Confidential Settlement on Behalf of a Fort Lee, New Jersey Man Sustained Nerve Injury During Root Canal Procedure.

The plaintiff underwent a root canal procedure in anticipation of a crown and eventual bridge. During the root canal sodium hypochlorite leaked into the plaintiff’s gums destroying tissue in the area of the buccal mucosa and eventually causing nerve damage.

Sodium hypochlorite is used to clean and disinfect the canals of teeth during endodontic procedures. It is caustic and it destroys tissue if it escapes the confines of the tooth.

The plaintiff experienced pain in the buccal mucosa in the area where the defendant dentist was performing the root canal procedure. The defendant stopped the root canal procedure and placed a temporary filling in the tooth when he noticed that a white lesion was forming in the gums. At the time, he was unaware that hypochlorite caused the injury. When the plaintiff returned a week later, however, the defendant saw additional significant tissue damage and concluded that hypochlorite leaked out of the tooth he was working on.

The plaintiff’s oral surgeon expert opined that the hypochlorite leaked from the tooth in one of two ways. First, there was a very small hole near the crown of the tooth that the substance could have escaped from. Second, the dentist could have caused a small hole in the root of the tooth he was working on when he was attempting to file down the canal. During discovery, the defendant indicated that he did not utilize a dental damn during root canal procedures. This could have allowed the hypochlorite that leaked out of the hole near the crown of the tooth to travel down to the buccal mucosa.

As a result of the injury, the plaintiff has a permanent sensation of numbness in his lower lip. The case settled after it was assigned to trial in Bergen County, New Jersey.

Confidential Settlement on Behalf of Hackettstown, New Jersey Woman Suffering an Injury to the Spinal Accessory Nerve

The plaintiff discovered a lump on the right side of her neck while showering. She consulted with her primary care physician who placed her on antibiotics for one week. When the lump did not go away, the plaintiff was referred for a CT scan, which was within normal limits. At that point, the plaintiff was referred to the defendant otolaryngologist.

The defendant ordered a second CT scan, which was also read as normal. Nevertheless, because a palpable mass was present and the defendant saw an abnormality in the pyriform sinus, he recommended a biopsy of the mass and a laryngoscopy.

The defendant performed an exisional biopsy and laryngoscopy. Within six weeks of the procedure the plaintiff could no longer lift her arms over her head. She went on to develop muscle wasting in her trapezius and eventually developed pain traveling down her right arm into her fingers.

Remarkably, when the defendant saw the plaintiff postoperatively he charted that he suspected an injury to the spinal accessory nerve. Nevertheless, he never advised the plaintiff of this fact, and she sought further follow-up care through a neurologist and spinal surgeon. The spinal surgeon recommended cervical fusion surgery. Fortunately, the plaintiff performed her own research and ascertained that she suffered an injury to her spinal accessory nerve during the lymph node biopsy.

Pre-suit research revealed that lymph node biopsies are a common cause of spinal accessory nerve injury. When an ENT suspects possible cancer because of neck adenopathy, accepted standards of care require that a fine needle aspiration biopsy be performed to avoid possible nerve injury. If a FNA biopsy is non-diagnostic, an excisional biopsy may be performed, but if the lymph node is in the area of the spinal accessory nerve, the nerve must be identified and preserved. The evidence established the defendant never attempted a FNA and never attempted to identify the spinal accessory nerve during the excisional surgery.

The defense hired an ENT who indicated that the defendant was not negligent because there was a possibility that the plaintiff might be suffering from Hodgkin’s lymphoma, and that condition cannot always be diagnosed with a FNA. This opinion, however, was not supported by the medical literature. The defendant also hired an orthopedic surgeon and a neurologist, who opined that the plaintiff’s postoperative problems were also related to cervical spine degeneration. This was contradicted by the records and the literature.

The case was resolved one week prior to the scheduled trial. The amount of the settlement is confidential.

Health Care Safety Index February/March 2016

Here are healthcare safety issues that have appeared in the news and medical journals throughout the last 60 days or so:

The American College of Chest Physicians issued new recommendations published in Chest indicating that oral anticoagulants including Apixaban, Edoxaban, Rivaroxaban, or Dabigatran are now the preferred agents for long-term anticoagulation in patients. The exceptions include patients who are pregnant, who have cancer or who have severe renal insufficiency.

In an article published in the New England Journal of Medicine, authors recommended that pregnant women scheduled to deliver between the 34th to 36th weeks of gestation by cesarean section receive a first course of antenatal corticosteroids to reduce the risk of adverse respiratory events in newborns.

The Society of Critical Care Medicine and European Society of Intensive Care Medicine issued new guidelines defining sepsis and septic shock.

In an article published in the Journal of Pediatric Orthopedics, the authors recommended an MRI to investigate the possibility of adjacent infections in pediatric patients suffering from septic arthritis. A threefold increase of an adjacent infection was present in patients with three or more of the following risk factors: age older than 4 years; symptoms longer than three days, C-reactive protein (CRP) greater than 13.8 mg/dL; platelets less than 314,000/microL; and absolute neutrophil count  higher than 8600/microL.

The FDA approved an intranasal naloxone spray (Narcan nasal spray) to reverse the effects of opioid overdose.

An article published in the Annals of Internal Medicine demonstrated that acupuncture is not effective in the treatment of hot flashes associated with menopause, although it may have a placebo effect.

A study published in JAMA Neurology suggested a possible link between proton pump inhibitors (PPIs) and risk of dementia in older adults.

The United States Multi-Society Task Force on Colorectal Cancer published new guidelines related to endoscopic surveillance for posttreatment colorectal cancer resection in Gastroenterology.

An article published in Gut concluded that Vonoprazan may be an effective option for H. pylori eradication in combination with antibiotics.

Healthcare Safety Index – January 2016

Here are healthcare safety issues that have appeared in the news and medical journals throughout the last 30 days or so:

The Centers for Disease Control and Prevention issued a recommendation that men with a pregnant partner should abstain from sex or use a condom if they live in or visited an area where mosquitos are spreading the Zika virus. Additionally, the CDC also recommended that pregnant women who have visited countries and territories plagued by the virus, mostly in Latin America, should be tested even if they do not exhibit symptoms of infection.

The Centers for Disease Control and Prevention recommended that hospitalized patients, patients with severe, complicated or progressive illness and patients at high risk for complications due to influenza be treated with antiviral medication irrespective of the outcome of rapid influenza diagnostic test results. The reasons for this are that (a) there have been reports of severe influenza with some deaths and (b) RIDT results have a high potential for false negatives.

A study published in Pediatrics found that exposure to beta-2 adrenergic agonists during pregnancy (used in asthma drugs) may increase the risk for autism spectrum disorders in children.

The American College of Physicians and the Centers for Disease Control and Prevention released a new clinical guideline on antibiotic use in adults with acute respiratory tract infections.Except for confirmed bacterial infections like streptococcal pharyngitis or acute bacterial sinusitis, antibiotics should not routinely be used.