Greater Palatine Artery Haematoma — ORE Part 1 MCQ

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ModerateOral SurgeryGreater Palatine Artery HaematomaORE Part 1

During administration of a greater palatine nerve block, a patient immediately develops a localised haematoma in the palatal tissues. Which event most likely caused this?

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Correct answer: C — The needle has punctured the greater palatine artery

A haematoma is a collection of blood caused by disruption of a blood vessel. The greater palatine artery forms part of the neurovascular bundle associated with the greater palatine nerve at the greater palatine foramen; needle puncture can therefore produce immediate bleeding into the palatal tissues. Introducing air would cause surgical emphysema rather than a haematoma. Vasoconstrictor-associated ischaemia is not an immediate focal blood collection. Local anaesthetic allergy causes features such as urticaria, angioedema, bronchospasm or anaphylaxis, not a localised traumatic haematoma. Nerve trauma may cause altered sensation or pain, but does not itself account for blood accumulation.

Reference: Kawasaki H, et al. Selective transarterial embolization for arterial hemorrhage after upper third molar extraction: illustrative cases. Journal of Neurosurgery: Case Lessons. 2023. https://pubmed.ncbi.nlm.nih.gov/37539867/