Needle entrance into the maxillary sinus during retrobulbar anesthesia

Three patients are presented to whom an accidental needle entrance into the maxillary sinus occurred during retrobulbar anesthesia. In all cases air was aspirated during the aspiration check at the end of needle advancement, and the patients reported a bitter taste after the injection of a small quantity of anesthetic. After withdrawal and careful reinsertion of the needle, maxillary sinus entrance was avoided and a successful retrobulbar block was achieved. Two of the patients had no history of previous facial trauma or surgery, whereas the third had suffered a recent blowout fracture of the orbital floor. The authors suggest that air aspiration or anesthetic passage into the pharynx during retrobulbar anesthesia should raise the suspicion of maxillary sinus entrance, even in patients without any history of facial trauma or surgery. The early recognition of sinus entrance can prevent retrobulbar block failure and reinjection of a second anesthetic dose.