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Background and Aims Managing pain in recurrent oral squamous cell carcinoma (SCC), particularly with post-radiotherapy(RT) mucositis, remains challenging. An 85-year-old female with recurrent right palatal SCC with ongoing palliative RT presented with severe refractory orofacial pain exacerbated by oral intake. Despite high-dose fentanyl, pregabalin, nortriptyline and ibuprofen, her pain control remained inadequate. A maxillary nerve block was proposed to target localised orofacial pain.Methods An 85-year-old female with severe post-radiotherapy mucositis-associated pain in the V2/V3 distributions had inadequate relief despite escalating opioids, with pain mainly localized to the V3 region. Distal V3 nerve blocks were not feasible due to an exophytic tumor and overlying skin changes. A right maxillary nerve and sphenopalatine ganglion block was performed via the pterygopalatine fossa using an ultrasound-guided infrazygomatic approach. A linear probe guided a 5 cm Stimuplex needle out-of-plane under aseptic conditions with local lignocaine infiltration. After confirming correct placement with hydrodissection and negative aspiration, 3 ml of 0.5% bupivacaine and 8 mg dexamethasone were administered.Results The patient experienced immediate pain relief and stable pain control with no need for breakthrough doses despite stopping the fentanyl infusion. The block appeared to provide modest but meaningful pain relief with no observed complications or neurological deficits. This suggests that anaesthetic spread from the PPF to the mandibular nerve may occur, potentially facilitated by anatomical communications within the region. Additionally, modulation of the SPG may contribute to the analgesic effect. These findings indicate that maxillary nerve blocks via the PPF can serve as a viable and potentially safer alternative to direct mandibular nerve blocks in cases of peripheral compression from tumor involvement.Abstract EP027 Figure 1Exophytic recurrent oral squamous cell carcinomaConclusions Ultrasound-guided maxillary nerve block via the pterygopalatine fossa is a safe, feasible option for managing focal orofacial pain in palliative head and neck cancer patients. It offers short-term relief and serve as a bridge to more definitive neurolytic techniques.