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Cervicocephalic artery dissections occurring during dental care have exceptionally been reported. We describe a case of internal carotid artery dissection, presenting as hypoglossal nerve palsy, occurring immediately after difficult inferior alveolar nerve anesthetic block for third inferior molar dental care. Carotid dissection was successfully treated with anticoagulation therapy while hypoglossal nerve palsy recovered with carotid dissection shrinkage. The etiopathogenetic mechanisms of this singular form of internal carotid artery dissection are discussed. The possibility of internal carotid artery dissection development during oral or dental procedure, specifically in cases of possible trivial intraoperative internal carotid artery injury, severe local periodontal infection, or prolonged cervical hyperextension should be considered. Every possible prophylactic measure should be taken (eg, sedating the patient during oral or dental procedures, aggressive preoperative management of general and local periodontal chronic infections, avoiding prolonged perioperative neck hyperextention) to prevent this very rare but potentially life-threatening complication.

In cases of initially undetected and staunched TKA-related PA-INJs, postoperative anticoagulation therapy may act as a potential trigger for final arterial rupture during mobilization exercises, followed by acute bleeding; in these cases, endovascular management represents an excellent treatment option. Close clinical and instrumental monitoring is strongly recommended after TKA, in patients who imperatively require full-dose anticoagulation therapy.

Arterial aneurysms in the forearm, wrist and hand are relatively uncommon. Penetrating injuries, arterial traumas, infections and repetitive microtraumas represent the most frequent cause of these secondary aneurysms or pseudo-aneurysms, while true nontraumaticor infective peripheral aneurysms of the upper extremities are very rarely encountered. Over the last 20 years these have been reported only sporadically, both in adults and children. We describe a case of bilateral true idiopathic saccular artery aneurysms in the hypothenar eminence, treated with excision and arterial continuity restoration by primary end-to-end anastomosis on the left side and conservatively on the right. To our knowledge, no other similar case has been documented to date. Starting from this original case we conducted a systematic review of the literature via PubMed search on peripheral aneurysms of the forearm and hand arteries from 1933 to the present, including specifically true distal ulnar and radial artery aneurysms. Etiology, clinical characteristics and management of these rare pathological entities are extensively discussed.