Trigemino-Cardiac Reflex: A Phenomenon Neglected in Maxillofacial Surgery?

Abstract

Background Trigemino-cardiac reflex is a physiologic response of the body to pressure effects in the region of distribution of the trigeminal nerve. Oral and maxillofacial surgical procedures can induce the development of this reflex, which leads to significant changes in the heart rate and sinus rhythms. This study intends to evaluate the effects of this reflex in patients with facial fractures and its subsequent management. Patients and Methods A total of thirty-seven patients with facial fractures who reported to the Department of Oral and Maxillofacial Surgery at Basaveswar Teaching and General Hospital, Gulbarga during a period from July 2015-March 2016 were considered for the study. Results A male preponderance is observed with the most susceptible age group being 21-30 years. Twenty-three patients sustained mid-facial fractures alone, nine patients had isolated mandible fractures and five patients had fractures of both the mid-face and mandible. A relative bradycardia was observed in the patients with mid-facial trauma, both at the time of presentation and also during the surgical reduction of midfacial fractures which improved after completion of procedure in most of the patients. However, in two patients, the bradycardia progressed to a cardiac asystole during midface manipulation which required immediate halt of the procedure and intravenous administration of atropine. Conclusion Trigeminocardiac reflex though physiologic, which usually tends to subside without complications is not to be neglected in the surgeries of the maxillofacial skeleton. A propensity for unforeseen complications due to this reflex has to be avoided by meticulous monitoring of the ECG.

Sudden arrhythmia followed by bradycardia during sagittal split ramus osteotomy: trigeminocardiac reflex

“…While TCR is generally expressed as bradycardia,6 this case is notable in that prominent supraventricular arrhythmia first appeared and led to bradycardia; accordingly, intravenous lidocaine and an anticholinergic agent were administered simultaneously, instead of anticholinergic agents alone, and were protective. Although TCR rarely occurs in orthognathic surgery, with a reported incidence of 1%–2%,7 clinicians should be aware of the possibility of TCR and able to judge and manage it promptly.…”

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures

“…TCR, a sudden decrease in pulse rate i.e., bradycardia and mean arterial blood pressure (MABP) but also apnoea and gastric hypermotility during stimulation of any branches of the trigeminal nerve. The pressure induced by the neural reflexes on the trigeminal nerve causes vagal stimulation leading to bradycardia [ 1 , 2 ]. In 1987, Bainton and Lizi [ 3 ], and Loewinger et al [ 4 ], suggested that TCR can be elicited by stimulating afferent paths other than the ciliary nerves (branches of the ophthalmic division of the trigeminal nerve) which are classically associated with the oculocardiac reflex .…”

“…Trigeminocardiac reflex (TCR) which was traditionally known as the oculocardiac reflex is a rare physiologic phenomenon that can be seen during a surgical procedure in the maxillofacial region. TCR was first observed by Kratschmer in 1870 [ 1 ]. Later, in 1908 a peripheral variant of TCR was observed by Aschner and Dagini and hence was then popularly known as Aschner-Dagini Reflex.…”

Case report: 2 cases of cardiac arrest caused by rhino-cardiac reflex while disinfecting nasal cavity before endonasal transsphenoidal endoscopic pituitary surgery

“…TCR most commonly occurs in maxillofacial surgery and direct traction stimulation of the trigeminal nerve branches during neurosurgery. TCR has been reported occasionally in skull base surgery and maxillofacial surgery [ 5 , 6 ]. It commonly happens in endoscopic sinus surgery with nasal packing or transsphenoidal approach for resection of pituitary adenomas [ 7 ].…”