title: Needle breakage during local anesthesia in the oral cavity--a retrospective of the last 50 years with guidelines for treatment and prevention.
abstract: Needle breakage in the oral cavity after local anesthesia is a common complication with possible serious complications of injuring vital structures. There are different possible reasons for needle breakage, with a main focus on preventable mistakes in treatment. In this study, an analysis of literature of the last 50 years as well as own cases has been performed to renew knowledge and prevention and therapy strategies for this serious complication. A systematic, multilingual review of medical literature from 1900 until today was conducted and information was evaluated systematically. In the majority of cases needle fracture happened during inferior alveolar nerve block. It is mainly a problem due to inadequate technique or the use of too thin needles for the performance of inferior alveolar nerve block. Different arguments about possible therapy strategies and methods exist. Basically, if a hypodermic needle fractures, it should be removed surgically under general anesthesia. To localize the fragment, use of either multi-plane X-rays or fluoroscopy with at least two reference needles in place or, if possible, of three-dimensional CT scans is recommended. This article shows, that despite progression in material, needle fracture is still an existing, preventable problem, if some basic rules are followed.
authors.affiliation: Department of Oral and Craniomaxillofacial Surgery, University Hospital of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland. augello@gmx.ch
authors.forename: Marcello
authors.initials: M
authors.lastname: Augello
authors.forename: Jeannette
authors.initials: J
authors.lastname: von Jackowski
authors.forename: Klaus Wilhelm
authors.initials: KW
authors.lastname: Grätz
authors.forename: Christine
authors.initials: C
authors.lastname: Jacobsen
mesh_terms: D000766:Anesthesia, Dental / Q000295:instrumentation*; D000772:Anesthesia, Local / Q000295:instrumentation*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004868:Equipment Failure; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery; D008338:Mandibular Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008340:Mandibular Nerve; D009055:Mouth / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D009339:Needles / Q000009:adverse effects*; D009407:Nerve Block / Q000295:instrumentation; D017410:Practice Guidelines as Topic; D011859:Radiography
chemical_list: D000779:Anesthetics, Local