A patient with Duchenne muscular dystrophy also has mucopolysaccharidosis and needs extraction of tooth T. Which anesthesia technique is most appropriate?

Correct answer: C. PDL (periodontal ligament) infiltration

• A. N2O/O2 sedation may seem appealing, but patients with Duchenne muscular dystrophy have compromised respiratory muscle function — N2O can further compromise respiratory reserve. Exercise caution with sedation in DMD.
• B. Mental nerve infiltration is for mandibular anterior teeth — tooth T is a primary maxillary left canine. Not appropriate.
• C. PDL (intraligamentary) infiltration delivers anesthetic directly into the periodontal ligament space, providing local anesthesia without requiring large volumes or complex techniques. It avoids the risks associated with block anesthesia in a medically complex patient with restricted airway (mucopolysaccharidosis causes macroglossia, thickened airway tissues). Tooth T (primary maxillary canine) can be anesthetized via PDL injection.
• D. IAN block requires mouth opening and cooperation that may be compromised in DMD/mucopolysaccharidosis patients with macroglossia and restricted airway. It also carries higher risk in medically compromised patients.