if not treated adequately, life-threatening conditions may develop over time as the fragment dislodges deeper in soft tissues. Clinical symptoms of the patient, as well as the findings gathered from detailed physical examination and radiographic evaluation, are important factors to consider before performing an exploratory surgery. Removal of a broken needle may be troublesome due to its proximity to vital anatomic structures. Multislice computed tomography is a reliable imaging modality that provides accurate information to pinpoint the exact location of the needle fragment.This report describes a case of needle breakage occurred during inferior alveolar nerve block which was performed to extract a third molar tooth and the migration of the broken fragment from the right mandibular ramus area into the perivertebral space, with special emphasis on the surgical retrieval technique with multiplanar computed tomography imaging guidance.