Management of a Broken Local Anesthetic Needle in the Mandibular Ramus: A Case Report and Literature Review

Abstract

Background: Needle fracture during dental injections is a rare but serious complication that can lead to infection, tissue damage, and other issues, often caused by avoidable factors like abrupt movements or bent needles. Prompt removal of broken needle fragments is crucial, and techniques like CT scans and radiographic equipment can aid in locating and retrieving the fragments. Aim: To report a clinical case of a fractured local anesthetic needle located in the mandibular ramus region and to describe the surgical management performed with the aid of an image intensifier. Additionally, this report discusses diagnostic strategies, surgical considerations, and preventive measures, emphasizing the importance of accurate localization to ensure safe removal and minimize neurological complications. Presentation of Case: A 31-year-old male patient was referred for removal of a fractured anesthetic needle located on the lingual aspect of the left mandibular ramus after unsuccessful retrieval attempts. Imaging examination revealed a 23.5 mm fragment positioned near the entrance of the mandibular canal, causing local paresthesia. Surgical removal was performed under local anesthesia and intravenous sedation using an image intensifier for real-time localization. The fragment was successfully removed without intraoperative complications. Discussion: Needle fracture during dental anesthesia is rare but potentially serious. Accurate localization is essential to prevent fragment migration and neurological injury. Imaging modalities such as CBCT and fluoroscopy play an important role in safe retrieval. Conclusion: The use of an image intensifier enabled precise localization and safe removal of the fractured needle, minimizing surgical risks and potential neurological complications.