In a child with hemophilia A requiring dental local anesthesia, which injection technique should be AVOIDED due to the highest risk of hematoma formation?

The inferior alveolar nerve block (IANB) poses the greatest risk of hematoma in patients with coagulopathies such as hemophilia A. The injection is made into the pterygomandibular space, a highly vascular area containing the inferior alveolar artery and vein. Accidental vascular puncture in this space in a hemophiliac patient can result in a rapidly expanding hematoma that may compress the airway — a life-threatening emergency. For patients with hemophilia requiring mandibular anesthesia, buccal infiltrations, intraligamentary injections, or intraosseous injections are preferred as safer alternatives. If an IAN block is unavoidable, factor replacement should be arranged in advance.