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To the Editor.
—I read with interest your letter to the editor by Schwartz et al in the June Archives (97:1177, 1979) that recounted a bizarre response to a dental injection.As a practicing oral surgeon with an interest in teaching surgical anatomy, I believe there is a simpler, more logical explanation of the route taken by the drug that explains the lateral and superior gaze diplopia. I do not dispute the involvement of the lateral rectus muscle as the causative agent of the diplopia. However, an understanding of the technique used for anesthetizing maxillary molars is essential to a correct interpretation of this incident.A standard dental syringe with a disposable 3-cm needle is used. It is accepted technique not to bury this needle to the hub when attempting anesthesia. There is, therefore, approximately 2.5 cm of needle length to be used when attempting anesthesia of posterior maxillary teeth.
Himmelfarb R. Interpreting the Cause of Diplopia After Dental Injection. Arch Ophthalmol. 1980;98(3):575. doi:10.1001/archopht.1980.01020030571031