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Case Reports
. 2022 Aug 17:2022:9626612.
doi: 10.1155/2022/9626612. eCollection 2022.

Accidental Insertion of a Broken Needle into the Pterygoid Mandibular Space during Inferior Alveolar Nerve Block: A Case Report

Kazuhiro Terada  1   2 , Kenji Yamagata  1 , Fumihiko Uchida  1 , Satoshi Fukuzawa  1 , Naomi Ishibashi-Kanno  1 , Hiroki Bukawa  1
Affiliations
Case Reports

Accidental Insertion of a Broken Needle into the Pterygoid Mandibular Space during Inferior Alveolar Nerve Block: A Case Report

Kazuhiro Terada et al. Case Rep Dent. .

Abstract

The incidence of needle breakage is estimated to be 0.000007%, and most needle breaks occur during inferior alveolar nerve block (IANB) administration and are localized to the pterygomandibular space. Although immediate surgical intervention is recommended for the removal of the fracture needles, intraoperative localization of a broken injection needle fragment can be challenging. Here, we present the case of a 36-year-old woman who underwent dental extraction of the left lower wisdom tooth under local anesthesia at a private office. At that time, a disposable 33G needle was broken and accidentally inserted into the pterygomandibular space during IANB. A broken injection needle was presented at the base of the left coronoid process of the mandible on computed tomography (CT). We successfully removed the broken injection needle using fluoroscopy and assisted endoscopy under general anesthesia.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Panoramic X-ray performed at the first visit. The broken injection needle can be seen at the base of the left coronoid process (arrows). (b) Lateral cephalometric X-ray. The broken injection needle can be seen at the base of the left coronoid process (arrows).
Figure 2
Figure 2
(a) Computed tomography (axial). The broken injection needle can be seen at the base of the left coronoid process (arrows). (b) Computed tomography (sagittal). The broken injection needle can be seen at the base of the left coronoid process (arrows).
Figure 3
Figure 3
(a) Intraoperative X-ray transmission device images. The position of the broken injection needle was confirmed with a sonde using fluoroscopy. (b) Intraoperative photograph. (c) Endoscopic image taken intraoperatively. An incision approximately 25 mm in length was made on the oblique line of the mandible. A broken injection needle pointing upward from the base of the coronoid process was confirmed in the medial pterygoid muscle. Broken injection needles are shown by an arrow.
Figure 4
Figure 4
The removed disposable dental injection needle and unused disposable dental injection.
See this image and copyright information in PMC

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