Abstract
Objective To review the literature concerning the management of dental needles broken off into
the deep spaces of the neck, to report what we believe is the first case of a fractured
dental needle migrating into the jugular foramen, and the unconventional use of endovascular
intervention to retrieve the needle fragment.
Design Case report with review of literature.
Setting Academic tertiary care center.
Participants Intervention was performed by the otolaryngology–head and neck surgery, vascular
surgery, and neurovascular interventional radiology teams.
Results Transoral exploration, including palatal split and exposure of the poststyloid parapharyngeal
space with C-arm image guidance, was unable to retrieve the broken needle, which traversed
the internal carotid lumen with the distal end entering the jugular foramen. Through
endovascular intervention, the neurovascular interventional radiology team captured
the proximal end of the needle and retrieved it through the femoral artery. The patient
recovered uneventfully.
Conclusion Fracture and loss of oral injection needles remain a persistent and preventable problem.
This case demonstrates a novel, minimally invasive, well-tolerated, and successful
method to extract a fractured needle that migrated into the lumen of the internal
carotid artery at the level of the skull base.
Keywords
skull base - endovascular - dental needle - internal carotid artery
