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Open Access 01-03-2019 | Original Article

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

Authors: Stephan Acham, Astrid Truschnegg, Petra Rugani, Barbara Kirnbauer, Knut Ernst Reinbacher, Wolfgang Zemann, Lumnije Kqiku, Norbert Jakse

Published in: Clinical Oral Investigations | Issue 3/2019

Abstract

Objectives

The aim of this publication is to provide a concept for prevention and a standardized step-by-step clinical approach to this rare but serious and potentially preventable complication of dental local anesthesia.

Materials and methods

We collected data with a PUBMED search using the key words “local anesthesia,” “dental anesthesia/anesthesia” OR “mandibular block anesthesia,” “complication,” “hypodermic needle,” “needle breakage” OR “needle fracture,” and “foreign body AND removal” OR “retrieval.” The existing literature was systematically evaluated from 1980 to date using Microsoft Excel 2007 (Microsoft Corporation).

Results

After analysis of the literature, we included 36 reports documenting 59 needle breakage events and defined possible risk factors and preventive measures. All relevant reported parameters were listed in tabular form. The main result of this article is a treatment algorithm for this complication.

Conclusions

Prevention of a needle fracture should be the main goal during local dental anesthesia. Use of longer hypodermic needle can obviate complex retrieval surgery. If immediate removal of the fragment fails, localization, planning, and the necessary surgical procedure should be arranged promptly.

Clinical relevance

Following a strict algorithm, successful surgical handling of this complication will depend on minimizing risk and following treatment recommendations closely.

Van den Akker HP and Baart JA (2017) Local Complications – Needle Breakage. In: Baart JA, Brand HS (eds.) Local Anaesthesia in Dentistry, Springer International Publishing, pp 148–150. ISBN 978–3–319-43704-0. doi: https://doi.org/10.1007/978-3-319-43705-7

Augello M, von Jackowski J, Grätz KW, Jacobsen C (2011) Needle breakage during local anesthesia in the oral cavity - a retrospective of the last 50 years with guidelines for treatment and prevention. Clin Oral Investig 15:3–8. https://doi.org/10.1007/s00784-010-0442-6 CrossRefPubMed

Prado FB, Caria PFH, Martins EC, Daruge E (2010) Dental broken needle migration to the skull base, Anatomical considerations and prevention. J Morphol Sci 27:98–101

Rahman N, Clarke M, Stassen LF (2013) Case report: management of broken dental needles in practice. J Ir Dent Assoc 59:241–245PubMed

Altay MA, Jee-Hyun Lyu D, Collette D, Baur DA, Quereshy FA, Teich ST, Gonzalez AE (2014) Transcervical migration of a broken dental needle: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 118:e161–e165. https://doi.org/10.1016/j.oooo.2014.04.001 CrossRefPubMed

Ribeiro L, Ramalho S, Gerós S, Ferreira EC, Faria e Almeida A, Condé A (2014) Needle in the external auditory canal: an unusual complication of inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol 117:e436–e437. https://doi.org/10.1016/j.oooo.2013.09.014 CrossRefPubMed

Queiroz SB, Lima VN, Amorim PH, Magro-Filho O, Amorim RF (2016) Retrieval of a Broken Dental Needle Close to the Facial Artery After Cervical Migration. J Craniofac Surg 27:e338–e340. https://doi.org/10.1097/SCS.0000000000002507 CrossRefPubMed

Pogrel MA (2009) Broken local anesthetic needles: a case series of 16 patients, with recommendations. J Am Dent Assoc 140:1517–1522CrossRefPubMed

Amies AB (1951) Broken needles. Aust J Dent 55:403–406PubMed

10.

Fraser-Moodie W (1966) Location and localisation of metal in the tissues. Br J Oral Surg 4:99–105CrossRefPubMed

11.

Fitzpatrick B (1967) The broken dental needle. Aust Dent J 12:243–245CrossRefPubMed

12.

Marks RB, Carlton DM, McDonald S (1984) Management of a broken needle in the pterygomandibular space: report of a case. J Am Dent Assoc 109:263–264CrossRefPubMed

13.

McDonogh T (1996) An unusual case of trismus and dysphagia. Br Dent J 180:465–466CrossRefPubMed

14.

Bedrock RD, Skigen A, Dolwick MF (1999) Retrieval of a broken needle in the pterygomandibular space. J Am Dent Assoc 130:685–687CrossRefPubMed

15.

Zeltser R, Cohen C, Casap N (2002) The implications of a broken needle in the pterygomandibular space: clinical guidelines for prevention and retrieval. Pediatr Dent 24:153–156PubMed

16.

Thompson M, Wright S, Cheng LH, Starr D (2003) Locating broken dental needles. Int J Oral Maxillofac Surg 32:642–644CrossRefPubMed

17.

Baart JA, van Amerongen WE, de Jong KJ, Allard RH (2006) Needle breakage during mandibular block anaesthesia: prevention and retrieval. [Dutch] Ned Tijdschr Tandheelkd 113:520–523PubMed

18.

Dojcinovic I, Hugentobler M, Richter M (2007) Needle breakage: a rare and potentially dangerous complication during local anesthesia. [French] Rev Stomatol Chir Maxillofac 108:222–224CrossRefPubMed

19.

Ethunandan M, Tran AL, Anand R, Bowden J, Seal MT, Brennan PA (2007) Needle breakage following inferior alveolar nerve block: implications and management. Br Dent J 202:395–397CrossRefPubMed

20.

Augello M, von Jackowski J, Dannemann C (2009) Nadelbruch als Komplikation bei der intraoralen Leitungsanästhesie im Unterkiefer. [German] Quintessenz 60:1263–1267

21.

Chrcanovic BR, Menezes DC Jr, Custódio ALN (2009) Complication of local dental anesthesia - a broken needle in the pterygomandibular space. Braz J Oral Sci 8:159–162

22.

Shah A, Mehta N, Von Arx DP (2009) Fracture of a dental needle during administration of an inferior alveolar nerve block. Dent Update 36:20–22 25CrossRefPubMed

23.

Rifkind JB (2011) Management of a broken needle in the pterygomandibular space following a Vazirani-Akinosi block: case report. J Can Dent Assoc 77:b64PubMed

24.

Bacci C, Mariuzzi ML, Ghirotto C, Fusetti S (2012) Local anesthesia needle breakage in a 5-year-old child during inferior alveolar nerve block with the Vazirani-Akinosi technique. [English, Italian] Minerva Stomatol 61:337–340PubMed

25.

Catelani C, Valente A, Rossi A, Bertolai R (2013) Broken anesthetic needle in the pterygomandibular space, Four case reports. [English, Italian] Minerva Stomatol 62:455–463PubMed

26.

Gerbino G, Zavattero E, Berrone M, Berrone S (2013) Management of needle breakage using intraoperative navigation following inferior alveolar nerve block. J Oral Maxillofac Surg 71:1819–1824. https://doi.org/10.1016/j.joms.2013.07.023 CrossRefPubMed

27.

Kim JH, Moon SY (2013) Removal of a broken needle using three-dimensional computed tomography: a case report. J Korean Assoc Oral Maxillofac Surg 39:251–253. https://doi.org/10.5125/jkaoms.2013.39.5.251 CrossRefPubMedPubMedCentral

28.

Acham S, Reinbacher KE (2014) Nadelbruch im Rahmen der zahnärztlichen Lokalanästhesie. [German] Quintessenz 65:1385–1393

29.

Bailey E, Rao J, Saksena A (2015) A Case Report: Fractured Needle in the Pterygomandibular Space Following Administration of an Inferior Dental Nerve Block. Dent Update 42:270–272CrossRefPubMed

30.

Lee TY, Zaid WS (2015) Broken dental needle retrieval using a surgical navigation system: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 119:e55–e59. https://doi.org/10.1016/j.oooo.2014.08.019 CrossRefPubMed

31.

Brooks J, Murphy MT (2016) A novel case of a broken dental anesthetic needle transecting the right internal carotid artery. J Am Dent Assoc 147:739–742. https://doi.org/10.1016/j.adaj.2016.03.014 CrossRefPubMed

32.

Casey JT, Lupo JE, Jenkins HA (2015) Retained dental needle migration across the skull base to the cochlea presenting as hearing loss. Otol Neurotol 36:e42–e45. https://doi.org/10.1097/MAO.0000000000000690 CrossRefPubMed

33.

Okumura Y, Hidaka H, Seiji K, Nomura K, Takata Y, Suzuki T, Katori Y (2015) Unique migration of a dental needle into the parapharyngeal space: successful removal by an intraoral approach and simulation for tracking visibility in X-ray fluoroscopy. Ann Otol Rhinol Laryngol 124:162–167. https://doi.org/10.1177/0003489414547106 CrossRefPubMed

34.

Okamoto Y, Takasugi Y, Moriya K, Furuya H (2000) Inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen: radiographic study of local anesthetic spread in the pterygomandibular space. Anesth Prog 47:130–133PubMedPubMedCentral

35.

Kronman JH, el-Bermani AW, Wonwatana S, Jumar A (1994) Preferred needle lengths for inferior alveolar anesthesia. Gen Dent 42:74–76PubMed

36.

Atterbury RA (1949) Minimizing risk of hypodermic needle breakage; removal of broken needle from mandible. J Am Dent Assoc 38:57–59CrossRefPubMed

37.

Säkkinen J, Huppunen M, Suuronen R (2005) Complications following local anaesthesia. Nor Tannlegeforen Tid 115:48–52

38.

Aldous JA (1968) Needle deflection: a factor in the administration of local anesthetics. J Am Dent Assoc 77:602–604CrossRefPubMed

39.

Pietruszka JF, Hoffman D, McGivern BE Jr (1986) A broken dental needle and its surgical removal: a case report. N Y State Dent J 52:28–31PubMed

40.

Mima T, Shirasuna K, Morioka S, Sugiyama M, Matsuya T (1989) A broken needle in the pterygomandibular space. [Japanese] Osaka Daigaku Shigaku Zasshi 34:418–422PubMed

41.

Stein KM (2015) Use of Intraoperative Navigation for Minimally Invasive Retrieval of a Broken Dental Needle. J Oral Maxillofac Surg 73:1911–1916. https://doi.org/10.1016/j.joms.2015.04.033 CrossRefPubMed

42.

Lehtinen R (1983) Penetration of 27- and 30-gauge dental needles. Int J Oral Surg 12:444–445CrossRefPubMed

43.

Fuller NP, Menke RA, Meyers WJ (1979) Perception of pain to three different intraoral penetrations of needles. J Am Dent Assoc 99:822–824CrossRefPubMed

44.

Kudo M (2005) Initial injection pressure for dental local anesthesia: effects on pain and anxiety. Anesth Prog 52:95–101CrossRefPubMedPubMedCentral

45.

Malamed SF, Reed K, Poorsattar S (2010) Needle breakage: incidence and prevention. Dent Clin North Am 54:745–756. https://doi.org/10.1016/j.cden.2010.06.013 CrossRefPubMed

46.

Bhatia S, Bounds G (1998) A broken needle in the pterygomandibular space: report of a case and review of the literature. Dent Update 25:35–37PubMed

47.

Faura-Solé M, Sánchez-Garcés MA, Berini-Aytes L, Gay-Escoda C (1999) Broken anesthetic injection needles: report of 5 cases. Quintessenz Int 30:461–465

48.

Malamed SF (2004) Handbook of Local Anesthesia, 5th edn. Mosby, St Louis, MO

49.

Reck SF, Fielding AF (1991) Linear radiopacity resembling broken needle. Oral Surg Oral Med Oral Pathol 72:757–758

50.

Archer WH, Mangie AS, Irby WB (1952) Removal of a broken mandibular needle using a modified Kazanjian guide; report of a case. Oral Surg Oral Med Oral Pathol 5:609–614CrossRefPubMed

51.

Kennett S, Curran JB, Jenkins GR (1973) Management of a broken hypodermic needle: report of a case. Anesth Prog 20:48–50PubMedPubMedCentral

52.

Nezafati S, Shahi S (2008) Removal of broken dental needle using mobile digital C-arm. J Oral Sci 50:351–353CrossRefPubMed

53.

Russel KC (1970) Report on Fractured Hypodermic Needle, https://ocw.mit.edu/courses/ materials-science-and-engineering/3-a27-case-studies-in-forensic-metallurgy-fall-2007/nefarious-needle/6.pdf. Accessed 5 Decembre 2017

54.

Burgess JO (1988) The broken dental needle - a hazard. Spec Care Dentist 8:71–73CrossRefPubMed

55.

Brucoli M, Deandreis M, Arcuri F, Benech A (2012) Management of a needle breakage during third molar extraction with C-ARM digital fluoroscope. J Craniofac Surg 23:1583–1584. https://doi.org/10.1097/SCS.0b013e3182505527 CrossRefPubMed

56.

Nicot R, Maes JM, Raoul G, Ferri J (2013) Head and neck cellulitis caused by a broken anesthesia needle. [French] Rev Stomatol Chir Maxillofac Chir Orale 114:180–183. https://doi.org/10.1016/j.revsto.2013.02.002 CrossRefPubMed

Title: 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
Authors: Stephan Acham
Astrid Truschnegg
Petra Rugani
Barbara Kirnbauer
Knut Ernst Reinbacher
Wolfgang Zemann
Lumnije Kqiku
Norbert Jakse
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 3/2019
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-018-2525-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

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