Abducens Nerve Palsy. An uncommon complication of removal of an upper wisdom tooth under local anaesthesia. (13th April 2020)

• Record Type: Journal Article
• Authors: Darwish, S.; Patel, A.; Steed, P.; Stagnell, S.
• Is Part Of: Oral surgery. Volume 13:Number 3(2020:Aug.)
• Page Start: 260
• Page End: 267
• Publication Date: 2020-04-13
• Subjects: anatomy -- complications -- ectopic tooth -- local anaesthesia -- wisdom tooth; Mouth -- Surgery -- Periodicals; 617.522059
• DOI: 10.1111/ors.12484
• Languages: English
• ISSNs: 1752-2471

Abstract

Abstract: Local anaesthetic is a key tool for all dentists in achieving painless treatment. Many complications have been reported secondary to a dental local anaesthetic, however those pertaining to the orbit and ocular muscles have been infrequent. This article describes three incidents when inadvertent abducens nerve palsy secondary to a dental local anaesthetic occurred during removal of an upper wisdom tooth, resulting in paresis of the lateral rectus muscle and diplopia. The patients were reassured and managed conservatively and there were no long‐term complications. The anatomical course of the abducens nerve from its origin to the lateral rectus muscle are discussed as well as potential mechanisms for the dental local anaesthetic to impact upon the nerve. Finally, following input from Opthalmology colleagues, recommendations for appropriate management are made to ensure a good outcome.