Hematoma formation after posterior superior alveolar nerve block

 # If hematoma formation occurs after posterior superior alveolar nerve block, it is due to the damage of:
A. Pterygoid venous plexus
B. Small capillaries and arterioles in the region
C. Facial artery
D. Internal maxillary artery

The correct answer is A. Pterygoid venous plexus.

Complications after posterior superior alveolar nerve block
1. Hematoma:
a. This is commonly produced by inserting the needle too far posteriorly into the pterygoid plexus of veins. In addition, the maxillary artery may be perforated. Use of a short needle minimizes the risk of pterygoid plexus puncture.

b. A visible intraoral hematoma develops within several minutes, usually noted in the buccal tissues of the mandibular region.
(1) There is no easily accessible intraoral area to which pressure can be applied to stop the hemorrhage.
(2) Bleeding continues until the pressure of extravascular blood is equal to or greater than that of intravascular blood.

Reference: Handbook of Local Anesthesia, Malamed, 6th Edition, Page 195

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