A Case of Needle Breakage during Dental Local Anesthesia: Prevention and Medico Legal Considerations
Keywords:Dental anesthesia, dental needle, broken dental needle, nerve block, inferior alveolar nerve.
Despite the development of stainless, flexible alloys used in modern, disposable dental needles, reports of needle breaking during the administration of local anesthesia still occur.
Although uncommon, the breakage of needles remains one of the most distressing complications of local anesthesia, since it can lead to serious and potentially life-threatening consequences by violating adjacent vital anatomical structures; however, it is also one of the easiest to prevent. A meticulous injection technique is imperative and, if breakage occurs, the situation must be resolved appropriately.
Through the description of a case of needle breakage during inferior alveolar nerve block, the author discusses how it is possible to prevent this potentially severe event and the importance of its correct management in the light of possible medico legal consequences.
Acham S, Truschnegg A, Rugani P, Kirnbauer B, Reinbacher KE, Zemann W, Kqiku L, Jakse N. 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. Clin Oral Investig 2019; 23 (3): 1109-19. https://doi.org/10.1007/s00784-018-2525-8
Malamed SF, Reed K, Poorsattar S. Needle breakage: incidence and prevention. Dent Clin N Am 2010; 54: 745-56. https://doi.org/10.1016/j.cden.2010.06.013
Augello M, von Jackowski J, Grätz KW, Jacobsen C. Needle breakage during local anesthesia in the oral cavity – a retrospective of the last 50 years with guidelines for treatment and prevention. Clin Oral Invest 2011; 15: 3-8. https://doi.org/10.1007/s00784-010-0442-6
Pogrel MA. Broken local anesthetic needles. A case series of 16 patients, with recommendations. JADA 2009; 140: 1517-22. https://doi.org/10.14219/jada.archive.2009.0103
Zeltser R, Cohen C, Casap N. The implications of a broken needle in the pterygomandibular space: clinical guidelines for prevention and retrieval 2020; 24(2): 153-6.
Jeong K-I, Yoon P-Y, Kim Y-K. Anesthetic dental needle breakage. J Dent Sci 2013; 8: 451-2. https://doi.org/10.1016/j.jds.2012.12.008
Altaj MA, Lyu DJH, Collette D, Baur DA, Quereshy FA, Teich ST, Gonzales AE. Transcervical migration of a broken dental needle: a case report and literature review 2014; 118: e161-5. https://doi.org/10.1016/j.oooo.2014.04.001
Lee H, Kim M, Park H, seo H, Lee J. Fracture of a dental needle during inferior alveolar nerve block in a young child: a case report. J Korean Acad Pediatr Dent 2016; 43(3): 320-6. https://doi.org/10.5933/JKAPD.2016.43.3.320
Ram D, Peretz B. Administering local anaesthesia to paediatric dental patients – current status and prospects for the future. Int J Paediatr Dent 2002; 12: 80-9. https://doi.org/10.1046/j.1365-263X.2002.00343.x
Ethunandan M, Tran AL, Anand R, Bowden J, Seal MT, Brennan PA. Needle breakage following inferior alveolar nerve block: implications and management. Br Dent J 2007; 202(7): 395-7. https://doi.org/10.1038/bdj.2007.272
Hamzani Y, Rosenfeld E, Chaushu G, Yahya BH. Is intraoperative navigation for needle breakage mandatory? JADA 2019; 150(2): 154-8. https://doi.org/10.1016/j.adaj.2018.09.007
Okamoto Y, Takasugi Y, Moriya K, Furuya H. 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 2000; 47: 130-3.
Barker BC, Davies PL. The applied anatomy of the pterygomandibular space. Br J oral Surg 1972; 10: 43-55. https://doi.org/10.1016/S0007-117X(72)80008-8
Chrcanovi BR, Corderito Menezes D, Custódio ALN. Complicationa of local dental anestesia – a broken needle in the pterygomandibular space. Braz J oral Sci 2009; 8(3): 159-162.
Shah A, Mehta N, Von Arx DP. Fracture of a dental needle during administration of an inferior alveolar nerve block. Dent Update 2009; 36: 20-5. https://doi.org/10.12968/denu.2009.36.1.20
Robinson SF, Mayhew RB, Cowan RD, Hawley RJ. Comparative study of deflection characteristics and fragility of 25-, 27-, and 30-gauge short dental needles. JADA 1984; 109: 920-4. https://doi.org/10.14219/jada.archive.1984.0246
Ram D, Hermida L, Amir E. Reaction of children to dental injection with 27- or 30-gauge needles. Int J Paediatr Dent 2007; 17: 383-7. https://doi.org/10.1111/j.1365-263X.2007.00860.x
Brand HS, Bekker W, Baart JA. Complications of local anaesthesia. An observational study. Int J Dent Hyg 2009; 74 (4): 270-2. https://doi.org/10.1111/j.1601-5037.2009.00372.x
Nezafati S, Shahi S. Removal of broken dental needle using mobile digital C-arm. J Oral Sci 2008; 50 (3): 351-3. https://doi.org/10.2334/josnusd.50.351
Park SS, Yang HJ, Lee UL, Kwon MS, Kim MJ, Lee JH, Hwang SJ. Clinical application of the dental mini C-arm for the removal of broken instruments in soft and hard tissue in the oral and maxillofacial area. J Craniomaxillofac Surg 2012; 40: 572-8. https://doi.org/10.1016/j.jcms.2011.10.013
Makwana M, Walsh S. Patient safety: needle breakage. Br Dent J 2017; 222(3): 140. https://doi.org/10.1038/sj.bdj.2017.94
Thompson M, Wright S, Cheng LHH, Starr D. Locating broken dental needles. Int J Oral Maxillofac Surg 2003; 32: 642-4. https://doi.org/10.1054/ijom.2003.0430
Kim J-H, Moon S-Y. Removal of a broken needle using three-dimensional computed tomography: a case report. J Korean Assoc Oral Maxillofac Surg 2013; 39: 251-3. https://doi.org/10.5125/jkaoms.2013.39.5.251