Pt. Has twitching eye after NSRCT #12

[HatInTheCat]

Hi everyone,

D3 here.
I completed RCT on #12 a couple weeks ago, and my pt. has a CC two weeks later of “his eye is twitching” on the ipsilateral side of injection and his eye has not stopped since the day of the procedure

Pt. Reports no allergies, med hx is remarkable, denies social use of alcohol, drugs and tobacco. BP is in elevated range and has no hx of surgeries.

Dental hx: pulpitis and symptomatic apical periodontitis on #12 and several various lesions upon clinical exam. No sinus tract present near site of 12. Probing depths were normal. Radiographically, no bony pathology. Anatomical landmarks WNL. #12 showed no PARL radiographically.

Prior to RCT, I delivered 1/2 carpule of 2% lido w/ 1:100k epi via maxillary infiltration above #12. Aspiration: neg. Pt. was anxious during tx and hated the smell of NaOCl.

Pt. Wore all PPE including safety goggles. Positively sure there was no spill of anything into his eyes.

Post op xrays showed no extrusion of gutta percha out of the apical foramen.

Here are all my differential dx’s:
Needle pierced part of the branch of the facial nerve that controls Orbicularis oculi

False negative aspiration, which needle may have hit an artery that anastomoses with infraorbital artery.

Pt. May have developed symptom independently of procedure?

Pt. may have ester allergy. Prior to that procedure, I completed a filling before and he said he was sore at the site of injection for a few days, which isn’t abnormal for some patients.

The patient reported no issues prior to leaving the chair pertaining to discomfort, nor did he report any symptoms to me that night after the procedure.

I have acknowledged to the patient that I am concerned about his complaint and will have some answers to him shortly, but I need help on how to handle this situation and would like to learn as much as I can regarding communicating back with the patient.

Thanks!


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[gumtee]

Has this resolved? I doubt it’s anything major or even related

 

[FutureDent020]

Most likely stress related or due to lack of sleep. Pt could have been overly stressed about the procedure or just other life events. It is the holidays...It will resolve.

 

[FutureDent020]

And even if it was something iatrogenic, it will resolve. Hitting a nerve with a syringe “could” cause parasthesia or temporary nerve damage. Usually it wouldn’t even do that. It doesn’t cause “twitching”.

 

[omfsing]

You probably hit the infraorbital nerve and now patient had some paresthesia s from the injection possibly due to some neuropraxia to the nerve, and thus patient may have subjective feeling of “twitching.” However, it’s hard to fully comment without examining the patient.

 

[HatInTheCat]

Most likely stress related or due to lack of sleep. Pt could have been overly stressed about the procedure or just other life events. It is the holidays...It will resolve.

Yeah, so I talked to the patient. Mentioned to him that attempting to rest a bit more may help him. Haven’t heard anything from him since that conversation. But I’ll see him in January to place a crown on the tooth, so I’ll follow up then. Thanks !


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[HatInTheCat]

Update: got the patient back in the chair and interviewed him for a bit. He kept palpating their infraorbital foramen above the eye and reported his twitches were not spontaneous. Looks like the patient over exaggerated his symptoms.


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[TanMan]

When **** like this happens, gotta love Medrol + ibuprofen 800.

Disclaimer: Not medical advice, no liabilities, good luck!