A needle breaks during an inferior alveolar nerve block and the fragment cannot be located or retrieved visually. What is the MOST appropriate next step?

Correct answer: D. Obtain a panoramic radiograph to localize the fragment

• A. Observation alone is inadequate. A retained needle can migrate and must be documented, localized and managed; this is also a reportable adverse event.
• B. Immediate blind exploration is contraindicated; muscle activity and probing migrate the fragment toward the skull base and neurovascular structures.
• C. Irrigating and dismissing the patient neither localizes nor addresses the retained foreign body and creates significant liability.
• D. Correct. When a needle fragment is not visible or graspable, do NOT probe blindly — blind exploration displaces the fragment deeper into the pterygomandibular space. Keep the patient calm, instruct them not to move the jaw, and obtain IMAGING (panoramic first; ideally supplemented by CBCT or two-plane films) to localize the fragment before any retrieval, then refer to an oral and maxillofacial surgeon.

Note: Prevention: never bend the needle, never insert to the hub, and use 25-gauge long needles for IAN blocks.