IUBio

Dental injection & facial nerves? (Was: Re: Facial Nerve Damage)

Joel M. Eichen joele at earthlink.net
Fri Jan 1 14:59:05 EST 1999


"spacey"

Can be due to epinephrine 1:100,000 or 1:50,000 which when
inadvertently injected into a vein can cause vaso-vagal syncope.
(Light-headedness and fainting - physiologic response).

Can also be due to an injection of anything including sterile water in
a patient with very low blood pressure and a low tolerance for this
kind of stuff.

Patient profile includes female, light-complected, and submerged
(passive) reactivity to stimuli. Usually a history of this response is
present.

So various physiologic and psychogenic stimuli can produce a "spacey"
response, if this is what you are referring to.

As for "allergy," its extremely rare. This is called "anaphylactic
reaction" and "spacey" does not apply. Urticaria, hives, etc does
apply. This is a very dangerous condition.


Cheers,

Joel

Joel M. Eichen, D.D.S.

----------


flefever at ix.netcom.com(F. Frank LeFever) wrote:


>I don't know much about this area, but besides the possibility of some
>specific/localized nerve damage related to specific site of injection,
>another angle too consider is propensity of local anesthetics (cocaine,
>procaine, et al.) to provoke seizure activity, and possible
>explanations of symptoms in terms of "partial continual epilepsy". 
>People vary in susceptibility to this effect.  I myself feel a bit
>"spacy" with lidocaine, I believe.

>F. Frank LeFever, Ph.D.
>New York Neuropsychology Group



>In <915203224.961121 at mnementh.southern.co.nz> Brian Sandle
><bsandle at southern.co.nz> writes: 
>>
>>I thought to follow up to the Brain stem thread, but maybe this
>article 
>>has vague relevance here.
>>************************
>>X-URL:
>http://neuro-www.mgh.harvard.edu/forum/TrigeminalNeuralgiaF/NumbSeizure
>afterAnesthet.html
>>
>>
>>                        Numb & Seizures? after Anesthet
>>                                       
>>   
>>    This response submitted by Brian Sandle on 1/1/99.
>>    Email Address: bsandle at southern.co.nz
>>    
>>   First dental anesthetic 1970s affected face to hair line. Avoided
>>   injections. Less touch senstive patch under left1ear around mid
>1980s.
>>   Had eighth nerve test O.K. New dentist 1993 insists on injections.
>>   Told him I feel seizure like for some days. Still insists. Left
>side
>>   of face not so tickle sensitive. Recent injection surprises with
>>   sudden rush of wrong feeling to left forehead. Even left eye tired
>now
>>   9 days later after upper 6th molar root dressing. Feel a bit jerky
>>   trying to right sensation. Anesthesia damage as1when diabetics'
>nerves
>>   hurt? TN? Thalamus? sci.med.dentistry before.
>>*********************************   
>>It is not very uncomfortable, but I don't want it to get worse if
>possible.
>>*********************************
>>   Re: RFI: tongue still numb 2mo after anaesthetic  more options
>>   
>>   Author:   Brian Sandle
>>   Email: bsandle at southern.co.nz
>>   Date: 1997/03/25
>>   Forums: sci.med.dentistry
>>   
>>Dr.W.Lee (docle at idirect.com) wrote:
>>: In article <5gl87q$f89 at news.istar.ca>, agwyvern at istar.ca says...
>>: >
>>: >I had a crown lengthening done recently (January) on teeth 36, 37,
>38
>>: >(Canadian numbering system: lower left, back 3 teeth). My dentist
>>: >administered anaesthetic by needle (I don't know the name) to a few
>>: >locations. Unfortunately, my understanding is that on one of the
>>: >applications the needle met a nerve dead-on: it felt like a wave of
>fire
>>: >in my mouth.
>>: >
>>: >At this point, I still have a numb sensation along the left side of
>my
>>: >tongue from the 38 location right to the tip (the tip only started
>going
>>: >numb a few days ago).
>>: >
>>: >Does anybody have any idea what actually could have happened here
>and
>>: >will the sensation likely disappear?
>>: >
>>: >Thanks in advance for any info you can supply.
>>: >
>>: >agwyvern at istar.ca
>>:
>>: The needle has likely touched upon the lingual nerve during the
>administratio
>>n
>>: of the anaesthetic.  While trying to inject the anaesthetic as close
>as
>>: possible to the nerve, it's quite possible that the tip of the
>needle had com
>>e
>>: in contact with the nerve.  But you shouldn't worry.  I've never
>heard of a
>>: case where there was a permanent nerve damage from a needle
>injection in the
>>: mouth.  I had a patient who had same symtoms as you (after a routine
>procedur
>>e
>>: involving anaesthetic) that lasted about a month then sensations
>completely
>>: returned.  If the problem lasts more than six months, it may be
>possible that
>>
>>: the nerve had been damaged by the surgical procedure rather than the
>needle.
>>:
>>: Dr.W.Lee DDS
>>:
>>But the fact that the deadness is increasing must be a worry.
>>
>>Can an injection lead to a small stroke in any patient, perhaps blood
>>pressure prone or prone to blood clots?
>>
>>How would it be known whether a clot is local to the tongue nerve or
>more
>>in the brain?
>>
>>I would like to suggest the following research:
>>
>>Do a neurological map of tickle, pressure and warmth senstivity of
>>several areas of the patients' heads and mouths several times before
>and
>>after anaesthesia.
>>
>>Should the patient be checked for thrombosis?
>>
>>Brian Sandle
>>****************************
>>
>>   Anesthesiology 1992 Nov;77(5):941-7
>>   
>>Local anesthetic-induced conduction block and nerve fiber injury in
>>streptozotocin-diabetic rats.
>>
>>    Kalichman MW, Calcutt NA
>>    
>>   Department of Anesthesia, Veterans Administration Medical Center,
>San
>>   Diego, California 92161-9151.
>>   
>>   Patients with diabetes may have peripheral neuropathy, which may
>have
>>   clinical implications for the use of regional nerve block. The
>effects
>>   of local anesthetics on nerve conduction and nerve fiber injury
>were
>>   tested in control rats and at 4 weeks after the onset of diabetes
>in
>>   rats injected with streptozotocin (50 mg/kg intraperitoneally).
>Nerve
>>   conduction was assessed by recording evoked electrical activity in
>>   hindpaw muscles following ipsilateral electrical stimulation of the
>>   sciatic nerve near the hip. Block of motor nerve conduction was
>>   quantified by recording the amplitude of the evoked response at
>1-min
>>   intervals for up to 15 min after the injection of 500 microliters
>1%
>>   lidocaine HCl or procaine HCl into the midthigh next to the sciatic
>>   nerve. In control animals, procaine was much less effective than
>>   lidocaine in producing conduction block. The rate and magnitude of
>>   lidocaine-induced conduction block were not significantly different
>>   between control and diabetic groups. However, conduction block due
>to
>>   procaine was sufficiently enhanced in diabetic rats to become
>>   comparable to that of lidocaine-treated control nerves.
>Long-lasting
>>   injury was assessed in sciatic nerve harvested 2 days after the
>>   extraneural injection of saline or 2 or 4% lidocaine HCl. Using a
>>   light microscope with a superimposed grid, nerve edema was
>quantified
>>   as the proportion of intersection points falling on extracellular
>>   space. Lidocaine induced edema in both control and diabetic nerves,
>>   but 4% lidocaine induced significantly more edema in diabetic
>nerves
>>   than in controls. Nerve fiber injury, based on light microscopic
>>   scoring of axonal degeneration and demyelination, was not observed
>in
>>   saline-treated nerves.
>>   
>>   Comments:
>>     * Comment in: Anesthesiology 1993 Apr;78(4):799-800
>>       
>>   PMID: 1443749, UI: 93073081
>>**************************
>>
>>Krakatoa <stephan at nospam.ucla.edu> wrote:
>>: In article <76e2gm$a00$1 at nnrp1.dejanews.com>, tamuller91 at hotmail.com
>wrote:
>>
>>:> I saw a neurologist about some numbness in the tip of my nose and
>upper lip
>>:> after being rear-ended in a car accident about a month ago.  He
>seemed
>>:> unconcerned and was satisfied with waiting another month to see if
>it got
>>:> better or worse (it hasn't changed since the accident), but I'm
>not!!  He
>>:> seemed to doubt whether or not it was a results of the accident
>(no, I didn't
>>:> hit my face on anything, I just got a good slam into the headrest
>at a torqued
>>:> angle.  My car was totalled).   I was slowing to a stop, leaning
>forward and
>>:> looking right when I was hit from behind.  I think I should insist
>on an MRI.
>>:> Anyone else have any other suggestions?  And... what exactly does
>an MRI do to
>>:> you, anyway?
>>:> 
>>:> Thanks for your help.  (I'm very scared about this!).
>>:> 
>>:> T.A. Muller
>>:> 
>>:> -----------== Posted via Deja News, The Discussion Network
>==----------
>>:> http://www.dejanews.com/       Search, Read, Discuss, or Start Your
>Own    
>>
>>: It is extremely unlikely an MRI would reveal anything. It is also
>unlikely
>>: any insurance company will cover the $3000+ cost either, unless they
>are
>>: in the Christmas spirit.
>>
>>: If the symptoms are caused by neurological damage it is probably
>quite
>>: mild, which is the main reason an MRI would be useless (of course,
>knowing
>>: there is damage there would also be useless anyway, since there is
>nothing
>>: you could do about it). MRIs are useful if you need to identify and
>>: localize substantial damage.  Even then, this information is only
>useful
>>: if you plan on doing something about it (like surgery for a tumor or
>>: hematoma); in your case, any surgery would likely make it worse,
>since the
>>: symptoms are mild.   Most likely, if the cause is neurological, it's
>>: caused by minor nerve damage or inflammation which will often
>dissapear as
>>: peripheral nerves are repaired or inflammation goes away.
>>
>>: So my 2c worth would to wait and hope it goes away. If you are not
>>: experiencing pain, this is the most important thing, and virtually
>>: anything you do about it may lead to pain, which is much worse than
>a loss
>>: of sensation...
>>
>>: Good luck and don't be afraid! if you lasted a month you will be
>fine.
>>
>>: Stephan
>>







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