Consideration of the greater palatine artery during surgery

The greater palatine artery provides blood supply to the posterior palate. There is accessory supply to much of the head and neck so cutting this artery will not result in any long term issues and it is often ligated. Most arteries in the head and neck can be ligated with no consequences due to the density of accessory supply. Exceptions include the internal carotid artery. Surgery around the palate including upper posterior extractions, periodontal surgery on posterior teeth and palatal graft harvests can affect this artery. The artery is always located at around the anterior-posterior level of the upper 7 at the transition of the vertical and horizontal slope of the palate.

Iif you cut the palatal artery:
1. Take a deep breath, don't panic
2. Inject a whole catridge of local anaesthetic at the side of bleed. Will cause temporary haemostasis due to pressure and vasoconstriction
3.  Find the site of the artery by pressing your mirror handle firmly at the expected site. You will know you have found it when the bleed stops completely.
4. Take a non resorbable 3/0 suture with a 1/2 circle needle (the palate is a 3/8 circle so a 3/8 needle won't exit. If you don't have 1/2c needles you can bend a 3/8c to a 1/2c) and take the suture to bone and back out again. Tie it off tight. The bleeding should stop. If it hasn't stopped you are in the wrong location or haven't taken the suture to bone. Non resorbable sutures are required as there can be delayed bleeding after some resorption or loosening of the suture.
5. Tie the loop around the adjacent 7 as the sutures will dig into the tissues and loosen
6. After 7 days there will be reflex vasodilation of the vessel as it expects to be healed already so bleeding can be delayed.