Severe restriction in jaw movement after routine injection of local anesthetic in patients who have fibrodysplasia ossificans progressiva.
OBJECTIVE
To determine the relationship of dental procedures to immediate ossification and ankylosis of the jaw in patients who have fibrodysplasia ossificans progressiva.


METHODS
A mail survey was conducted of the 60 patient-members of the International Fibrodysplasia Ossificans Progressiva Association. All 41 patients (18 males, 23 females) who responded were examined. Instantaneous exact hazard rates for ossification of the jaw were calculated by the Weibull model.


RESULTS
Thirty-six patients had dental procedures performed. Twenty-one (58%) patients had received an injection of local anesthetic. Five (24%) patients had an immediate flare-up of fibrodysplasia ossificans progressiva with ossification and permanent ankylosis of the jaw (expected occurrence, 0.031; p < 0.0001). None of the 12 patients who had comparable dental work without injections developed heterotopic ossification (expected occurrence, 0.019; not significant).


CONCLUSIONS
Injections of local anesthetic during dental procedures pose serious and immediate risk for inciting heterotopic ossification and ankylosis of the jaw in patients who have fibrodysplasia ossificans progressiva and should be assiduously avoided.
Luchetti
W
W
Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, USA.
Cohen
R B
RB
Hahn
G V
GV
Rocke
D M
DM
Helpin
M
M
Zasloff
M
M
Kaplan
F S
FS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental / Q000009:adverse effects*; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D000844:Ankylosis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003793:Dental Restoration, Permanent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects; D008297:Male; D008334:Mandible / Q000503:physiopathology*; D008410:Masticatory Muscles / Q000503:physiopathology*; D008875:Middle Aged; D009221:Myositis Ossificans / Q000150:complications / Q000503:physiopathology*; D009967:Orthodontic Appliances; D009999:Ossification, Heterotopic / Q000209:etiology; D012307:Risk Factors; D013705:Temporomandibular Joint Disorders / Q000209:etiology; D014081:Tooth Extraction
D000779:Anesthetics, Local