下顎後牙區局部浸潤性麻醉時斷針之處置－病例報告

Management of Needle Breakage during Infiltrating Anesthesia of the Posterior mandible-case Report

鄭仁昌(Jen-Chan Cheng) ； 陳元武(Yuan-Wu Chen) ； 夏毅然(Yi-Jan Hsia)

《中華牙醫學雜誌（中文版）》 1卷1期 (2005/03) Pp. 47-53

https://doi.org/10.7106/CJD.200503.0047

摘要

由於目前使用拋棄式麻醉針頭，使得在施行口內注射麻醉劑時，發生斷針的情況已降低很多，但如果針頭製造品質不良、器械使用不當、操作技巧不純熟以及病人的過度反應等情形之下，仍然會有斷針的可能發生。根據文獻報告記載，牙科麻醉針頭斷針的情形多發生於在施打下顎神經阻斷麻醉時。本病例為一31歲男性，在牙科診所接受技牙手術時，牙醫師施行下顎後牙區局部浸潤性麻醉時發生針頭斷針，然後轉介至本院接受治療。在電腦斷層掃描定位及全身麻醉下，成功將斷裂針頭取出。術後並無神經麻木及感染現象，亦無張口受限情況。本篇報告的主要目的除了敘述當斷針發生時我們應如何處理斷針的情況，再加以分析臨床上造成斷針的原因，以期爾後能減少此狀況之發生。發生斷針原因可能是使用較小的針頭及不當彎曲針頭所造成。一但發生斷針時，及時取出斷裂針頭是必要的。如果針頭已陷入深層組織，可利用電腦斷層掃描來定位斷裂針頭的位置。建議在全身麻醉的狀況下，去除不利手術的環境因素，方便醫師以手術方式取出斷裂針頭。

關鍵字

斷針 ； 局部麻醉 ； 下顎

並列摘要

The use of modern disposable needles has made breakage during local dental anesthesia rare, with the problem being largely restricted to needles of poor quality and situations of improper manipulation, unskilled technique, or sudden unexpected movement by the patient. According to available reports, breakage of dental anesthetic needles mostly occurs during mandibular block anesthesia. In May 2003, a needle broke while a 31-year-old man was undergoing local infiltrating anesthesia for extraction of tooth #38 at a local dental office, and he was referred to our hospital for help. After a CT scan to determine the exact location of the broken needle, it was removed under general anesthesia. There was no paresthesia, infection, or limitation of mouth opening after surgery. The goals of this paper are to describe how a dentist and oral surgeon efficiently removed the broken needle and to analyze the reasons for needle breakage in order to reduce the incidence in clinical practice. The probable reasons for breakage in this case were usage of a small (30-gauge) needle and improper bending of the needle. Once a needle breaks, it is necessary to remove it as soon as possible. If the broken needle is submerged in deep tissue, a CT scan is a proper aid for locating it. An oral and maxillofacial surgeon can then remove the broken needle under general anesthesia.

並列關鍵字

injection needles ； local anesthesia ； mandible