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   Table of Contents      
CASE REPORT
Year : 1989  |  Volume : 37  |  Issue : 1  |  Page : 27

Sixth nerve palsy following dental anaesthesia


Department of Ophthalmology, Rangaraya Medical College & Ophthalmic Surgeon, Government General Hospital, K A K I N A D A, India

Correspondence Address:
C Mangaiah Sarma
Department of Ophthalmology, Rangaraya Medical College & Ophthalmic Surgeon, Government General Hospital, K A K I N A D A
India
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Source of Support: None, Conflict of Interest: None


PMID: 2807498

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  Abstract 

A case of sixth nerve palsy following dental anaesthesia given for tooth extraction is reported.


How to cite this article:
Sarma C M, Nagemdra Babu B V, Manjulamma M. Sixth nerve palsy following dental anaesthesia. Indian J Ophthalmol 1989;37:27

How to cite this URL:
Sarma C M, Nagemdra Babu B V, Manjulamma M. Sixth nerve palsy following dental anaesthesia. Indian J Ophthalmol [serial online] 1989 [cited 2019 Sep 22];37:27. Available from: http://www.ijo.in/text.asp?1989/37/1/27/26107


  Introduction Top


Sixth nerve palsy has been described due to various causes. Paralysis of the sixth nerve following sphenopalatine block given in Dental Surgery was first reported by Goodside and Weigneist in 1946. Since then no case has been reported in the available literature. Hence the present case is reported as a rare cause of sixth nerve palsy.


  Case report Top


A forty year old female patient attended the Dental O.P.D. on 22-5-1988 for caries of the left upper last molar tooth for which she was advised tooth extraction. Dental anaesthesia was given by the local infiltration method over the corresponding site of the left upper last molar tooth and tooth extraction was carried out. Within half an hour the patient complained of diplopia on left gaze for. which she was referred to the Ophthalmic out patient department. - On examination left esotropia was present. Ocular movements showed limitation of movement in left lateral gaze. Anterior segment was normal in both eyes. Pupils were normal in size and shape and were reacting to light. Both fundi were normal. Visual acuity was 6/6 in both eyes. Diplopia charting revealed a left sixth nerve palsy.

As the palsy occurred following intra - oral maxillary injection of 2% Xylocaine no investigations were carried out. The patient was kept under observation. Within 48 hours the patient recovered completely. Ocular movements were nor­mal and full in range in all directions with no diplopia.


  Discussion Top


Abducent paralysis following sphenopalatine block is very rare. Involvement of the sixth nerve along with a disturbance in the maxillary division of the Trigeminal nerve is described in a lesion in the upper part of the sphenopalatine fossa. This is usually caused by a tumour of the accessory sinuses or nasopharynx which was described by Behr in 1925. But this may also follow a sphenopalatine block used in Dental Sur­gery. By sphenopalatine block the entire half of the maxilla can be anaesthetised. It can be given both by intra oral route and extra oral route. In our case injection was given by local infiltration method intra-orally. The xylocaine which was injected probably escaped into the spheno-maxillary fossa and resulted in sixth nerve palsy along with the sphenopalatine block. Other ocular complications described following sphenopalatine block are weakness of the eye lid and dilata­tion of the pupil which were not present in our case[2].

 
  References Top

1.
Goodside and Weigneist, American Journal of Ophthalmology 29, 1295, 1946.   Back to cited text no. 1
    
2.
Duke Elder - system of Ophthalmology Vol. XII. Henry Kimpton, London. 744, 1972.  Back to cited text no. 2
    




 

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