Needle in the external auditory canal: an unusual complication of inferior alveolar nerve block

doi:10.1016/j.oooo.2013.09.014

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Volume 117, Issue 6, June 2014, Pages e436-e437

https://doi.org/10.1016/j.oooo.2013.09.014 Get rights and content

Inferior alveolar nerve block is used to anesthetize the ipsilateral mandible. The most commonly used technique is one in which the anesthetic is injected directly into the pterygomandibular space, by an intraoral approach. The fracture of the needle, although uncommon, can lead to potentially serious complications. The needle is usually found in the pterygomandibular space, although it can migrate and damage adjacent structures, with variable consequences. The authors report an unusual case of a fractured needle, migrating to the external auditory canal, as a result of an inferior alveolar nerve block.

Section snippets

Case Report

A 25-year-old woman was referred by her maxillofacial surgeon to our department of otorhinolaryngology presenting with left otalgia and pain in the ipsilateral temporomandibular joint. There was a previous history of a needle fracture in the past year, caused by an unexpected movement during an inferior alveolar nerve (IAN) block for a dental procedure. Being unable to remove the broken needle, the dentist sent the patient to the local emergency department, where an orthopanoramic radiograph

Discussion

Mandibular anesthesia is based on blocking the posterior branch of the mandibular nerve as well as its distal branches, allowing adequate pain control when performing dental and localized surgical procedures. The most commonly used technique consists of the infiltration of local anesthetic solution in the proximity of the IAN, proximally to the mandibular foramen.1, 2 The needle should be inserted in the pterygotemporal depression, which is limited medially by the pterygomandibular raphe and

Conclusion

To our knowledge, this is the first case described in the literature in which the fractured needle migrated to the external auditory canal, reaching the tympanic membrane at its lateral segment. In our view, this case demonstrates the need to remove the foreign body, when possible, owing to the risk of its damaging important structures.

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Neural blockade anesthesia of the mandibular nerve and its terminal branches: rationale for different anaesthetic technics including their advantages and disadvantages
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Needle breakage following inferior alveolar nerve bock: implications and management
Br Dent J
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There are more references available in the full text version of this article.

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Citation Excerpt :
In terms of the time until needle removal, Acham et al. [10] reported that it was removed immediately (within 1 day after the event) in most cases, removal of the fragments was delayed (3–12 months) or late (> 1 year) in 12.8 % of cases. Previous reports have noted that broken needles have sometimes advanced to sites where they might have caused life-threatening complications, such as the external auditory canal [2], internal carotid artery [12], and skull base [13]. These reports suggest that it is necessary to remove the broken needle as soon as possible.
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Oral and maxillofacial surgeryOnline only articleNeedle in the external auditory canal: an unusual complication of inferior alveolar nerve block

Section snippets

Case Report

Discussion

Conclusion

Arch Oral Biol

Neural blockade anesthesia of the mandibular nerve and its terminal branches: rationale for different anaesthetic technics including their advantages and disadvantages

Anesthesiol Res Pract

Needle breakage following inferior alveolar nerve bock: implications and management

Br Dent J

Oral and maxillofacial surgery
Online only article
Needle in the external auditory canal: an unusual complication of inferior alveolar nerve block