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Sandre LB, de Paula E Silva E, Izidro AER, Neto WMP, da Costa Moraes CA, da Rosa ELS. Observational and descriptive analysis of broken dental needles: a case series. Oral Maxillofac Surg 2023; 27:433-443. [PMID: 35661006 DOI: 10.1007/s10006-022-01078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Lorena Batista Sandre
- Oral and Maxillofacial Surgery, Hospital de Base Do Distrito Federal, Brasília, DF, Brazil
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2
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Seon S, Lee BS, Choi BJ, Ohe JY, Lee JW, Jung J, Hwang BY, Kim MA, Kwon YD. Removal of a suture needle: a case report. Maxillofac Plast Reconstr Surg 2021; 43:22. [PMID: 34224020 PMCID: PMC8257847 DOI: 10.1186/s40902-021-00309-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/25/2021] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Suyun Seon
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Baek-Soo Lee
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Byung-Joon Choi
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Joo-Young Ohe
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Junho Jung
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Bo-Yeon Hwang
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Min-Ah Kim
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Yong-Dae Kwon
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea.
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Lukas D, Jan M, Constantinus P, Paul L. Fractured Needle Removal With a 3-Dimensionally Printed Surgical Guide: A Case Report and Literature Review. J Oral Maxillofac Surg 2020; 79:1019-1024. [PMID: 33271183 DOI: 10.1016/j.joms.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Driesen Lukas
- Medical Student, Department of OMFS, University Hospitals Leuven, Leuven, Belgium
| | - Meeus Jan
- Resident, Department of OMFS, University Hospitals Leuven, Leuven, Belgium
| | | | - Legrand Paul
- Visiting Professor, Department of OMFS, University Hospitals Leuven, Leuven, Belgium.
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OLIVEIRA AHAD, ABDO NETO E, BARBOSA SJC, STEFENON L. Avaliação da deformação de agulhas gengivais e análise fractal. REVISTA DE ODONTOLOGIA DA UNESP 2018. [DOI: 10.1590/1807-2577.03918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Letícia STEFENON
- Faculdade Especializada na Área de Saúde do Rio Grande do Sul, Brasil
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5
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Kuzin AV, Gurin AN, Shcherbakov AM. [Needle fractures during mandibular block: prevention and emergency care algorithm]. STOMATOLOGII︠A︡ 2018; 97:56-59. [PMID: 29992941 DOI: 10.17116/stomat201897356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- A V Kuzin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A N Gurin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Acham S, Truschnegg A, Rugani P, Kirnbauer B, Reinbacher KE, Zemann W, Kqiku L, Jakse N. Needle fracture as a complication of dental local anesthesia: recommendations for prevention and a comprehensive treatment algorithm based on literature from the past four decades. Clin Oral Investig 2018; 23:1109-1119. [DOI: 10.1007/s00784-018-2525-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/11/2018] [Indexed: 02/06/2023]
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Wu JH, Yuan Y, Jiang LQ, Xia Y, Wang Y, Xu SG, Zhou PY. Removing a metal foreign object successfully from a patient's retroperitoneal space using laparoscopy and a novel navigation system. Ann R Coll Surg Engl 2018; 100:e114-e117. [PMID: 29607721 DOI: 10.1308/rcsann.2018.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Trauma with foreign objects retained within the human body has become a common surgical emergency condition. Traditional surgical methods often involve creating large incisions in soft tissue and may lead to additional complications during wound healing. We have developed a new method of removing foreign bodies from patients' abdomens by using laparoscopy with the help of a novel navigation system that provides accurate positioning. This approach is minimally invasive and simple. This is the first combination of both technologies in this field.
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Affiliation(s)
- J H Wu
- Department of Emergency, Changhai Hospital, Second Military Medical University , Shanghai , China.,JH Wu and Y Yuan are contributed equally to the article
| | - Y Yuan
- Department of Emergency, Changhai Hospital, Second Military Medical University , Shanghai , China.,JH Wu and Y Yuan are contributed equally to the article
| | - L Q Jiang
- Department of Emergency, Changhai Hospital, Second Military Medical University , Shanghai , China
| | - Y Xia
- Department of Emergency, Changhai Hospital, Second Military Medical University , Shanghai , China
| | - Y Wang
- Department of Emergency, Changhai Hospital, Second Military Medical University , Shanghai , China
| | - S G Xu
- Department of Emergency, Changhai Hospital, Second Military Medical University , Shanghai , China.,Department of Orthopedics, Changhai Hospital, Second Military Medical University , Shanghai , China.,SG Xu and PY Zhou are correspondences to this article
| | - P Y Zhou
- Department of Emergency, Changhai Hospital, Second Military Medical University , Shanghai , China.,Department of Orthopedics, Changhai Hospital, Second Military Medical University , Shanghai , China.,SG Xu and PY Zhou are correspondences to this article
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You JS, Kim SG, Oh JS, Choi HI, Jih MK. Removal of a fractured needle during inferior alveolar nerve block: two case reports. J Dent Anesth Pain Med 2017; 17:225-229. [PMID: 29090254 PMCID: PMC5647823 DOI: 10.17245/jdapm.2017.17.3.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 11/23/2022] Open
Abstract
The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.
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Affiliation(s)
- Jae-Seek You
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwang-ju, Korea
| | - Su-Gwan Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwang-ju, Korea
| | - Ji-Su Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwang-ju, Korea
| | - Hae-In Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwang-ju, Korea
| | - Myeong-Kwan Jih
- Department of Pediatric Dentistry, School of Dentistry, Chosun University, Gwang-ju, Korea
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Retrieval of a Broken Dental Needle Close to the Facial Artery After Cervical Migration. J Craniofac Surg 2017; 27:e338-40. [PMID: 27171952 DOI: 10.1097/scs.0000000000002507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Use of imaging tools like digital C-arm, tridimensional tomography, and navigational surgery has proven its value to the surgical removal of broken needles. A 32-year-old patient was referred for evaluation of a fractured needle during inferior alveolar nerve block attempt few days before. The patient complained of a pricking sensation at the injured area while moving the neck. A contrasted computed tomography was performed for further evaluation of the needle toward the vascular network of the neck, showing a close location by the left facial artery, parallel to the styloid process of the temporal bone. The needle was then released from the underlying tissues and retrieved. Although considered a rare intercurrence, there are still reports of breaking needles during dental anesthesia. Such reports are almost always related to inferior alveolar nerve blocks, associated with the use of short, thin needles, and after multiple bending movements before the insertion of the needle in the tissues. Accurate image examinations such as contrasted computed tomography are of great importance for planning the surgical removal, especially in patients of migration next to important vessels of the neck.
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10
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Villalobos MIDOEB, Leite TCGF, Barra SG, Werneche DTPDC, Manzi FR, Cardoso CAEA. Radiographic and computed tomography monitoring of a fractured needle fragment in the mandibular branch. Imaging Sci Dent 2017; 47:63-68. [PMID: 28361032 PMCID: PMC5370251 DOI: 10.5624/isd.2017.47.1.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 10/02/2016] [Accepted: 02/08/2017] [Indexed: 11/18/2022] Open
Abstract
Some complications can arise with the usage of local anesthesia for dental procedures, including the fracture of needles in the patient. This is a rare incident, usually caused by the patient's sudden movements during anesthetic block. Its complications are not common, but can include pain, trismus, inflammation in the region, difficulty in swallowing, and migration of the object, which is the least common but has the ability to cause more serious damage to the patient. This report describes a case in which, after the fracture of the anesthetic needle used during alveolar nerve block for exodontia of the left mandibular third molar, the fragment moved significantly in the first 2 months, before stabilizing after the third month of radiographic monitoring.
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Affiliation(s)
| | | | - Samila Gonçalves Barra
- Department of Dentistry, Pontificial Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Flavio Ricardo Manzi
- Department of Dentistry, Pontificial Catholic University of Minas Gerais, Belo Horizonte, Brazil
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Retained dental needle migration across the skull base to the cochlea presenting as hearing loss. Otol Neurotol 2015; 36:e42-5. [PMID: 25569371 DOI: 10.1097/mao.0000000000000690] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Long-term retained foreign bodies in the human body have been reported across many specialties, but relatively few exist in the ENT literature. PATIENTS We present a case report of a patient with a broken dental needle fragment in the posterior oral cavity with subsequent migration to the cochlea over the course of 4 years, eventually leading to hearing loss. CT scan and middle ear exploration demonstrated a 4-cm metallic fragment abutting the base of the cochlea, immediately adjacent to the internal carotid artery. INTERVENTIONS The needle segment was removed through an endaural approach without complication. RESULTS Postoperatively, the patient had improvements in PTA and speech discrimination, as well as the resolution of chronic otalgia and jaw pain. Imaging, audiologic results, and surgical details and pictures are presented herein. CONCLUSION To our knowledge, based on a thorough PubMed and Google Scholar search, there are no reports of such a foreign body migration from the oral cavity to the skull base.
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Lee TYT, Zaid WS. Broken dental needle retrieval using a surgical navigation system: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:e55-9. [PMID: 25442246 DOI: 10.1016/j.oooo.2014.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/11/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
This paper reports a case of fractured needle retrieval in the pterygomandibular space using the Medtronic surgical navigation system. Current literature on needle fracture and retrieval in the oral cavity was also reviewed. A literature search was conducted in the following databases: PubMed, MDConsult, The Cochrane Library, and Google. A variety of keywords were used, including "needle fracture," "broken dental needle," "needle injuries in dentistry," "foreign body retrieval," and "dental needle retrieval." Articles published after 1980 were reviewed. Seventeen articles that involved broken dental needle retrieval were selected.
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Affiliation(s)
- Tim Yen Ting Lee
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University School of Dentistry, New Orleans, LA, USA.
| | - Waleed Suliman Zaid
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University School of Dentistry, New Orleans, LA, USA
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