LA didn't work entire side of face became droopy and eye paralyzed like..couldn't get it to blink

[geni]

Hi! I have always been able to get LA before dental treatment and it worked great. However, my last two procedures the LA has failed. I am 36 years old so not certain of body changing has anything to do with it; however, my entire face became paralyzed like... having no control of the motions. My lip became droopy and my eye was tearing because I could not make it blink. I could, however, feel my tongue and my gums.

This has happened twice in the past year. I just don't understand why it isn't working, he tried three shots in the back and then even used the wand by the tooth several times. Could he have something new that he is using and that is why it doesn't work? I think it it time to find a new dentist, he even drilled into my gum line this time, which was minimally painful at the time (so I guess the LA was working somewhat); however, it is killing me now!

I appreciate any input! I don't want to have to go through this again!

 

[brit]

A dentist will be along shortly but here's a link to a couple of older threads on a similar subject:

LOST VISION DURING DENTAL WORK

Spoke to my periodontist today about extensive work that must be done to remove decay on the bone of 2 teeth above the gums. Very unpleasant and I am nervous. The problem I need answered is something he was concerned about. Many years back I saw a dentist that gave me Novacain that included...

www.dentalfearcentral.org

When it happened to me, I eventually changed dentists and subsequently had LA without any difficulty whatsoever (new dentist has 25 years experience). You shouldn't let them continue if you are not numb but it sounds like the follow-up injections with TheWand did work from what you said.

NB the first link works but the one to Mike's explanation does not any more for some reason.

 

[Gordon]

If it's happened that many times, your dentist seriously needs to have a look at their injection technique.

Like it says in that other post, the dentist has missed the inferior dental nerve which supplies sensation to the teeth and frozen the facial nerve, which supplies motor signals to the face. It can happen by accident occasionally, but multiple times is getting a bit careless I think.

 

[Zzzdentist]

From page 37 of Local Anesthetic Review by Dr. Anthony Mennito (ShhhHhhh... excerpt "borrowed" without permission)

Facial Nerve Paralysis
If the local is injected into the parotid gland, it will affect the facial nerve and the patient will notice facial drooping and will not be able to close their eye. If the needle is directed too posteriorly during an inferior alveolar nerve block or is over inserted during an Akinosi nerve block, the parotid gland may be anesthetized. Bone should be contacted before deposition of solution in the inferior alveolar nerve block to make sure the tip of the needle is not in the parotid gland. Inferior alveolar nerve anesthesia will not develop if the solution is in the parotid gland.

This is also self-limiting, and symptoms will diminish as the anesthetic effect wears off. The tear ducts in the eye will still function, but remove a contact lens if present. Explain the situation to the patient and give them the option of reinjecting and continuing treatment or postponing treatment until another day.

 

[DrMike]

Good responses from Gordon and zzz. It does sound like technique as Gordon says. It does happen from time to time - I've probably done it half a dozen times in my 10 years or so of doing blocks. I've not had it happen to the same person twice however! Usually we make sure that it will be away from the parotid gland by ensuring we feel a dull tap as we tap the bone of the mandible before injecting. Sometimes people's anatomy varies however and this can be difficult- I have cases occasionally where bone contact during a block can be difficult to achieve. (I've noticed that it sometimes seems to be especially difficult finding landmarks for the positioning of the injection in people who are overweight).

Also, as an inferior block can be uncomfortable - it is possible that your dentist (being aware of your anxiety), and having not felt the contact with bone, has injected anyway rather than put you through the discomfort of having to take the needle out and then reinsert it, or repositioning it. Really the best thing to do is get the contact and be sure it is going in the right place - but as you can see - that is not always as easy as it sounds.