Needle breakage may be a damaging experience for both medical practitioners and patients. Medical literature provides numerous cases of dental practitioners being confronted with this problem. We have studied the clinical case of the patient L. at the Moscow State University of Medicine and Dentistry involving needle breakage during conductive anesthesia. We propose our medical approach to solving this issue alongside with a desirable course of action, providing additional recommendations and suggesting intraosseous anesthesia as a safer type of pain management.
Отлом иглы может быть выраженным негативным опытом для практикующего врача и пациента. По данным изученной литературы многие практикующие врачи-стоматологи встречаются с этим осложнением. Мы проанализировали клинический случай пациента в МГМСУ им. А.И. Евдокимова с мигрировавшим отломком иглы при методе проводниковой анестезии. Предложили тактику поведения врача в данной клинической ситуации и алгоритм действий. Разработали рекомендации и предложили внутрикостную анестезию как более безопасный вид обезболивания. Проанализировали легкость извлечения отломка инъекционной иглы из костной ткани тела нижней челюсти методом внутрикостной анестезии и оценили отсутствие способности к миграции.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is recommended for the diagnosis of mediastinal lymph nodes by the American College of Chest Physicians guidelines; however, the guidelines state that this procedure should only be performed by a trained bronchoscopist. Complications related to needle malfunction during the EBUS-TBNA procedure have recently been reported. We herein describe a rare case involving the successful management of a needle breakage that occurred as an unusual complication of EBUS-TBNA. An 81-year-old male patient with a medical history of myocardial infarction was introduced to our institution to undergo an evaluation for mediastinal and right hilar lymphadenopathy on chest computed tomography (CT). We performed EBUS-TBNA in a 14×10 mm subcarinal lymph node station using a 22 G aspiration needle (NA-201SX-4022, Vizishot®, Olympus, Japan) for diagnosing and staging of the patient\'s lung cancer. After the second aspiration, we noticed that the needle tip was broken and that it was stuck in the right main bronchus. We immediately removed the broken needle tip from the right main bronchus by flexible bronchoscopy using an ID 8.5 mm tracheal tube without cuff inflation. The length of the needle tip was 13 mm and it was considerably bent. The EBUS scope did not suffer any apparent damage. The patient did not have any other procedure-related complications. Needle breakage during EBUS-TBNA is rare; however, inhaling or swallowing of a broken needle tip has the potential to cause serious complications. Bronchoscopists should therefore be aware of the possibility of needle breakage, which is an important complication during EBUS-TBNA.

OBJECTIVE: The aim of this study was to evaluate factors associated with the needle breakage of antegrade suture passer and the effect of intratendinous remnant needle tip on clinical outcomes after rotator cuff repair.
METHODS: We retrospectively reviewed 283 patients (138 men and 145 women; mean age: 59.7 ± 9.3 years) who underwent arthroscopic repair for full-thickness rotator cuff tear. We evaluated the characteristics of 16 patients in whose needle tip had been broken and embedded and remained in the rotator cuff (remnant needle group) and compared them with the remaining 267 patients (control group). Afterwards, another 64 patients were selected from control group (1:4 matching) after propensity score matching (PSM). The groups were compared anatomically with MRI or ultrasonography and functionally (serial pain VAS and ROM; ASES, Constant, UCLA and SST scores) at a minimum follow-up of 1 year.
RESULTS: The remnant needle group showed preoperative thicker tendon (6.72 mm vs 5.33 mm, p = 0.047), higher tendinosis (mean grade, 1.88 vs. 1.43, p = 0.029), and more frequent delaminated tears (p = 0.035) compared with control group. When we compare the clinical outcomes after PSM, the initial pain VAS of the remnant needle tip group was higher up to 3 months (pain VAS: 4.13 ± 2.07 vs 2.48 ± 1.61 (p = 0.032) at 5 weeks and 3.79 ± 2.12 vs 2.25 ± 1.76 (p = 0.044) at 3 months), however the difference disappeared after 6 months postoperatively. In final evaluation, there was no significant differences in every outcome parameters (all p > 0.05).
CONCLUSIONS: Breakage of the needle of the antegrade suture passer occurred more frequently in the thicker tendon, higher tendinosis, and delaminated tears. The retained broken needle tip was associated with higher pain scores during the early postoperative period, but revealed no difference in final outcomes by using PSM.
METHODS: Level III, Therapeutic Study.

Needle breakage when administering local anesthetic in the oral cavity can be of major concern to both the patient and the dentist. Intraoperative navigation has become the most popular advanced imaging technique.
In this report, the authors describe a case of needle breakage during inferior alveolar nerve block for a dental procedure. Using preoperative imaging, the authors located the needle and removed it while the patient was under general anesthesia. The authors review studies and case reports similar to the pre- and intraoperative imaging modalities presented in their report.
Preoperative 3-dimensional imaging is sufficient for establishing the exact location of the broken needle, especially in cases in which potential migration is unlikely.

OBJECTIVE: The aim of this publication is to provide a concept for prevention and a standardized step-by-step clinical approach to this rare but serious and potentially preventable complication of dental local anesthesia.
METHODS: We collected data with a PUBMED search using the key words \"local anesthesia,\" \"dental anesthesia/anesthesia\" OR \"mandibular block anesthesia,\" \"complication,\" \"hypodermic needle,\" \"needle breakage\" OR \"needle fracture,\" and \"foreign body AND removal\" OR \"retrieval.\" The existing literature was systematically evaluated from 1980 to date using Microsoft Excel 2007 (Microsoft Corporation).
RESULTS: After analysis of the literature, we included 36 reports documenting 59 needle breakage events and defined possible risk factors and preventive measures. All relevant reported parameters were listed in tabular form. The main result of this article is a treatment algorithm for this complication.
CONCLUSIONS: Prevention of a needle fracture should be the main goal during local dental anesthesia. Use of longer hypodermic needle can obviate complex retrieval surgery. If immediate removal of the fragment fails, localization, planning, and the necessary surgical procedure should be arranged promptly.
CONCLUSIONS: Following a strict algorithm, successful surgical handling of this complication will depend on minimizing risk and following treatment recommendations closely.

BACKGROUND: Needle breakage during the administration of dental analgesia is an extremely rare event.
METHODS: A case of needle breakage during the administration of an inferior alveolar nerve block occurred in a child with KBG syndrome. During the injection, a sudden movement of the child caused the breakage of the needle. The next day, the retrieval of the needle was performed surgically under general analgesia.
RESULTS: Three months after the surgery the healing was good. Two years later the child underwent a dental extraction with the aid of nitrous oxide/oxygen analgesia/anxiolysis.
CONCLUSIONS: Needle fracture is a possible event during the administration of dental analgesia in children.