Delayed Trigeminocardiac Reflex Induced by an Intraorbital Foreign Body

Abstract

Objective: To emphasize the importance of the mechanism and surgical approach to trigeminocardiac reflex (TCR) developing 48 h after orbital trauma due to a foreign body. Case Report: After gunshot injury of a 17-year-old male patient, computerized tomography evaluation revealed a right globe perforation and an intraorbital metallic foreign body in the right orbita adjacent to the lateral wall. The ocular perforation was repaired, but the foreign body was not removed. Constant bradycardia (45/min) developed 48 h after the operation. Since there were no cardiological findings, a temporary cardiac pacemaker was inserted and on the 6th postoperative day, the foreign body was removed through orbitolateral approach. After the removal of the foreign body, bradycardia completely recovered. Conclusion: In the presence of an intraorbital foreign body accompanied by globe perforation, TCR may develop 48 h after the trauma and insertion of a temporary pacemaker may be required to control the cardiac rhythm. In this paper, the delayed TCR complication presented an indication for the removal of the intraorbital foreign body.

Use of polyetheretherketone (PEEK) in orbital floor fracture reconstruction – A case for concern

“…Previous reports of delayed OCR seen postoperatively were in cases where foreign bodies were present within the orbital cavity [13,14]. In cases with postoperative presentation, it is likely that pressure to the globe by these foreign objects may well be the stimuli for OCR.…”

Bradicardia Induced by Intraocular Foreign Body: Case Report

“…sağ göz perforasyonu olan 17 yaşında bir olguda perforasyon onarımından 48 sonra bradikardinin devam ettiğini, geçici kardiyak "pace-maker" takıldığını, postoperatif altıncı gün sağ orbita yan duvarında saptanan yabancı cisim çı-karıldıktan sonra kalp ritminin normale döndü-ğünü bildirmişlerdir. 9 Göz cerrahileri sırasında sebat eden bradikardi durumunda ilk seçenek antikolinerjik ajanların uygul anmasıdır. Ancak antikolinerjiklere yanıt alı-namadığında EPM takılması düşünülebilir.…”

The Incidence of Trigeminocardiac Reflex in Endovascular Treatment of Dural Arteriovenous Fistula with Onyx

“…TCR can be elicited by stimulating the afferent pathway not only from ciliary nerves but also from sensory branches of maxillary and mandibular divisions of the trigeminal nerve 15 . Induced TCR during corrections of craniofacial and maxillofacial deformities has been described 14,15,22,24 . But until recently, TCR was described as a complication of Onyx embolization for DAVFs 25 .…”