To the Editor.
—We recently observed three episodes of the complication reported by Wilson and Ruiz1 in the October 1985 issue of the Archives. In all cases, the complication occurred in elderly thin ladies, only one of whom weighed over 45 kg.In reviewing the anatomy of the neck in the area of the stylomastoid foramen, it becomes apparent that only a centimeter separates the stylomastoid foramen from the jugular foramen and the carotid canal. The glossopharyngeal, vagus, and spinal accessory nerves exit the skull through the jugular foramen. The vagus is incorporated into the sheath of the internal carotid artery. It is not too difficult to imagine a spread of the anesthetic agent for a centimeter, particularly when volumes of 4 to 5 mL are used with hyaluronidase and when the patient is thin.As in the patient described by Wilson and Ruiz, all three of our patients
Shoch D. Complications of the Nadbath Facial Nerve Block. Arch Ophthalmol. 1986;104(8):1114–1115. doi:10.1001/archopht.1986.01050200020011
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