MSA Nerve Block — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsMSA Nerve BlockORE Part 1

A patient requires extraction of a maxillary first molar. A posterior superior alveolar nerve block and palatal infiltration have been given. The palatal tissues are anaesthetised, but the buccal gingiva adjacent to the tooth remains sensitive. Which additional anaesthetic technique is most appropriate?

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Correct answer: B — Middle superior alveolar block or buccal infiltration

A maxillary first molar may receive supply through the middle superior alveolar distribution, particularly the mesiobuccal root and associated buccal tissues. A posterior superior alveolar block can therefore leave the anterior buccal aspect sensitive. The appropriate supplement is a middle superior alveolar block or, more simply, a buccal infiltration adjacent to the tooth. The palatal injection has already addressed palatal soft tissues; a nasopalatine block would not correct buccal sensitivity. Inferior alveolar and mental blocks are mandibular techniques. An infraorbital block may anaesthetise branches contributing to the area, but it is unnecessarily extensive and is not the most appropriate focused supplement for this finding.

Reference: Khalil H. Anterior and middle superior alveolar nerve block for anesthesia of maxillary teeth using conventional syringe. J Korean Assoc Oral Maxillofac Surg. 2013. https://pubmed.ncbi.nlm.nih.gov/23559916/