Managing temporary paralysis of the periocular muscles in dental practice

If a local anaesthetic is inadvertently injected into the parotid gland (eg a misdirected mandibular block or posterior maxillary infiltration), it will diffuse to the branches of the seventh cranial (facial) nerve. This may cause temporary paralysis of the periocular muscles.

Patient with right-sided facial palsy shows a patient with right-sided facial palsy.

In dental practice, follow the advice in Management of temporary paralysis of the periocular muscles in dental practice for first-aid management of patients with temporary paralysis of the periocular muscles.

Figure 1. Patient with right-sided facial palsy

This patient had a right posterior superior infiltration for restoration of the maxillary molars. Note the inability to close the right eye and right side of the lips. The left side is functioning normally. Patient permission was obtained for use of this image.

Figure 2. Management of temporary paralysis of the periocular muscles in dental practice

If temporary paralysis of the periocular muscles occurs:

  • Stop the local anaesthetic injection and dental treatment.
  • Explain what has happened and reassure the patient that the paralysis is temporary.
  • Advise the patient not to rub the eyes.
  • Close the eye and cover with two eye patches—fold the first patch in half and place over the eye, then tape the second patch over the top of the folded patch.
  • Keep the patient under observation until the ability to blink starts to return. This usually happens within the hour, depending on the dose and strength of the local anaesthetic.
  • The patient should not drive that day and should be escorted home.
  • Check on the patient by phone later that day. If the patient has not fully recovered within 12 hours, medical review is required.