Title: Lateral rectus palsy after removal of mandibular metal-work
Abstract:
Background:
Fortunately, the need to remove metal-work after open reduction internal fixation of the facial skeleton is relatively uncommon. The procedure is typically tolerated well, with patients discharged the same day. An uncommon complication of local anaesthetic administration during these procedures is temporary paralysis of muscle(s). While clinically dramatic, the condition is self-resolving. We present a case of a 27 year old female that developed a unilateral abducens nerve palsy after removal of bilateral mandibular plates and screws.
Methods:
A 27 year old female was referred to our clinic with complaints of tenderness and discomfort arising from the position of 2 mandibular plates, placed previously during a repair of a mandible fracture. She underwent removal of both plates and screws under general anaesthetic with no intra-operative complications. Prior to extubation, 20ml of 0.25% marcaine with 1:400,000 adrenaline was administered via bilateral closed-mouth blocks.
In the recovery suite she was found to be unable to abduct her left eye; medial, superior and inferior range of movement was maintained. Both pupils were equal and reactive to light; right eye and other facial muscle movements were unaffected. She had no other neurological deficits. After consultation with neurology and ophthalmology teams, she underwent an urgent brain MRI which was clear.
Results:
Approximately 6 hours after surgery her symptoms had entirely resolved. She was diagnosed with a left abducens nerve palsy attributed to spread of local anaesthetic from intra-operative blocks. She was kept overnight for observation and discharged the following day.
Conclusion:
Administration of local anaesthetic can be directed, but the spread to surrounding tissues cannot be controlled. This presentation will help clinicians become aware of an unusual complication of local anaesthetic administration, its presentation and how best to manage it.
Audience Take Away:
- The audience will learn about the clinical presentation and management principles of a lateral rectus palsy
- The audience will learn about an unusual, but clinically dramatic complication of local anaesthetic administration
- Other faculties may use this to help develop local management guidelines
