A novel case of a broken dental anesthetic needle transecting the right internal carotid artery

Abstract

Background and overview: Although dental anesthetic needle fractures remain an uncommon occurrence, there is a lack of consensus on the management of the treatment of this complication. Complications could include trismus, dysphagia, or infection that may lead to more deleterious results.

Case description: In this case study, a 47-year-old man underwent a routine dental extraction at a private office. During administration of the inferior alveolar nerve block, a dental anesthetic needle fractured. The general dental practitioner dismissed the patient and reassured him that no retrieval of the needle was needed. Several weeks later, the patient sought care for severe, acute pain and dysphagia. Traditional retrieval techniques were unsuccessful, and the authors consulted the neurosurgery team. The patient underwent endovascular surgery with digital subtraction angiography for retrieval of the needle from the right internal carotid artery.

Conclusions and practical implications: Most authors in the literature agree that proper technique and equipment are paramount in avoiding fractures of dental anesthetic needles. Although needle fracture is a rare complication, immediate referral and retrieval of the broken needle by an appropriately trained surgeon is essential for optimal outcomes. This case demonstrates an example of a broken needle that migrated and transected the internal carotid artery at the jugular foramen. All dental practitioners must be cognizant of the potentially serious complications associated with a retained broken needle.

Keywords: Carotid artery; computed tomography; decision making; nerve block; oral and maxillofacial surgery; stroke; syringes.