Removal of a broken dental needle in the pterygomandibular space using an image intensifier: two case reports

Introduction: Accidents and complications are elements that can occasionally be associated with the procedures realized within work dentist environment. Among some accidents related to dental practice, needle fracture during local anesthesia is noteworthy due to its rarity. Objective: This work seeks to report two cases of removal of a broken dental needle in the pterygomandibular space using an image intensifier. Material and Methods: In both cases, the accident happened during an inferior alveolar nerve block. The surgeons requested image exams to locate the objects using general anesthesia. In the surgery, a transoral incision was made to remove the broken needle from the pterygomandibular space, guided by an image intensifier. Results: Both surgeries were a success. The broken needles were found quickly with the use of the image intensifier, and no postoperative complications were observed. Conclusion: The correct assessment of fractured dental position is essential for its removal. The use of the image intensifier has been showing advantages, such as offering fast transoperative dynamic images and at different angles, thus providing opportunity for calmer surgery and with less risk for the patient and the operator.

Management of a ruptured epidural catheter, an anesthesiologist's dilemma: a case report

Epidural anesthesia is a widely used anesthetic technique in lower extremity surgeries although it is a relatively safe procedure, it can have complications, such as rupture of the epidural catheter. This is a 69-year-old male patient with a diagnosis of Wagner IV diabetic foot is presented, which was scheduled for left supracondylar amputation in which after epidural block, retention of the catheter tip in the epidural space at level L2-L3 was seen, so hemi laminectomy was performed in a second surgical stage in L2 and removal of the epidural catheter. Ideally a broken needle should be removed as soon as possible.

Computer-Controlled Local Anesthesia Complication: Surgical Retrieval of a Broken Dental Needle in Noncooperative Autistic Paediatric Patient

The article describes an unusual case of retrieval of 8 mm fragment of a broken 30-gauge 21 mm dental needle in a 6 y.o. noncooperative autistic male patient. The needle of a computer-controlled local anesthesia device was broken during an attempt to administer local anesthetic, in order to perform conservative treatment of teeth 55 and 54 by a pedodontist. Despite the fact that the patient was under nitrous oxide sedation, an unexpected movement of the patient occurred and resulted in needle breakage. Due to the lack of patient cooperation, the surgical retrieval of a broken needle was performed under general anesthesia as part of one-day surgery procedures. The purpose of the article is to emphasize careful decision-making in proper choice of dental instruments during treatment of noncooperative paediatric patients even under sedation and to suggest dentists to carry out treatment of such patients under general anesthesia.

Broken needle in gluteal region following an intramuscular injection: a case report

<p class="abstract">Incidence of broken hypodermic needle in patients has been decreased because of superior manufacturing techniques. Breaking of hypodermic needle after intramuscular injection has been rarely reported. We report a case of broken needle in the gluteal region in a 36 years old woman following an intramuscular injection. Patient arrived in the emergency after 2 days of the episode. Patient was taken for surgery for removal of the needle. Initially attempts for removal of needle were made without use of image intensifier under local anaesthesia, but it failed as it was very difficult to locate the needle. Patient was taken up for surgery under spinal anaesthesia with the use of image intensifier. Broken needle was located and removed. The following case describes the management of broken hypodermic needle and suggests valuable guidelines for minimising the chances of undue complications arising due to needle migration.</p>

Pins and needles in the groin: an incidental finding of retained needle fragments in an intravenous drug user

A female intravenous drug user was reviewed in A&E following a deliberate overdose. After claiming to have swallowed a razor blade, an abdominal radiograph was performed; this showed a linear metallic density projected over the right side of the pelvis, eventually identified as a needle fragment. Subsequent CT imaging revealed three additional needles situated within the groin. Duplex assessment also identified bilateral arteriovenous fistulae. The patient remained asymptomatic and was managed conservatively. She could recall several occasions when a needle had broken while injecting. This scenario was more likely if the needle had been used many times previously, causing it to become blunt and bent. There are cases reported of adverse patient outcomes secondary to broken needle fragments but awareness among medical professionals remains poor.