Sir, we would like to bring this case report to the attention of your readers as a timely reminder to them of the small but significant risk of needle breakage during inferior alveolar nerve block. This has serious implications for the patient and practitioner.1

A 62-year-old male was referred to the local maxillofacial team by his dentist following the breakage of a dental needle in the pterygomandibular space while administering an inferior alveolar nerve block. Plain radiographs showed the presence of the needle high in the ramus.

The needle was electively removed under general anaesthesia. Surgical exploration of the pterygomandibular space was carried out with the aid of image intensification in theatre2 and the needle was found positioned medial to the lingual nerve (Fig. 1). Recovery was uneventful.

Figure 1
figure 1

The needle was found positioned medial to the lingual nerve

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Although needle breakage is rare, it can and does occur. Evidence shows breakage is most common during administration of an inferior alveolar nerve block with a short 30-gauge needle.3

Prompt referral to the maxillofacial team is essential due to the risk of needle migration into vital structures and also to minimise long term morbidity for the patient. Complications include trismus, pain, infection, and damage to the inferior alveolar and lingual nerves.1

To prevent needle breakage practitioners should use 27-gauge 35 mm needles for IAN block, avoid inserting to full length or burying the needle in the tissues, ensure patient cooperation thus avoiding sudden movements, and avoid bending needles or changing direction while still located deep in the tissues or exerting lateral pressure on withdrawal.3

Figure 2
figure 2

The 20 mm retrieved needle

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