7. Local Complications of Local Anesthesia

Question 1

Needle breakage

Etiology: unexpected movement

• avoid ____
• avoid ____ needles
• ____ rests

Problem: if unretrieved, lead to ____ and infection

Answer 1

bending
smaller
finger
scarring

Question 2

Needle Breakage

Prevention:
____ Needles
Don’t Advance to ____
Don’t ____ Once in Tissues Finger Rest

Management:
Keep Patient \_\_\_\_
Keep Mouth Open: Bite \_\_\_\_ 
If Visualized Remove with \_\_\_\_
If Unvisualized Do Not \_\_\_\_
or Make Blind Attempts 
Refer to Oral Surgeon

Answer 2

larger
hub
redirect
still
block
hemostat
probe

Question 3

Needle Breakage
If superficial- remove w ____
If deep - refer to ____ for consultation

Answer 3

hemostat

OMFS

Question 4

Pain on Injection
\_\_\_\_ Injection
\_\_\_\_ needle from multiple injections 
\_\_\_\_ needle from bone contact 
\_\_\_\_ trauma

Answer 4

rapid
dull
barbed
periosteal

Question 5

Burning on Injection
____ of anesthetic solution
____ injection (> 1.8 cc in 1 minute)
____ of cartridge

Answer 5

pH
rapid
contamination

Question 6

Persistent Anesthesia or Paresthesia

Trauma to ____ or nerve by needle
Injection at ____ with pressure from hematoma or edema
____ anesthetic solution

Answer 6

nerve sheath
foramen
contaminated

Question 7

Persistant Anesthesia/Parasthesia

Prevention:
Don’t speak carpules in ____ Adhere to protocol: ____

Management:
Most resolve ____
Examine and document affected areas for follow-up
Persistant anesthesia - consult ____

Answer 7

alcohol
aspiration
spontaneously
OS

Question 8

Paresthesia

Hyperesthesia = ____ sensitivity to ____ stimuli

Dysesthesia = ____ sensation to ____ stimuli

Answer 8

increased
noxious

painful
non-noxious

Question 9

Trismus (Difficulty in Opening Mouth)

Etiology:
\_\_\_\_ of muscles of mastication
\_\_\_\_ to muscles or blood vessels
\_\_\_\_
\_\_\_\_
large volumes of local \_\_\_\_

Answer 9

inflammation
trauma
infection
hematoma
anesthesia

Question 10

Trismus

“Prolonged, tetonic spasm of jaw muscles”

\_\_\_\_ of injection
\_\_\_\_ of anesthetic
Irritation of muscle from \_\_\_\_ solutions
\_\_\_\_
Post-injection \_\_\_\_

Answer 10

trauma
volume
contaminated
hemorrhage
infection

Question 11

Trismus

Problem:
Prolonged trismus can lead to ____
Most spontaneously ____

Prevention:
\_\_\_\_ needles 
\_\_\_\_ technique 
Aspirate
Minimal \_\_\_\_

Management:
____
____
Muscle Relants

Answer 11

hypomobility
resolve

sharp
aseptic
volumes

heat
NSAIDs

Question 12

Hematoma

Etiology:
Tear of artery or 
vein following \_\_\_\_ stick
injury of \_\_\_\_ bundle 
Occurs in potential \_\_\_\_ spaces

Problem:
____
Trismus
____

Answer 12

needle
NV
fascial
bruising
infection

Question 13

Hematoma

Prevention:
Know ____
____
____ number of injections

Management:
Immediate:
\_\_\_\_
\_\_\_\_ for 24 hrs. 
Time

Answer 13

anatomy
aspirate
minimize
pressure
ice

Question 14

Local Complications of Local Anesthesia

____ Tissue (Necrosis)
Self-____ soft tissue injury
____ nerve paralysis
____

Answer 14

sloughing
inflicted
facial
infection

Question 15

Infection

Etiology:
____
Introduction with ____ stick (contaminated needle)

Problem:
Spread of infection through ____ planes
____

Answer 15

rare
needle
fascial
trismus

Question 16

Infection

Infection:
____ needles
____ technique
Prepare tissues

Management:
\_\_\_\_
Frequent F/U 
Unresolving infection:
Refer to \_\_\_\_ Surgeon

Answer 16

disposable
aseptic
antibiotics
oral

Question 17

Lip/Tongue Biting

Etiology: local ____ damage
secondary to anesthesia: ____

Problem:

• ____
• pain

Answer 17

tissue
children
swelling

Question 18

Lip/tongue biting

Prevention:
____ acting anesthetics
Patient and parent ____

Management:
____
Rises
____ of lips

Answer 18

short
education
analgesics
lubrication

Question 19

Facial Nerve

Facial nerve trunk is ____ cm (1.5 to 2.8 cm) inferior to lowest concavity of bony ____

Answer 19

2.3

external auditory canal

Question 20

Facial nerve crosses the ____ 0.8 to 3.5 cm from the anterior margin of the bony ____

Answer 20

zygomatic arch

external canal

Question 21

Ophthalmologic Complications of Local Anesthesia

```
Loss of ____
____ (diplopia
____
____
“red eye”)
~~~

Answer 21

corneal reflex
ophthalmoplegia
ptosis
conjunctival dilation

Question 22

Oral lesions

Etiology:
Local ____ to anesthetic or topical
Local ischemia from ____ (palate) Prolonged pressure

Problem:
____ loss
____

Answer 22

allergy
vasoconstrictor
tissue
pain

Question 23

Oral Lesions

Prevention:
limit ____
avoid drugs w history of ____
avoid over ____ of tissues

Management:
____
____ Anesthetic (Orabase)

Answer 23

vasoconstrictors
atopy
inflation
rinses
topical

Question 24

Post-anesthetic complications

• apthous ulceration - ____
• herpetic ulceration - activates latent ____ in ____

Answer 24

autoimmune
virus
dorsal ganglia