{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T12:57:31Z","timestamp":1755694651761},"reference-count":39,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016]]},"abstract":"<jats:p>Complications associated with various local anesthetic techniques have been recorded in case reports and reviews. This current case reports a transient incident of blurred, double vision (diplopia) following a Gow-Gates mandibular block injection. There is descriptive discussion on possibilities associated with intra-arterial injection, intravenous injection, diffusion through tissue planes, and the autonomic nervous system pathway to lend credence suggesting the etiology of the complication. For practitioners, recognizing when a complication arises from anesthesia delivery and managing the patient in an appropriate manner is essential to an overall agreeable outcome.<\/jats:p>","DOI":"10.2344\/15-00020.1","type":"journal-article","created":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T20:25:08Z","timestamp":1472761508000},"page":"139-146","source":"Crossref","is-referenced-by-count":6,"title":["Temporary Diplopia After Gow-Gates Injection: Case Report and Review"],"prefix":"10.2344","volume":"63","author":[{"given":"Bernadette Alvear","family":"Fa","sequence":"first","affiliation":[{"name":"Assistant Professor, Department of Integrated Reconstructive Sciences, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven R.","family":"Speaker","sequence":"additional","affiliation":[{"name":"Resident, Advanced Education in Orthodontics and Dentofacial Orthopedics\/MBA Residency, Roseman University of Health Sciences, Henderson, Nevada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan W.","family":"Budenz","sequence":"additional","affiliation":[{"name":"Professor, Department of Biomedical Sciences, and Vice Chair of Diagnostic Sciences and Services, Department of Dental Practice, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1191","reference":[{"key":"i0003-3006-63-3-139-b01","series-title":"Handbook of Local Anesthesia. 5th ed","first-page":"139","article-title":"Techniques of regional anesthesia in dentistry","author":"Malamed \n              SF","year":"2004","unstructured":"Malamed \n              SF\n            \n          . Techniques of regional anesthesia in dentistry. In:Malamed SF, ed. Handbook of Local Anesthesia. 5th ed. St Louis, Mo: Mosby;2004:139\u2013253."},{"key":"i0003-3006-63-3-139-b02","series-title":"J Am Dent Assoc","first-page":"888","article-title":"Avoiding complications in local anesthesia induction: anatomical considerations","volume":"134","author":"Blanton \n              PL,","year":"2003","unstructured":"Blanton \n              PL, \n            \n            \n              Jeske \n              AH. \n            \n          \n          Avoiding complications in local anesthesia induction: anatomical considerations. J Am Dent Assoc. 2003;134:888\u2013893."},{"key":"i0003-3006-63-3-139-b03","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol","first-page":"319","article-title":"Adverse drug reactions to local anesthetics: a systematic review","volume":"115","author":"Liu \n              W,","year":"2013","unstructured":"Liu \n              W, \n            \n            \n              Yang \n              X, \n            \n            \n              Li \n              C, \n            \n            \n              Mo \n              A. \n            \n          \n          Adverse drug reactions to local anesthetics: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:319\u2013327."},{"key":"i0003-3006-63-3-139-b04","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol","first-page":"e1","article-title":"Long buccal nerve block: a previously unreported complication","volume":"112","author":"Herd \n              MK,","year":"2011","unstructured":"Herd \n              MK, \n            \n            \n              Smith \n              RJR, \n            \n            \n              Brennan \n              PA. \n            \n          \n          Long buccal nerve block: a previously unreported complication. Oral Surg Oral Med Oral Pathol Oral Radiol. 2011;112:e1\u2013e3."},{"key":"i0003-3006-63-3-139-b05","series-title":"Br J Oral Maxillofac Surg","first-page":"51","article-title":"An unusual delayed complication of inferior alveolar nerve block","volume":"48","author":"Smyth \n              J,","year":"2010","unstructured":"Smyth \n              J, \n            \n            \n              Marley \n              J. \n            \n          \n          An unusual delayed complication of inferior alveolar nerve block. Br J Oral Maxillofac Surg. 2010;48:51\u201352."},{"key":"i0003-3006-63-3-139-b06","series-title":"J Am Dent Assoc","first-page":"1702","article-title":"Case report: complications of an intra-arterial injection from an inferior alveolar nerve block","volume":"132","author":"Webber \n              B,","year":"2001","unstructured":"Webber \n              B, \n            \n            \n              Orlansky \n              H, \n            \n            \n              Lipton \n              C, \n            \n            \n              Stevens \n              M. \n            \n          \n          Case report: complications of an intra-arterial injection from an inferior alveolar nerve block. J Am Dent Assoc. 2001;132:1702\u20131704."},{"key":"i0003-3006-63-3-139-b07","series-title":"J Oral Surg Anesth Hosp Dent Serv","first-page":"61","article-title":"Deviation of eye and transient blurring of vision after mandibular nerve anesthesia","volume":"20","author":"Cooper \n              JC.","year":"1962","unstructured":"Cooper \n              JC. \n            \n          \n          Deviation of eye and transient blurring of vision after mandibular nerve anesthesia. J Oral Surg Anesth Hosp Dent Serv. 1962;20:61\u201362."},{"key":"i0003-3006-63-3-139-b08","series-title":"Br Dent J","first-page":"23","article-title":"Ocular complication of inferior dental nerve block","volume":"132","author":"Rood \n              JP.","year":"1972","unstructured":"Rood \n              JP. \n            \n          \n          Ocular complication of inferior dental nerve block. Br Dent J. 1972;132:23\u201324."},{"key":"i0003-3006-63-3-139-b09","series-title":"J Endod","first-page":"261","article-title":"Diplopia resulting from a mandibular injection","volume":"9","author":"Goldenberg \n              AS.","year":"1983","unstructured":"Goldenberg \n              AS. \n            \n          \n          Diplopia resulting from a mandibular injection. J Endod. 1983;9:261\u2013262."},{"key":"i0003-3006-63-3-139-b10","series-title":"Anesth Prog","first-page":"9","article-title":"Ocular complications resulting from intra-arterial injection during inferior alveolar nerve anesthesia","volume":"29","author":"Cole \n              JK.","year":"1982","unstructured":"Cole \n              JK. \n            \n          \n          Ocular complications resulting from intra-arterial injection during inferior alveolar nerve anesthesia. Anesth Prog. 1982;29:9\u201310."},{"key":"i0003-3006-63-3-139-b11","series-title":"S Afr Dent J","first-page":"235","article-title":"Ocular complications of dental local anesthesia","volume":"53","author":"Van der Bijl \n              P,","year":"1998","unstructured":"Van der Bijl \n              P, \n            \n            \n              Meyer \n              D. \n            \n          \n          Ocular complications of dental local anesthesia. S Afr Dent J. 1998;53:235\u2013238."},{"key":"i0003-3006-63-3-139-b12","series-title":"Aust Dent J","first-page":"131","article-title":"Temporary uniocular blindness and ophthalmoplegia associated with a mandibular block injection: a case report","volume":"45","author":"Wilkie \n              GJ,","year":"2000","unstructured":"Wilkie \n              GJ, \n            \n          \n          Temporary uniocular blindness and ophthalmoplegia associated with a mandibular block injection: a case report. Aust Dent J. 2000;45:131\u2013133."},{"key":"i0003-3006-63-3-139-b13","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol","first-page":"21","article-title":"Ophthalmologic complications after intraoral local anesthesia with articaine","volume":"90","author":"Pe\u00f1arrocha-Diago \n              M,","year":"2000","unstructured":"Pe\u00f1arrocha-Diago \n              M, \n            \n            \n              Sanchis-Bielsa \n              JM. \n            \n          \n          Ophthalmologic complications after intraoral local anesthesia with articaine. 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Quintessence Int. 2001;32:232\u2013234."},{"key":"i0003-3006-63-3-139-b15","series-title":"J Calif Dent Assoc","first-page":"57","article-title":"Ocular complications after inferior alveolar nerve block: a case report","volume":"38","author":"Al-Sandook \n              T,","year":"2010","unstructured":"Al-Sandook \n              T, \n            \n            \n              Al-Saraj \n              A. \n            \n          \n          Ocular complications after inferior alveolar nerve block: a case report. J Calif Dent Assoc. 2010;38:57\u201359."},{"key":"i0003-3006-63-3-139-b16","series-title":"Int J Oral Maxillofac Surg","first-page":"220","article-title":"Permanent vision loss in one eye following administration of local anesthesia for a dental extraction","volume":"34","author":"Rishiraj \n              B,","year":"2005","unstructured":"Rishiraj \n              B, \n            \n            \n              Epstein \n              JB, \n            \n            \n              Fine \n              D, \n            \n            \n              Nabi \n              S, \n            \n            \n              Wade \n              NK. \n            \n          \n          Permanent vision loss in one eye following administration of local anesthesia for a dental extraction. Int J Oral Maxillofac Surg. 2005;34:220\u2013223."},{"unstructured":"University of the Pacific. School of Dentistry 2015\u20132016 catalog. Academic administrative policies. 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Oral Surg Oral Med Oral Pathol. 1973;36:321\u2013328."},{"key":"i0003-3006-63-3-139-b19","series-title":"Med Oral Patol Oral Cir Bucal","first-page":"e688","article-title":"Ocular complications following dental local anesthesia","volume":"16","author":"Aguado-Gil \n              JM,","year":"2011","unstructured":"Aguado-Gil \n              JM, \n            \n            \n              Barona-Dorado \n              C, \n            \n            \n              Lillo-Rodr\u00edguez \n              JC, \n            \n            \n              De la Fuente-Gonz\u00e1lez \n              DS, \n            \n            \n              Mart\u00ednez-Gonz\u00e1lez \n              JM. \n            \n          \n          Ocular complications following dental local anesthesia. Med Oral Patol Oral Cir Bucal. 2011;16:e688\u2013e693."},{"key":"i0003-3006-63-3-139-b20","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol","first-page":"e1","article-title":"Ophthalmologic complications after intraoral local anesthesia: case report and review of literature","volume":"113","author":"Steenen \n              SA,","year":"2012","unstructured":"Steenen \n              SA, \n            \n            \n              Dubois \n              L, \n            \n            \n              Saeed \n              P, \n            \n            \n              de Lange \n              J. \n            \n          \n          Ophthalmologic complications after intraoral local anesthesia: case report and review of literature. 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Calif Dent Assoc J. 1995;23:55\u201369."},{"key":"i0003-3006-63-3-139-b23","series-title":"J Am Dent Assoc","first-page":"1142","article-title":"Reverse carotid blood flow: a possible explanation for some reactions to local anesthetics","volume":"94","author":"Aldrete \n              JA,","year":"1977","unstructured":"Aldrete \n              JA, \n            \n            \n              Narang \n              R, \n            \n            \n              Sada \n              T, \n            \n            et al. \n          Reverse carotid blood flow: a possible explanation for some reactions to local anesthetics. J Am Dent Assoc. 1977;94:1142\u20131145."},{"key":"i0003-3006-63-3-139-b24","series-title":"The Head and Neck. 3rd ed","first-page":"151","author":"Hollinshead \n              WH.","year":"1982","unstructured":"Hollinshead \n              WH. \n            \n          \n          The Head and Neck. 3rd ed. Philadelphia, PA: Harper & Row;1982:151\u2013155. Anatomy for Surgeons; Vol 1."},{"key":"i0003-3006-63-3-139-b25","series-title":"Br J Ophthalmol","first-page":"193","article-title":"The central artery of the retina, I. Origin and course","volume":"44","author":"Singh \n              S,","year":"1960","unstructured":"Singh \n              S, \n            \n            \n              Dass \n              R. \n            \n          \n          The central artery of the retina, I. Origin and course. Br J Ophthalmol. 1960;44:193\u2013212."},{"issue":"8","key":"i0003-3006-63-3-139-b26","series-title":"Hong Kong Med Diary","first-page":"4","article-title":"Ocular complications after inferior alveolar nerve block","volume":"11","author":"Lee \n              C.","year":"2006","unstructured":"Lee \n              C. \n            \n          \n          Ocular complications after inferior alveolar nerve block. Hong Kong Med Diary. 2006;11(8):4\u20135."},{"key":"i0003-3006-63-3-139-b27","series-title":"J Can Dent Assoc","first-page":"927","article-title":"Transient loss of power of accommodation in 1 eye following inferior alveolar nerve block: report of 2 cases","volume":"72","author":"Ngeow \n              WC,","year":"2007","unstructured":"Ngeow \n              WC, \n            \n            \n              Shim \n              CK, \n            \n            \n              Chai \n              WL. \n            \n          \n          Transient loss of power of accommodation in 1 eye following inferior alveolar nerve block: report of 2 cases. J Can Dent Assoc. 2007;72:927\u2013931."},{"key":"i0003-3006-63-3-139-b28","series-title":"Br Dent J","first-page":"32","article-title":"Upper lip blanching and diplopia associated with local anesthesia of the inferior alveolar nerve","volume":"202","author":"Scott \n              JK,","year":"2007","unstructured":"Scott \n              JK, \n            \n            \n              Moxham \n              BJ, \n            \n            \n              Downie \n              IP, \n            \n          \n          Upper lip blanching and diplopia associated with local anesthesia of the inferior alveolar nerve. Br Dent J. 2007;202:32\u201333."},{"key":"i0003-3006-63-3-139-b29","series-title":"J Neuroophthalmol","first-page":"95","article-title":"Ophthalmic complications of dental anesthesia: three new cases","volume":"25","author":"Horowitz \n              J,","year":"2005","unstructured":"Horowitz \n              J, \n            \n            \n              Almog \n              Y, \n            \n            \n              Wolf \n              A, \n            \n            \n              Buckman \n              G, \n            \n            \n              Geyer \n              O, \n            \n          \n          Ophthalmic complications of dental anesthesia: three new cases. J Neuroophthalmol. 2005;25:95\u2013100."},{"key":"i0003-3006-63-3-139-b30","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"730","article-title":"Transient diplopia following maxillary anesthetic injection","volume":"101","author":"Magliocca \n              KR,","year":"2006","unstructured":"Magliocca \n              KR, \n            \n            \n              Kessel \n              NC, \n            \n            \n              Cortright \n              GW. \n            \n          \n          Transient diplopia following maxillary anesthetic injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:730\u2013733."},{"key":"i0003-3006-63-3-139-b31","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"e21","article-title":"Diplopia after inferior alveolar nerve block anesthesia: report of 2 cases and literature review","volume":"107","author":"Choi \n              E-H,","year":"2009","unstructured":"Choi \n              E-H, \n            \n            \n              Seo \n              J-Y, \n            \n            \n              Jung \n              B-Y, \n            \n            \n              Park \n              W. \n            \n          \n          Diplopia after inferior alveolar nerve block anesthesia: report of 2 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:e21\u2013e24."},{"key":"i0003-3006-63-3-139-b32","series-title":"Oral Maxillofac Surg","first-page":"67","article-title":"Amaurosis, ophthalmoplegia, ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anesthesia","volume":"15","author":"Williams \n              JV,","year":"2011","unstructured":"Williams \n              JV, \n            \n            \n              Williams \n              LR, \n            \n            \n              Colbert \n              SD, \n            \n            \n              Revington \n              PJ. \n            \n          \n          Amaurosis, ophthalmoplegia, ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anesthesia. Oral Maxillofac Surg. 2011;15:67\u201370."},{"key":"i0003-3006-63-3-139-b33","series-title":"Pediatr Dent","first-page":"343","article-title":"Ocular complications following an inferior alveolar nerve block on a child patient: a review of the literature and report of a case","volume":"34","author":"Yoon \n              RK,","year":"2012","unstructured":"Yoon \n              RK, \n            \n            \n              Chussid \n              S. \n            \n          \n          Ocular complications following an inferior alveolar nerve block on a child patient: a review of the literature and report of a case. Pediatr Dent. 2012;34:343\u2013346."},{"key":"i0003-3006-63-3-139-b34","series-title":"J Am Dent Assoc","first-page":"1420","article-title":"Case report: middle ear problems after a Gow-Gates injection","volume":"132","author":"Brodsky \n              CD,","year":"2001","unstructured":"Brodsky \n              CD, \n            \n            \n              Dower \n              JS\n              Jr. \n            \n          \n          Case report: middle ear problems after a Gow-Gates injection. J Am Dent Assoc. 2001;132:1420\u20131423."},{"key":"i0003-3006-63-3-139-b35","series-title":"Anesth Prog","first-page":"193","article-title":"Gow-Gates mandibular block\u2014applied anatomy and histology","volume":"36","author":"Gow-Gates \n              G,","year":"1989","unstructured":"Gow-Gates \n              G, \n            \n            \n              Watson \n              JE. \n            \n          \n          Gow-Gates mandibular block\u2014applied anatomy and histology. Anesth Prog. 1989;36:193\u2013195."},{"key":"i0003-3006-63-3-139-b36","series-title":"Handbook of Local Anesthesia. 5th ed","first-page":"237","article-title":"Techniques in mandibular anesthesia","author":"Malamed \n              SF","year":"2004","unstructured":"Malamed \n              SF\n            \n          . Techniques in mandibular anesthesia. In:Malamed SF, ed. Handbook of Local Anesthesia. 5th ed. St Louis, Mo: Mosby;2004:237\u2013242."},{"key":"i0003-3006-63-3-139-b37","series-title":"J Am Dent Assoc","first-page":"127","article-title":"Temporary paralysis of cranial nerves III, IV, and VI after a Gow-Gates injection","volume":"119","author":"Fish \n              LR,","year":"1989","unstructured":"Fish \n              LR, \n            \n            \n              McIntire \n              DN, \n            \n            \n              Johnson \n              L. \n            \n          \n          Temporary paralysis of cranial nerves III, IV, and VI after a Gow-Gates injection. J Am Dent Assoc. 1989;119:127\u2013130."},{"key":"i0003-3006-63-3-139-b38","series-title":"Compendium","first-page":"94","article-title":"An unusual complication resulting from a Gow-Gates mandibular block","volume":"14","author":"Dryden \n              J.","year":"1993","unstructured":"Dryden \n              J. \n            \n          \n          An unusual complication resulting from a Gow-Gates mandibular block. Compendium. 1993;14:94\u2013100."},{"key":"i0003-3006-63-3-139-b39","series-title":"Handbook of Local Anesthesia. 5th ed","first-page":"310","article-title":"Systemic complications","author":"Malamed \n              SF","year":"2004","unstructured":"Malamed \n              SF\n            \n          . Systemic complications. In:Malamed SF, ed. Handbook of Local Anesthesia. 5th ed. 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