Needle breakage during local anesthesia in the oral cavity—a retrospective of the last 50 years with guidelines for treatment and prevention

• Published in: Clinical oral investigations Vol. 15; no. 1; pp. 3 - 8
• Main Authors: Augello, Marcello, von Jackowski, Jeannette, Grätz, Klaus Wilhelm, Jacobsen, Christine
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.02.2011; Springer Nature B.V
• Subjects: Anesthesia, Dental - instrumentation; Anesthesia, Local - instrumentation; Anesthetics, Local - administration & dosage; Dentistry; Equipment Failure; Foreign Bodies - diagnostic imaging; Foreign Bodies - etiology; Foreign Bodies - surgery; Humans; Mandible - diagnostic imaging; Mandible - surgery; Mandibular Injuries - diagnostic imaging; Mandibular Injuries - etiology; Mandibular Injuries - surgery; Mandibular Nerve; Medicine; Mouth - diagnostic imaging; Mouth - injuries; Mouth - surgery; Needles - adverse effects; Nerve Block - instrumentation; Practice Guidelines as Topic; Radiography; Review; Prevention; Needle dimension; Broken hypodermic needle; Literature analysis; Local anesthesia
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-010-0442-6

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.