What happens if the clinician punctures the pterygoid plexus during a PSA nerve block?

When a clinician punctures the pterygoid plexus during a PSA (Posterior Superior Alveolar) nerve block, it can lead to the formation of a hematoma. The pterygoid plexus is a network of veins located in the infratemporal fossa, and it is closely associated with the maxillary artery and various nerves. If a needle inadvertently penetrates this plexus, blood can escape into the surrounding tissue, resulting in swelling and discoloration—characteristics of a hematoma.

The potential pain and swelling from a hematoma can be uncomfortable for the patient and may complicate future dental procedures. Additionally, the presence of a hematoma can affect the clinician's ability to perform further injections in the area. Therefore, understanding this risk is crucial for safe and effective administration of local anesthesia in dental practice.