Surgical Retrieval of a Broken Local Anesthetic Needle in the Pterygomandibular Space Using CBCT and C-Arm Guidance

Background and Clinical Significance: Needle fracture during inferior alveolar nerve block is a rare complication, but it can nevertheless result in serious complications, especially when the fragment migrates into deep anatomical spaces like the pterygomandibular region. Accurate localization and safe retrieval are vital in preventing infection, chronic pain, neurovascular injury, and long-term functional impairment. Case Presentation: We present a case of a 27-year-old patient who had a fractured needle fragment from a local anesthetic procedure retained in the left pterygomandibular space. Cone beam computed tomography (CBCT) was carried out to verify the presence of the metallic foreign body and to define its exact three-dimensional position in relation to adjacent bone and soft tissue landmarks. The approach was transoral, and the surgery was done under general anesthesia. During the surgery C-arm fluoroscopy was used to help guide localization and retrieval, along with the help of radiopaque reference markers to assist in determining the trajectory. The fragment was removed without any issue. After the surgery, the patient's condition improved well, and he showed no signs of functional deficits. Conclusions: The management of broken needle fragments in the pterygomandibular space can be safely and effectively done using a combination of preoperative CBCT and intraoperative C-arm guidance. This technique allows for exact location determination, minimizes unnecessary dissection of the tissue, and will make the surgery safer in complicated areas.