What may occur when highly concentrated vasoconstricting solution is used for hemostasis over a prolonged period during a greater palatine nerve block?

• A. Ischemia & necrosis of soft tissues
• B. Infection only
• C. Allergic reaction
• D. Hematoma formation

Answer: (A)

Prolonged exposure of palatal tissues to a highly concentrated vasoconstrictor during a greater palatine nerve block can cause tissue ischemia and necrosis. The vasoconstrictor constricts local blood vessels by stimulating alpha receptors, dramatically reducing blood flow to the area. The palate has a relatively limited network of collateral circulation, and the palatal mucosa is thin, so sustained high-level vasoconstriction can deprive the tissue of oxygen and nutrients. When perfusion is kept down for an extended period, cells begin to suffer and may die, leading to necrosis of the soft tissues.

Infection isn’t a direct result of vasoconstriction, and while an allergic reaction can occur, it doesn’t explain tissue death from prolonged ischemia. Hematoma formation is more about vessel injury or bleeding during injection and is typically mitigated by vasoconstriction rather than caused by it, so it’s not the best fit for this scenario.