dental-carpule type.

The dentist may have inadvertently injected the needle into the facial artery as it passes out Facial Anesthesia and of the mandibular notch and into the Paralysis Due to Intracheck musculature. Irritation from Arterial Injection of the needle and/or the neo-cobefrin Local Anesthesia caused a transitory spasm of the arA 40-year-old woman was given an tery, which accounts for the pain and inferior alveolar nerve block by her blanching in her upper lip area. While dentist in preparation for treating a such spasms may be relieved spontanecarious lower right first molar. The ously, the injection of a local anesdentist administered 1.8 ml. of mepi- thetic agent directly into the artery vacaine-HCl 2% with neo-cobefrin will give greater assurance of relaxa1: 20,000, through a non-aspirating car- tion. It was fortuitous that mepivapule-type syringe. Then, 0.2 ml. of caine was the drug being injected. The facial artery then carried the the same solution were injected into the mucobuccal fold adjacent to the solution through its branches (supefirst molar in order to block the buc- rior labial artery, angular artery, etc.) cinator nerve. The instant that the to give anesthesia of the anterior part second injection was given, 'the patient of the face. Branches of the facial experienced a momentary, "searing" nerve in that area were anesthetized pain in her upper lip, and the dentist as well, which accounts for the trannoticed a blanching at the corner of sitory facial paralysis. The angular arthe mouth. A few seconds later, a tery anastomoses with the infraorbital partial right facial paralysis developed, artery, ascends to the medial angle of with the patient unable -to close her the orbit and anastomoses with 'the right eye completely, or pucker her dorsal nasal branch of the ophthalmic lips, or to smile on the right side. artery, all of which accounts for the There was a numbness of the right anesthesia and paralysis around the side of the face. Examination of the eye region. Ecchymosis seen at the injection site mouth revealed an ecchymotic area at resulted from arterial leakage after the the site of the mucobuccal fold injecneedle was withdrawn. tion. About one hour later, normal This case points out the advantage sensation returned, and the paralysis of an using aspirating-type of syringe. disappeared. Discussion: The syringe used for ROBERT KAPLAN, D.D.S. this injection was a non-aspirating I. RUSSELL WEINSTEIN, D.D.S.

CASE REPORT

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