Temporary Diplopia After Gow-Gates Injection: Case Report and Review

Ocular complications associated with inferior dental nerve block: a systematic review

Ocular complications associated with anesthesia of the lower dental nerve may arise during or after administration of the local anesthetic, whether temporary or permanent. This situation generates concern for both the clinician and the patient. The purpose of this article is to identify ocular complications related to lower dental nerve block, analyzing signs, symptoms, gender, age, type of procedure, and duration of complications.

METHODS

In September 2023, we conducted a systematic review using various databases, such as PubMed, ScienceDirect, and Google Scholar, using relevant search terms. There were no restrictions on the date or language of the articles.

RESULTS

We identified 39 articles that met the selection criteria, covering an analysis of 45 cases. Complications showed a higher incidence in women, with 65.11%, compared to 34.8% in men. The most frequent ocular complications reported were diplopia (44%), amaurosis (28%) and eyelid ptosis (17.77%).

CONCLUSIONS

Ocular complications related to lower tooth nerve block are rare, but they can occur. A higher incidence is observed in women than in men, and there is no specific age that predominates in its appearance. Diplopia is the most common ocular complication, followed by amaurosis, eyelid ptosis, and blurred vision. These complications may manifest during the infiltration of the anesthetic, immediately after the procedure, or a few hours later.

[Aspiration test as dental anesthesia safety criterion]

Intravascular anesthetic injection can lead to acute toxic reaction even the minimal dose of the drug was administered. The aspiration test is a generally accepted standard for local anesthesia in medicine, specially designed to reduce the risk of emergency conditions. Medical instruments should be adapted for aspiration test, the local anesthetic carpule should have a retention notch, and the dental syringe plunger need to have retention elements. The aspiration test protocol may vary. For legal protection of the doctor the aspiration test result should be described in the patient's medical record.

Accidental Intravascular Local Anesthetic Injection of the Facial Artery

Local anesthesia techniques are widely used in dentistry because of their numerous advantages, including safety. Several articles have been published on local and systemic complications stemming from the use of local anesthesia, one of which is accidental intravascular injection, usually reported during inferior alveolar nerve blocks. A 58-year-old man presented to the dental office for extraction of the lower left first molar. During delivery of a supplemental injection in the buccal vestibular mucosa to anesthetize the buccal nerve, an accidental intra-arterial injection to the facial artery occurred, causing sudden sharp pain and immediate pallor along the course of the facial artery. The pallor resolved in approximately 20 minutes. Buccal infiltration was repeated successfully, and the tooth was extracted uneventfully. This case appears to be the first report in the literature to describe the accidental intravascular injection of local anesthetic involving the facial artery and discuss its clinical implications.

Evaluation of different mandibular blocks for the removal of lower third molars: a meta-analysis of randomised clinical trials

OBJECTIVES

To describe the efficacy and number of side effects for the Gow-Gates mandibular block (GGMB) and Vazirani-Akinosi mandibular block (VAMB) compared to inferior alveolar nerve block (IANB) in patients requiring lower third molar (L3M) extraction.

MATERIALS AND METHODS

A systematic search was performed in three electronic databases and complemented with a manual search. The inclusion criteria were randomised clinical trials in healthy patients who underwent at least one L3M extraction. Screening and article selection were carried out by two independent reviewers. After data extraction, a meta-analysis was performed for the success rate, number of positive aspirations, and onset time outcomes.

RESULTS

Six randomised clinical trials were included out of the 367 potentially eligible papers. No significant differences were found in terms of success rate using GGMB (risk ratio [RR] 1.04; 95% confidence interval [CI] 0.92 to 1.18; P = 0.48) nor VAMB (RR 0.96; 95% CI 0.86 to 1.06; P = 0.41). The VAMB group exhibited a lower number of positive aspirations than the IANB group (RR 0.08; 95% CI 0.01 to 0.55; P = 0.01), but there was no statistically significant difference between the GGMB and IANB groups (RR 1.06; 95% CI 0.13 to 8.78; P = 0.96). The delayed onset was even longer in GGMB (mean difference [MD] 3.32 min; 95% CI 1.98 to 4.66; P < 0.001) and VAMB (MD 0.90 min; 95% CI 0.37 to 1.43; P = 0.0001) than IANB.

CONCLUSIONS

GGMB and VAMB seem to be effective and safe anaesthetic techniques for the removal of L3M, but these blocks exhibited a more delayed onset time than IANB.

CLINICAL RELEVANCE

GGMB and VAMB are safe and effective anaesthetic techniques for the removal of L3M. However, IANB can still be considered the first option since GGMB and VAMB exhibited more delayed onset times and variable buccal nerve anaesthesia.