Broken Endodontic Instrument Caused Inferior Alveolar Nerve Paraesthesia: A Case Report. - Broken Endodontic Instrument Caused Inferior Alveolar Nerve Paraesthesia: A Case Report. - Open Access Pub

A healthy 55-year-old man was referred to the Department of Endodontics, Oral and Dental Healthy Hospital, Eski？ehir suffering from pain and paraesthesia in the left lower lip and chin.A panoramic radiograph revealed the presence of broken endodontic instrument beyond the apex of the mandibular left third molar. A cone beam computed tomography (CBCT) examination was undertaken, which revealed that the broken instrument was inside the mandibular canal. Damage to the inferior alveolar nerve (IAN) secondary to extrusion of a broken endodontic instrument was diagnosed. Extraction of the tooth was decided and the patient was prescribed with 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. One month after the incident, the signs and symptoms were gone. The complete resolution of the paraesthesia and the control of pain achieved in the present case suggest that surgical removal of broken endodontic instrument extruded into the mandibular canal with the use of prednisone and pregabalin is a good option in the management of inferior alveolar nerve injury. DOI10.14302/issn.2473-1005.jdoi-15-912 Injury to the inferior alveolar nerve (IAN) following endodontic treatment in the posterior mandibular teeth is a relatively infrequent complication resulting in disabling sensory disturbances such as pain, paraesthesia, and dysaesthesia of the lower lip and chin area.1 Paraesthesia is defined as an abnormal sensation with clinical manifestations such as burning, prickling, tingling, numbness, itching or formication, which is not unpleasant.1, 2 The possible etiologic factors for endodontic related paraesthesia are periapical infection and iatrogenic injury to the nerve.2, 3 Overinstrumentation during root canal treatment with manual or rotary instruments allowing overfilling of mandibular molar and premolar is a potential iatrogenic cause of inferior alveolar nerve injury.4, 5 The suggested therapeutic sequence for endodontically related paraesthesia is the control of pain and inflammation and, whenever possible, the surgical elimination of the cause.6, 7 The primary aim of surgical treatment should be the entire removal of the foreign body and protection of the nerve.6, 8 The aim of this paper is to describe a case of labiomandibular paraesthesia due to broken endodontic instrument extrusion into the mandibular canal, and the use of cone-beam computed tomography (CBCT) to aid the diagnosis and treatment. A 55-year-old man was referred to the Department of