What is the best immediate treatment for a haematoma following an inferior alveolar or posterior superior alveolar nerve block?

Correct answer: D. Apply direct pressure and a cold pack

• A. A haematoma is a bleeding event, not an allergic one. Antihistamines have no role.
• B. Corticosteroids are not indicated for a simple haematoma.
• C. Warm packs are correct AFTER the first 24 hours, when the aim shifts from limiting bleeding to promoting resolution and resorption of the collected blood through vasodilation.
• D. CORRECT for the IMMEDIATE phase. Direct pressure over the site limits further extravasation, and cold produces vasoconstriction and reduces both the size of the haematoma and the associated swelling. This is the first 24-hour management.

Note: Sequence to remember: COLD first 24 hours, WARM thereafter. Reassure the patient that discolouration will spread and change colour over 7 to 14 days before resolving. Advise them of the possibility of trismus, and consider antibiotics if there is significant swelling, since a haematoma is an excellent culture medium. The posterior superior alveolar block carries the highest haematoma risk because of the pterygoid venous plexus — minimize risk by using a short needle and controlling depth of penetration.