Restor Dent Endod.  2012 Nov;37(4):232-235.

Hypoesthesia after IAN block anesthesia with lidocaine: management of mild to moderate nerve injury

• Moon S
• Lee SJ
• Kim E
• Lee CY

Abstract

Hypoesthesia after an inferior alveolar nerve (IAN) block does not commonly occur, but some cases are reported. The causes of hypoesthesia include a needle injury or toxicity of local anesthetic agents, and the incidence itself can cause stress to both dentists and patients. This case presents a hypoesthesia on mental nerve area followed by IAN block anesthesia with 2% lidocaine. Prescription of steroids for a week was performed and periodic follow up was done. After 1 wk, the symptoms got much better and after 4 mon, hypoesthesia completely disappeared. During this healing period, only early steroid medication was prescribed. In most cases, hypoesthesia is resolved within 6 mon, but being aware of etiology and the treatment options of hypoesthesia is important. Because the hypoesthesia caused by IAN block anesthesia is a mild to moderate nerve injury, early detection of symptom and prescription of steroids could be helpful for improvement of the hypoesthesia.

Keyword

Hypoesthesia; Inferior alveolar nerve block; Lidocaine; Local anesthetics; Medication

MeSH Terms

Anesthesia
Anesthetics
Anesthetics, Local
Dentists
Follow-Up Studies
Humans
Hypesthesia
Incidence
Lidocaine
Mandibular Nerve
Needles
Prescriptions
Steroids
Anesthetics
Anesthetics, Local
Lidocaine
Steroids

Figure

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  Figure 1 Mapping from the first visit after nerve injury indicates that the hypoesthesia was on the right mental nerve area.

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  Figure 2 Mapping at 5 weeks follow-up after the nerve injury. The hypoesthetic region was reduced compared to the first mapping.

Reference

1. Lichtor T, Mullan JF. A 10-year follow-up review of percutaneous microcompression of the trigeminal ganglion. J Neurosurg. 1990. 72:49–54.

2. Hillerup S, Jensen RH, Ersbøll BK. Trigeminal nerve injury associated with injection of local anesthetics: needle lesion or neurotoxicity? J Am Dent Assoc. 2011. 142:531–539.

3. Haas DA, Lennon D. A 21 year retrospective study of reports of paresthesia following local anesthetic administration. J Can Dent Assoc. 1995. 61:319–320. 323–326. 329–330.

4. Krafft TC, Hickel R. Clinical investigation into the incidence of direct damage to the lingual nerve caused by local anaesthesia. J Craniomaxillofac Surg. 1994. 22:294–296.

5. Dower JS Jr. Anesthetic study questioned. J Am Dent Assoc. 2007. 138:708. 710. author reply 710, 712.

6. Pogrel MA, Thamby S. Permanent nerve involvement resulting from inferior alveolar nerve blocks. J Am Dent Assoc. 2000. 131:901–907.

7. Pogrel MA, Bryan J, Regezi J. Nerve damage associated with inferior alveolar nerve blocks. J Am Dent Assoc. 1995. 126:1150–1155.

8. Haas DA. An update on local anesthetics in dentistry. J Can Dent Assoc. 2002. 68:546–551.

9. Reina MA, López A, De Andrés JA, Machés F. Possibility of nerve lesions related to peripheral nerve blocks. A study of the human sciatic nerve using different needles. Rev Esp Anestesiol Reanim. 2003. 50:274–283.

10. Garisto GA, Gaffen AS, Lawrence HP, Tenenbaum HC, Haas DA. Occurrence of paresthesia after dental local anesthetic administration in the United States. J Am Dent Assoc. 2010. 141:836–844.

11. Kirihara Y, Saito Y, Sakura S, Hashimoto K, Kishimoto T, Yasui Y. Comparative neurotoxicity of intrathecal and epidural lidocaine in rats. Anesthesiology. 2003. 99:961–968.

12. Gaffen AS, Haas DA. Retrospective review of voluntary reports of nonsurgical paresthesia in dentistry. J Can Dent Assoc. 2009. 75:579.

13. Omer GE Jr. Methods of assessment of injury and recovery of peripheral nerves. Surg Clin North Am. 1981. 61:303–319.

14. Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951. 74:491–516.

15. Seddon HJ, Medawar PB, Smith H. Rate of regeneration of peripheral nerves in man. J Physiol. 1943. 102:191–215.

16. Lagalla G, Logullo F, Di Bella P, Provinciali L, Ceravolo MG. Influence of early high-dose steroid treatment on Bell's palsy evolution. Neurol Sci. 2002. 23:107–112.

17. Austin JR, Peskind SP, Austin SG, Rice DH. Idiopathic facial nerve paralysis: a randomized double blind controlled study of placebo versus prednisone. Laryngoscope. 1993. 103:1326–1333.

18. Wray SH. Optic neuritis: guidelines. Curr Opin Neurol. 1995. 8:72–76.

19. Ramsey MJ, DerSimonian R, Holtel MR, Burgess LP. Corticosteroid treatment for idiopathic facial nerve paralysis: a meta-analysis. Laryngoscope. 2000. 110:335–341.

20. Seo K, Tanaka Y, Terumitsu M, Someya G. Efficacy of steroid treatment for sensory impairment after orthognathic surgery. J Oral Maxillofac Surg. 2004. 62:1193–1197.

21. Lewis MA, Sankar V, De Laat A, Benoliel R. Management of neuropathic orofacial pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007. 103:S32.e1–S32.e24.

22. Park JH, Lee SH, Kim ST. Pharmacologic management of trigeminal nerve injury pain after dental implant surgery. Int J Prosthodont. 2010. 23:342–346.