Displacement of a needle fragment for the region of the carotid trigon

Abstract

Most outpatient emergencies due to needle fracture in dental patients occur during or immediately after infiltration of the local anesthetic. The pterygomandibular area for the inferior alveolar nerve block is the site where there is a higher frequency of needle fracture. The reasons for this accident are varied, with the most common causes being: needle failure, sudden patient movement, professional technique errors, or even reuse of the needle causing metal fatigue. In front of the fracture, the fragment of the needle can remain static or follow several paths, being extremely important its immediate location. If the fragment of the fractured needle is visualized, it can be removed with the aid of a hemostatic forceps by the dental surgeon himself. However, if it is submerged and consequently moving, this fragment can be lost in the tissues and thus, the patient must undergo surgery for the removal of the fragment by a buccomaxillofacial surgeon. This paper describes the clinical case of a patient complaining of pain and discomfort due to the presence of a fractured needle fragment accidentally after having undergone pterygomandibular anesthesia. The clinical management of the case and the treatment instituted were discussed, based on the literature.