Endovascular Extraction of a Needle from the Internal Carotid Artery: A Novel Approach to a Controversial Dental Misadventure

Abstract

Objective To review the literature concerning the management of dental needles broken off into the deep spaces of the neck, to report what we believe is the first case of a fractured dental needle migrating into the jugular foramen, and the unconventional use of endovascular intervention to retrieve the needle fragment. Design Case report with review of literature. Setting Academic tertiary care center. Participants Intervention was performed by the otolaryngology–head and neck surgery, vascular surgery, and neurovascular interventional radiology teams. Results Transoral exploration, including palatal split and exposure of the poststyloid parapharyngeal space with C-arm image guidance, was unable to retrieve the broken needle, which traversed the internal carotid lumen with the distal end entering the jugular foramen. Through endovascular intervention, the neurovascular interventional radiology team captured the proximal end of the needle and retrieved it through the femoral artery. The patient recovered uneventfully. Conclusion Fracture and loss of oral injection needles remain a persistent and preventable problem. This case demonstrates a novel, minimally invasive, well-tolerated, and successful method to extract a fractured needle that migrated into the lumen of the internal carotid artery at the level of the skull base.

A needle in a haystack: Report of a retained archwire fragment in the pterygomandibular space

“…Successful removal of the needle was ultimately accomplished with a microsnare and balloon catheter during a cerebral angiogram. 2 The anatomic location of the broken needle and its metallic nature somewhat parallels the incident described in the present case report.…”

“…Regarding management of embedded hypodermic needles, Giurintano et al reported that retrieval under general anesthesia is the current recommendation, noting that delay in retrieval can result in migration of the foreign object. 2 Intraoperative CT or fluoroscopy is recommended to guide surgical retrieval procedures. The lack of evidence of migration of the archwire fragment in the case of our first patient supports the surgeons' recommendation to not attempt retrieval at this time.…”

Needle fractures during mandibular block: prevention and emergency care algorithm

“…Лечение. На основании данных, полученных нами при обзоре литературы, лечение проводят двумя способами: 1) экстренная госпитализация; 2) наблюдение и последующее оперативное лечение [1,3,[9][10][11][12][13][14]. Преимущества того или иного метода нами выявлено не было, однако каждый из способов имеет право на применение.…”