Locating Broken Needles

Int. J. Oral Maxillofac. Surg.
2003; 32: 642644

doi:10.1054/ijom.2003.0430, available online at http//www.sciencedirect.com
Technical Note
Locating broken dental

needles
M. Thompson, S. Wright, L. H. H. Cheng, D. Starr: Technical note: Locating
broken dental needles. Int. J. Oral Maxillofac. Surg. 2003; 32: 642644. 2003
International Association of Oral and Maxillofacial Surgeons. Published by
Elsevier Ltd. All rights reserved.
M. Thompson1, S. Wright2,
L. H. H. Cheng2, D. Starr3
1
Department of Maxillofacial Surgery,

Middlesbrough General Hospital, Aryesome
Green Lane, Middlesbrough TS5 5AZ, UK;
2
Department of Maxillofacial Surgery,
Addenbrookes NHS Trust, Hills Road,
Cambridge CB2 2QQ, UK; 3Hull Infirmary,
Hull, UK
Abstract. Broken dental needles are a rare event. They are diicult to find and
remove. We report two cases in which broken needles were located using a simple
stereotactic method with the aid of an image intensifier.
Key words: image intensifier; dental needle.
Introduction
needle fractured. The fragment disappeared into the tissues and the dental
Before the advent of the disposable

spiral-constructed dental needle, breakage of needles during the administration
of local anaesthetics was not an uncommon event. B1 reported 100 cases of
broken needles over a 14 year period
from 1914 to 1928. Needle fracture is
now a rare complication. This is probably due to the use of modern flexible
alloys in their fabrication. When fracture
occurs it is usually due to the inappropriate use of short, narrow gauge needles
inserted to the hub or bending before use
as well as poor operator technique. The
most common site for loss of a fractured
needle is the pterygomandibular space
during an inferior dental nerve block2.
Removal of broken needles is considered
necessary due to the risk of migration
and injury to vital structures3. Locating
and retrieving needle fragments represents a challenge to the maxillofacial
surgeon. We report on two cases in
which fluoroscopy was used to locate the
needle fragments and aid their removal.
practitioner had attempted an inferior

dental nerve block during which the
Accepted for publication 1 April 2003
Case 1
A 62-year-old woman was referred
urgently to the department of maxillofacial surgery for the removal of a
broken needle from the right pterygomandibular space. The patient had been
attending her general dental practitioner
for routine treatment. The dental
0901-5027/03/000642+03 $30.00/0
Fig. 1. Radiograph demonstrating the fractured needle.
2003 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Locating broken dental needles
643
Fig. 2. Image intensifier view of the fractured needle in case 1.
practitioner was unable to retrieve it.

The patient did not complain of pain or
limited opening. Clinical examination
revealed bruising in the right pterygomandibular region, but no bleeding or
visible puncture wounds. The dental
practitioner sent the hub of the broken
needle which was 27 gauge. Radiographs
confirmed the presence and position of
the needle fragment (Fig. 1). The patient
underwent a general anaesthetic for the
exploration. The mandible was stabilized
by use of a mouth prop. An image
intensifier was used with two localizing
needles at dierent angles to the broken
needle for localization (Fig. 2). Through
a vertical incision parallel and medial to
the anterior border of the ramus the
needle fragment was retrieved from the
pterygomandibular space. Postoperative
recovery was uneventful with no evidence of trismus.
Case 2
The needle was broken in a 10-year-old
boy when his general dental practitioner
attempted to give a left inferior alveolar
nerve block. The needle broke at the hub
and the fragment was not visible for

retrieval. Radiographs confirmed the
presence of the needle fragment in the
left pterygomandibular space. The same
technique was used to locate and retrieve
the needle fragment.
Discussion
Determining the position of a broken
needle in the pterygomandibular space in
an anaesthetized patient is a diicult task.
Several dierent techniques have been
described including the use of metal detectors. These have been used for localization of metallic foreign bodies in the
floor of the mouth4 and have been successfully used to find a broken needle
in the pterygomandibular space5. Metal
detectors though are not readily available
and the probe must be small enough to
use in the mouth. The more common
method is the use of intraoperative
radiographs with localizing needles6,7.
Intraoperative radiographs though are
diicult to obtain and prolong the
procedure.
The method we used in these two cases
was a simple stereotactic technique using
an image intensifier and two 19-gauge

venepuncture needles under general anaesthesia. This technique was originally
described by Ariyan for removal of
foreign bodies from the extremities8.
Though the spatial resolution of the
image intensifier is about 45 lp mm 1
compared to 100 lp mm 1 for a plain
radiograph, it is able to demonstrate
the reference needles and the fractured
needle. It has several advantages over
using intraoperative radiographs. Images can be taken quickly and at varying
angles to aid localization without disturbing the reference needles, and the
images can be viewed immediately in the
ambient lighting of theatre. Image intensifiers are usually readily available in
theatres as they required for orthopaedic
and urological surgery.
We believe that this is a useful technique that can be used by surgeons confronted by retained dental needle in the
oral cavity.
References
1. B T. A report of 100 cases of hypodermic needles broken during administration o oral local anaesthesia. Dent
Cosmos 1928: 70: 865874.
644
Thompson et al.
2. A WH. Oral and Maxillofacial

Surgery, 5th edition. Philadelphia:
Saunders 1975: 15401680.
3. A AB. Broken needles. Aust Dent J
1951: 55: 403406.
4. M UJ, F K, G MJ.
The use of a metal detector for localisation of a metallic foreign body in the
floor of the mouth. Br J Oral Maxillofac
Surg 1993: 31: 191192.
5. MD T. An unusual case of
trismus and dysphagia. Br Dent J 1996:
180: 465466.
6. H HK. A simple technique for localising

a broken dental needle in the pterygomandibular region. Aust Dent J 1988: 33:
308309.
7. P JF, H D, M
BE. A broken dental needle and its surgical removal. NY State Dent J 1986:
Aug/Sept: 2831.
8. A S. A simple stereotactic method
to isolate and remove foreign bodies.
Arch Surg 1977: 112: 857859.
Address:
Mark Thompson
Department of Maxillofacial Surgery
Middlesbrough General Hospital
Aryesome Green Lane
Middlesbrough TS5 5AZ
Tel: 01642 854209
Fax: 01642 824727
E-mail: [email protected]

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Int. J. Oral Maxillofac. Surg.

2003; 32: 642644

Locating broken dental

Department of Maxillofacial Surgery,

Key words: image intensifier; dental needle.

Before the advent of the disposable

practitioner had attempted an inferior

Accepted for publication 1 April 2003

Fig. 1. Radiograph demonstrating the fractured needle.

Locating broken dental needles

Fig. 2. Image intensifier view of the fractured needle in case 1.

practitioner was unable to retrieve it.

and the fragment was not visible for

an image intensifier and two 19-gauge

2. A WH. Oral and Maxillofacial

6. H HK. A simple technique for localising

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