Intraoperative cardiac arrest etiologies in head and neck surgery: A comprehensive review

Abstract

With a firm understanding of the mechanistic underpinning of this rare phenomenon, otolaryngologic surgeons can be better prepared for its occurrence.

Trigeminocardiac reflex in pediatric adenotonsillectomy: A report of two cases with literature review

“…This study presents two pediatric cases of TCR during mouth retraction in adenotonsillectomy surgery, both resolved with removal of the mechanical stimulation alone. Early intraoperative recognition by the surgeon and anesthesiologist allows for timely removal of the mechanical stimulus to circumvent the TCR and prevent complications such as ischemia, or even death, especially in the vulnerable pediatric population …”

“…Overstimulation of the maxillary branch of the trigeminal nerve (cranial nerve [CN] V2) leading to TCR can occur with craniofacial surgeries, such as Le Fort I osteotomies, midface fracture plating, and zygomatic arch fracture reduction . Sinus surgery can also induce TCR, as CN V2 innervates the nasal passages and cavernous sinus wall . Temporomandibular joint arthroscopy or manipulation of the mandibular condyle during fracture repair can lead to TCR due to overstimulation of the auriculotemporal nerve, a branch of the mandibular branch of CN V (CN V3) .…”

“…4,11 Sinus surgery can also induce TCR, as CN V2 innervates the nasal passages and cavernous sinus wall. 3,6 Temporomandibular joint arthroscopy or manipulation of the mandibular condyle during fracture repair can lead to TCR due to overstimulation of the auriculotemporal nerve, a branch of the mandibular branch of CN V (CN V3). 5 Skull base surgeries, such as cerebellopontine tumor resections and transsphenoidal surgery, can also disturb the trigeminal nerve and lead to TCR.…”

“…Mechanical stretching, pressure, or movement of any of the three branches of the trigeminal nerve can lead to TCR intraoperatively. Common otolaryngology procedures associated with TCR include Le Fort I osteotomies, midface fracture plating, mandibular condyle manipulation, and skull base surgery . There is a theoretically increased risk of TCR in the pediatric population due to a higher baseline vagal tone in children, although there are few studies describing this phenomenon in children .…”

“…Common otolaryngology procedures associated with TCR include Le Fort I osteotomies, midface fracture plating, mandibular condyle manipulation, and skull base surgery. [3][4][5][6][7] There is a theoretically increased risk of TCR in the pediatric population due to a higher baseline vagal tone in children, although there are few studies describing this phenomenon in children. [8][9][10] This study presents two pediatric cases of TCR during mouth retraction in adenotonsillectomy surgery.…”