NEEDLE BREAKAGE DURING INFERIOR ALVEOLAR NERVE BLOCK ANESTHESIA: A REVIEW

F. Tricca¹, S.R. Tari¹, S. Benedicenti², S. A. Gehrke³ , F. Inchingolo⁴ , A. Scarano¹

¹ Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, Chieti, Italy
² Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
³ Universidad Católica de Murcia (UCAM), Murcia, Spain
⁴ Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, Bari, Italy

Correspondence to:

Annals of Stomatology 2022 September-December; 2(3): 114-120
https://doi.org/10.69129/stomatol/2022v2iss3_6

Received: 3 September 2022 Accepted: 2 October 2022

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Abstract

Needle breakage is a frustrating accident during inferior alveolar nerve block administration. Proper treatment of such a complication is fundamental considering that, without an appropriate localization, the fragment manipulation may worsen the condition and lead to a deeper migration into vital structures. This review examines in depth the potential risk factors of needle breakage, analyzing the proper management and treatment of such conditions. Preventive measures are also proposed to decrease the risk of breakage. Changing the needle direction is only allowed if most of the needle is withdrawn with the tip just beneath the mucosa. The use of a bidirectional rotation insertion technique during the administration could be another measure to minimize needle deflection. Repeated injections with the same needle, should be avoided since they increase fragility and susceptibility to fracture. Needles and syringes should be checked for irregularities before the injection. Furthermore, adequate preoperative sedation should be considered, especially in pediatric patients, to achieve proper compliance. After carefully evaluating the entry point, if the fragment is still visible, an immediate attempt to retrieve it with fine artery forceps is required. When the needle is completely covered by the mucosa, the retrieval becomes complex and unproper maneuvers may lead to a further displacement into deeper tissues.

Keywords: anesthesia, IAN, inferior alveolar nerve, needle breakage