Immunisation against hepatitis A, hepatitis B and typhoid fever via combined vaccination: rationale, immunogenicity and reactogenicity.

Objective  To review the literature concerning the management of dental needles broken off into the deep spaces of the neck, to report what we believe is the first case of a fractured dental needle migrating into the jugular foramen, and the unconventional use of endovascular intervention to retrieve the needle fragment. Design  Case report with review of literature. Setting  Academic tertiary care center. Participants  Intervention was performed by the otolaryngology-head and neck surgery, vascular surgery, and neurovascular interventional radiology teams. Results  Transoral exploration, including palatal split and exposure of the poststyloid parapharyngeal space with C-arm image guidance, was unable to retrieve the broken needle, which traversed the internal carotid lumen with the distal end entering the jugular foramen. Through endovascular intervention, the neurovascular interventional radiology team captured the proximal end of the needle and retrieved it through the femoral artery. The patient recovered uneventfully. Conclusion  Fracture and loss of oral injection needles remain a persistent and preventable problem. This case demonstrates a novel, minimally invasive, well-tolerated, and successful method to extract a fractured needle that migrated into the lumen of the internal carotid artery at the level of the skull base.