Temporary paralysis of cranial nerves III, IV, and VI after a Gow-Gates injection

Article Abstract:

The Gow-Gates injection is a procedure for dental anesthesia that has many advantages, but can produce temporary nerve paralysis if certain injection criteria are not met. The technique involves injection of anesthetic into the region of the neck of the condyle (the part of the lower jaw that inserts into the head), using the bony surface as a landmark before any medication is released. A case history is discussed of a patient who received a Gow-Gates mandibular block (lower jaw anesthesia) prior to removal of retained tooth roots in the right lower jaw. Beginning three minutes after the injection, the patient experienced double vision, drooping of the right eyelid, and an inability to move the right eye. In addition, the light reflexes of the right eye were affected. The symptoms vanished 20 minutes after the dental procedure was completed. This anesthetic agent was apparently mistakenly injected into the blood system where it was taken to the cavernous sinus, a blood-filled chamber in the brain through which several cranial nerves pass (nerves controlling eye and eyelid movements). Correct use of the Gow-Gates technique requires careful aspiration of the syringe before injection to be sure no blood vessel has been encountered, as well as the insertion of the needle into the proper location with respect to the neck of the condyle. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Anesthesia, Dosage and administration

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Selecting drugs for the pregnant dental patient

Article Abstract:

Dental care of pregnant women requires the careful selection of anesthetics and other drugs to minimize risks to the developing fetus. High-dose and sustained exposure to nitrous oxide has been associated with birth defects and spontaneous abortion. Gentamicin and other aminoglycoside antibiotics may cause deafness in the fetus. Local anesthetics can cause fetal depression, but they are generally considered safe. Acetaminophen is the safest drug for pain control, as ibuprofen, aspirin, codeine and propoxyphene have been associated with complications of pregnancy.

Care and treatment, Pregnant women, Nitrous oxide, Aminoglycosides, Anesthesia in obstetrics, Obstetrical anesthesia

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Middle ear problems after a Gow-Gates injection

Article Abstract:

The case of a 22-year-old man is reported who developed problems with his middle ear after receiving a Gow-Gates injection in a dentist?s office. This is used to anesthetize the patient?s jaw and is less painful than traditional dental anesthesia injections. However, he reported problems with his ear immediately after the injection and for 10 days afterwards.

Causes of, Ear diseases, Complications

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