Transient facial nerve palsy following dental anaesthesia

Session Details

Session Title: Moderated Poster Session: A Bouquet of Topics

Venue: Poster Village: Pod 2

First Author: : J.Panthagani UK

Co Author(s): :    T. Jenyon   G. Moussa                    

Abstract Details

Purpose:

It is important for the Ophthalmologist to be aware of this rare complication following local anaesthetic infiltration in dental surgery due to management of corneal exposure that may ensue following a facial nerve palsy. Several underlying mechanisms have been described: 1. direct trauma from the needle 2. air blast during surgery 3. haematoma formation with subsequent compression of the nerve 4. infiltration of the peripheral branches of the facial nerve with local anaesthetic.

Setting:

New Cross Hospital, Wolverhampton, United Kingdom

Methods:

Case report on a 30-year-old, otherwise well female who underwent removal of 3 impacted wisdom teeth under general anaesthetic.  Towards the end of the procedure 1.7ml of bupivacaine local anaesthetic was infiltrated using a 27G needle to provide post-operative analgesia.

Results:

The patient was referred immediately by the dental team to the local eye unit for assessment. There was an isolated lower motor neurone 7th nerve palsy with significant lagophthalmos with a poor Bell's phenomenon. Ocular lubricants were prescribed and advice on managing the cornea. Photos were taken at presentation. Fortunately, there was a gradual improvement in facial expression after several hours and by the following day, full facial nerve function, including eyelid closure had returned.

Conclusions:

Most reported cases are of the immediate type with rapid recovery as was seen in our case. However, prolonged facial nerve palsy following dental surgery has been described.  Axonal ischaemia secondary to sympathetic stimulation (anaesthesia progress), reactivation of herpes virus or excessive stretching of the nerve from prolonged oral instrumentation have been suggested to be the cause in these cases. Therefore, there must be an appreciation of this complication following dental surgery by Ophthalmologists in order for adequate management.

Financial Disclosure:

None