In the high tuberosity approach to maxillary nerve block, where is the needle inserted?

• A. Height of MB fold above distal aspect of maxillary 2nd molar
• B. Infraorbital foramen
• C. Over the canine eminence
• D. Through the greater palatine canal

Answer: (A)

The high tuberosity maxillary nerve block targets the maxillary nerve as it passes behind the maxillary tuberosity. The needle is placed at the height of the buccal mucobuccal fold over the distal aspect of the maxillary second molar and then advanced medially and slightly superiorly toward the pterygopalatine fossa. This landing point aligns the needle with the nerve trunk before it branches, allowing the anesthetic to affect the maxillary nerve and its branches.

This site is distinct from other routes: the infraorbital foramen route targets the infraorbital nerve rather than the trunk behind the tuberosity; the canine eminence is a landmark more relevant to anterior approaches; and the greater palatine canal route anesthetizes the greater palatine nerve in the palatal tissue, not the maxillary nerve trunk in the infratemporal region.