During which nerve block is the pterygoid plexus more likely to get punctured?

The pterygoid plexus is a network of veins located in the infratemporal fossa, and it is particularly at risk during the administration of the posterior superior alveolar (PSA) nerve block. The PSA nerve block targets the posterior superior alveolar nerve, which is responsible for innervating the maxillary molars.

When performing this block, the needle is typically inserted at a location that places it in close proximity to the pterygoid plexus. The anatomical positioning of the plexus, situated right next to the maxillary tuberosity, increases the risk of inadvertently puncturing these venous structures during the injection. If the pterygoid plexus is punctured, this can lead to complications such as hematoma formation, which may complicate the healing process.

In contrast, the other nerve blocks, such as the MSA and ASA blocks, are situated more anteriorly in the maxilla and are less likely to encounter the pterygoid plexus. The nasopalatine block, performed at the incisive papilla, is also distant from this venous plexus. Thus, while all nerve blocks require careful technique to avoid complications, the PSA nerve block notably has a higher risk for