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IANB Haematoma Conservative Management — ORE Part 1 MCQ

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EasyOral SurgeryIANB Haematoma Conservative ManagementORE Part 1

During an inferior alveolar nerve block, a patient develops an immediate, localised pterygomandibular-space haematoma. The swelling is not enlarging and there are no airway symptoms. What is the most appropriate immediate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Stop treatment; apply cold and external pressure; provide analgesia, advice and review

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

The correct answer is A. A localised, non-progressive haematoma following local-anaesthetic injection is managed conservatively: stop treatment, use external pressure to limit further bleeding and cold to reduce swelling, provide appropriate analgesia, explain expected bruising and transient trismus, and arrange review/safety-netting. Incision, aspiration or drainage (B and E) may worsen bleeding and are not indicated for an uncomplicated haematoma. Antibiotics (B and C) are not routinely required because a haematoma is not an infection. Continuing treatment (C) is inappropriate while the complication is assessed. Heat and massage in the acute phase (D) may increase local blood flow and swelling. A rapidly enlarging swelling, dysphagia, dyspnoea or other airway concern requires urgent escalation rather than routine conservative care.

Reference: Marques ALN, et al. Edema and hematoma after local anesthesia via posterior superior alveolar nerve block: a case report. Journal of Dental Anesthesia and Pain Medicine, 2022. https://pubmed.ncbi.nlm.nih.gov/35693352/