Case Description. Unusual middle ear symptoms immediately followed the administration of 1.8 milliliters of 3 percent mepivacaine for a Gow-Gates mandibular block injection. Over the course of 10 days, the patient had complaints of inner ear pressure, inability to equilibrate ear pressure, decreased hearing, pain and severe headache before returning to normal without further complaints and complications.

Conclusions. The cause of the complications was either a hematoma, a technique problem causing trauma and inflammation, an anatomical variation or any combination of these.

Clinical Implications. Proper technique, knowledge of the anatomy of the injection area and familiarity with potential complications are important in the administration of local anesthetic.