© 2007 Nature Publishing Group Altered sensation Sir, we would like to report the case of a 58-year-old female who was referred to a maxillofacial unit by her dentist, with persistent numbness and altered hearing, following a buccal infi ltra tion (1 ml 2% lignocaine with 1:80,000 adrenaline) for periodontal treatment in the upper right seven region. She had a medical history of myocardial infarction, unstable angina, hyperten sion, asthma, hypercholesterolaemia, diet controlled diabetes mellitus and osteoarthritis and was taking several medications, none of which interact with local anaesthetic. Clinical examination revealed dimin ished sharp and blunt discrimination of the first and second divisions of the right trigeminal nerve. No other abnor mality was found. Intraorally there was tenderness of the buccal gingivae adjacent to the upper right second molar tooth, which was also tender to percus sion but vital. An ENT opinion was sought in relation to the auditory acuity, but no abnormalities were diagnosed and no further investigations were required. Diagnoses of right fi rst and second division trigeminal neuropathy, reduced auditory acuity and tinnitus were made. At two week review the upper right seven was extracted. After ten months there was limited recovery of the trigeminal nerve, but the reduced auditory acuity and tinnitus were still present. An audiogram and MR imag ing arranged at this stage were reported as normal. Interestingly, at this review bilateral temporomandibular joint dys function was found. The exact mechanism causing these symptoms is unknown; the following theories have been proposed: • Retrograde anaesthetic vasocon strictor access to the middle ear via venous system resulting in vasos pasm of the cochlear division of the internal auditory artery, leading to vestibulocochlear nerve dysfunction1 • Nerve damage following direct needle penetration2 or upon withdrawal of a barbed needle.2,3 Such barbs rupture the perineurium, herniate the Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London W1G 8YS E-mail email@example.com Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space.