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.

THE MANDIBULAR NERVE, ITS COURSE, ANATOMICAL VARIATIONS AND PTERYGOMANDIBULAR SPACE. - A SYSTEMATIC REVIEW.

Knowledge of mandibular nerve and its branches is important when performing dental and surgical procedures of mandible. So, this systematic review article revealed all details of mandibular nerve course and also important anatomical variations. Mandibular nerve during its course go through the pterygomandibular space and this space is important for inferior alveolar nerve block anaesthesia, so all details of pterygomandibular structure are also included in this review.

Management of iatrogenic displacement of maxillary third molar into pterygomandibular space: case report

<p>Third molar surgery is the most common minor oral surgical procedure performed in dental clinics. Displacement of maxillary third molar tooth into adjacent spaces such as infratemporal fossa, maxillary sinus has been reported earlier. We present an unusual case of iatrogenic displacement of maxillary third molar into pterygomandibular space. A 24 year old dental undergraduate reported to Department of Oral surgery with complaints of trismus and swelling in the check region after unsuccessful attempt at extraction of maxillary right third molar tooth. Computed tomography scan localized the tooth in the pterygomandibular space. A surgical removal of the displaced tooth was performed under general anesthesia. Displaced tooth was approached by an intraoral vertical incision along the anterior border of ramus of mandible. Correlating with computed tomography scan, tooth was located and removed followed by suturing of the surgical site. A good knowledge of the operating area and adjoining spaces is essential to avoid iatrogenic damage to tissues during minor oral surgery procedures. Adequate exposure and appropriate instrumentation during surgery can prevent undue complications and ensure quality patient care.</p>