If resistance is felt while performing the greater palatine canal approach, what should you do?

• A. Withdraw and advance at a different angle
• B. Continue advancing with increased force
• C. Increase injection volume and push through
• D. Stop and switch to a different nerve block

Answer: (A)

When you feel resistance during the greater palatine canal approach, it means your needle is likely against bone or off the canal path. Forcing the needle forward can injure tissue, create a false path, or prevent the anesthetic from reaching the target nerve. The correct move is to withdraw a bit and redirect the needle at a different angle, then re-advance along a path that better aligns with the palatine canal toward the pterygopalatine fossa. Make small, deliberate adjustments and recheck landmarks as you proceed, pausing if you again meet resistance. If after careful re-aiming you still can’t find the canal, consider alternative anesthesia options rather than continuing to push.