Facial Nerve Palsy after Inferior Alveolar Nerve Block: A Rare Presentation of Ocular Complication and Literature Review

Abstract

Many ocular complications are described in the literature after dental injections. Facial nerve palsy is a rare complication. We report a case of a 60-year-old woman in the American Society of Anesthesiologists (ASA) I classification under orthodontic treatment with aligners that required an inferior alveolar block for endodontic treatment. Optocaine with epinephrine 1:200,000 and a disposable needle 25 G × 36 mm mounted on a dental syringe were used, and the effect of the anesthesia arose after 10 min. Facial nerve palsy on the side of the injection arose after 1 h and 40 min from the injection, and the patient was immediately visited by an ophthalmologist who reported the examination reported in the present case report. The authors report this unusual case with a subsequent onset and short duration of facial nerve palsy and discuss possible anesthetic solution pathways.

Keywords: anesthesia; bell palsy; dental anesthesia; dental injection; endodontics; facial nerve palsy; facial palsy; inferior alveolar block; ocular complication; ophthalmic complication; optocaine.

Figure 1

(A) Panoramic X-ray with a periapical lesion of the left mandibular second molar with mandibular foramen very posterior; (B) periapical X-ray after the endodontic retreatment.

Figure 2

Image of the patient at the onset of facial nerve palsy and lagophtalmus with a Bell’s phenomenon.

Figure 3

Recovery of the patient with correct eye closure.