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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2017; 78(03): e106-e108
DOI: 10.1055/s-0037-1604282
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Endovascular Extraction of a Needle from the Internal Carotid Artery: A Novel Approach to a Controversial Dental Misadventure

Jonathan P. Giurintano
1   Department of Otolaryngology–Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Jessica Somerville
1   Department of Otolaryngology–Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Merry Sebelik
2   Department of Otolaryngology–Head & Neck Surgery, Emory University, Atlanta, Georgia, United States
,
Daniel Hoit
3   Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
L. Madison Michael III
3   Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Courtney B. Shires
1   Department of Otolaryngology–Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
› Author Affiliations
Further Information

Publication History

23 November 2016

08 May 2017

Publication Date:
23 August 2017 (online)

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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
 

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