Original Article

Evaluation of trigeminocardiac reflex during Le Fort I and sagittal split ramus osteotomies

Abstract

Introduction:  The  trigeminocardiac  reflex  (TCR)  refers  to  the  sudden development of bradycardia as well as asystole along with arterial hypotension associated with any manipulation of sensory branches of the trigeminal nerve. Clinically, the TCR has been reported to occur during craniofacial surgery. It is crucial to learn about this sudden physiological response during maxillofacial surgery that is likely to happen with any craniofacial surgical procedures. Materials and Methods: In  this clinical study 44 volunteers without any systemically compromising conditions were divided into 2 groups. The first group underwent Le Fort I osteotomy and the second mandibular osteotomy. Mean  arterial  blood  pressure  and  pulse  rate  (MABP1,  PR1)  values  were recorded before down fracture (DF) of maxilla and Sagittal Splitting (SS) of mandible, during DF and SS (MABP2, PR2), and after DF and SS (MABP3, PR3). The data were analyzed using repeated measure ANOVA tests (p =0.05).Result: In Le Fort I group, PR1 and PR3 were significantly higher than PR2 (P< .001). MABP2 was significantly lower compared with MABP1 and MABP3 (P < .001). PR2 and MABP2 showed a mean decrease of 7.4% and 8.9%  compared  with  PR1  and  MABP1,  respectively.  In  second  group differences on MABP and PR was not statistically significant.Conclusion: It is concluded that TCR is triggered by the stimulation of V2 but V3 branch stimulation does not cause such reflex.

Roberts RS, Best JA, Shapiro RD.Trigeminocardiac reflex during temporomandibular joint arthroscopy: report of a case. J Oral Maxillofac Surg 1999;57:854.

Schaller B. Trigeminocardiac reflex. A clinical phenomenon or a new physiological entity? J Neurol 2004;25:658-65.

Shelly MP, Church JJ. Bradycardia and facial surgery [letter]. Anaesthesia 1988; 43:422.

Bainton R, Lizi E. Cardiac asystole complicating zygomatic arch fracture. Oral Surg Oral Med Oral Pathol 1987;64:24- 5.10.

Lübbers HT, Zweifel D, Grätz KW, Kruse A.Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral MaxillofacSurg 2010;68(6):1317–1321.

Bohluli B, Ashtiani AK, Khayampoor A, Sadr- Eshkevari P. Trigeminocardiac reflex: a MaxFax literature review. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2009; 108 (2): 184-8.

Barnard NA, Bainton R. Bradycardia and the trigeminal nerve. JcraniomaxillofacSurg 1990;18 (8):359-60.

Robideaux V. Oculocardiac reflex caused by midface disimpaction. Anesthesiology 1978;49(6):433.

Bainton R, Barnard N, Wiles JR, Brice J. Sinus arrest complicating a bitemporal approach to the treatment of pan-facial fractures. Br J Oral MaxillofacSurg 1990; 28 (2):109-10.

Precious DS, Skulsky FG. Cardiac dysrhythmias complicating maxillofacial surgery. Int J Oral MaxillofacSurg 1990; 19 (5):279-82.

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IssueVol 2, No 1-2 (Winter/Spring 2015) QRcode
SectionOriginal Article(s)
Keywords
Trigeminocardiac reflex (TCR) Le Fort Osteotomy Sagittal split ramus osteotomy
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Shirani G, Momeni M, Mahmoudi M. Evaluation of trigeminocardiac reflex during Le Fort I and sagittal split ramus osteotomies. J Craniomaxillofac Res. 2015;2(1-2):83-85.