Description of Event or Problem · 1
10/14/96 CALLED BY DR EARLIER THIS MORNING: HE REPORTS THAT HE HAS A PT WHO WAS UNDERGOING ROUTINE DENTAL LOCAL ANESTHESIA (LEFT INFERIOR ALVEOLAR NERVE) THIS MORNING (FOR A ROUTINE DENTAL PROCEDURE), WHEN NEEDLE ATTACHED TO SYRINGE BROKE DURING INJECTION. DR REPORTS NO DEVIATION FROM HIS REGULAR ROUTINE FOR DENTAL INJECTIONS, & HE STATES THAT HE HAS NEVER HAD THIS HAPPEN BEFORE. DR EXPRESSED APPROPRIATE CONCERN FOR THIS PT, & HAS ASKED TO SEE HIM AS SOON AS POSSIBLE. SURGEON WILL WORK THIS PT INTO HIS ALREADY BUSY SCHEDULE THIS AFTERNOON (AS SOON AS POSSIBLE). 10/14/96-A 46 YR-OLD WHITE MALE, PRESENTS AS A REFERRAL FROM DR FOR EVAL & TREATMENT OF A BROKEN NEEDLE, WHILE GIVING A LEFT INFERIOR ALVEOLAR NERVE BLOCK EARLIER TODAY. PT PRESENTS SOMEWHAT APPREHENSIVE, & IS EXPRESSING CONCERN OVER NEED FOR HAVING NEEDLE TIP REMOVED. PAST MED HISTORY HE REPORTS AS UNREMARKABLE (HE DENIES ANY HISTORY OF CARDIAC, PULMONARY, HEPATIC VASCULAR, GASTRO INTESTINAL, RENAL, OR HEPATIC PROBLEMS), +20-30 PACK/YR SMOKER; HE TAKES NO REGULAR MEDICATIONS, & HAD NO KNOWN DRUG ALLERGIES. EXAMINATION: NC/AT; APPREHENSIVE WHITE MALE IN "NAD". FOCUSED ORAL EXAM REVEALS + PUNTURE SITE IN LEFT POSTERIOR PTERYGOMANDIBULAR RAPHE REGION (PRESUMABLY SITE OF INJECTION). PT DOES HAVE SOME REMAINING MILD DEGREE OF ANESTHESIA, & SOME SLIGHT DEGREE OF TRISMUS (DUE TO SOARNESS). SURGEON THINKS THAT HE CAN PALPATE END OF NEEDLE IN TISSUES. RADIOGRAPHIC EXAM: PANORAMIC RADIOGRAP[HIC EXAM SHOWS + APPROX 20MM RETAINED METALLIC STRUCTURE, AT LEVEL OF MID RAMUS OF LEFT MANDIBLE, PRESUMABLY RETAINED NEEDLE TIP. PA & LATERAL CEPHALOMETRIC FIRMS ALSO SHOW RETIANED NEEDLE TIP LOCATED IN BEFORE MENTIONED REGIONS, WITH PA FILM ISOLATING TIP OF MEDIAL ASPECT OF MANDIBLE (WHICH IS EXPECTED LOCATION FOR THIS TYPE OF INJECTION). ASSESSMENT: 46 YR-OLD WHITE MALE WITH RETAINED FOREIGN BODY (DENTAL INJECTION NEEDLE) IN LEFT PTERYGOMANDIBULAR SPACE (NEEDLE BROKE OFF WHILE REFERRING DR WAS GIVING ROUTINE LEFT INFERIOR ALVEOLAR INJECTION). PLAN: SUREGON THINKS THAT HE CAN FEEL TIP OF THIS NEEDLE FAIRLY SUPERFICIAL TO ORAL MUCOSA, DR HAS OFFERED TO THIS PT OPTION OF PROCEEDING TODAY WITH ATTEMPTED REMOVAL OF THIS NEEDLE TIP UNDER LOCAL ANESTHESIA IN OFFICE. PT REFUSED, HOWEVER, STATING THAT HE IS APPREHENSIVE, & WOULD PREFER THAT PROCEDURE BE PERFORMED IN HOSP UNDER GENERAL ANESTHESIA. SURGEON SEES NO PROBLEM WITH DOING THIS, EXCEPT FOR FACT THAT THIS MANEUVER MAY DELAY RETRIEVAL OF THE OBJECT FOR 1-2 DAYS. SURGEON WILL GO AHEAD & MAKE NECESSARY ARRANGEMENTS FOR REMOVAL OF OBJECT UNDER GENERAL ANESTHESIA. SURGEON HAS SPENT MUCH TIME WITH THIS PT DISCUSSING POTENTIAL BENEFITS & RISKS OF PROPOSED PROCEDURE. ALTERNATIVE TO ABOVE PROCEDURE IS LIMITED-IF HE LEAVES FOREIGN BODY IN PLACE, SURGEON ANTICIPATES THAT HIS TRISMUS WILL WORSEN, THE POTENTIAL FOR INFECTION WILL REMAIN AS LONG AS NEEDLE IS ALLOWED TO BE LEFT INTACT.