L Ortiz-Peces, M Álvaro-Martínez, Á-D Moreiras-Sánchez, G Chacón-Ferrer, M Andura-Correas, J-L Castillo-Pardo de Vera, L Ortiz-González, J-L Cebrián-Carretero
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引用次数: 0
Abstract
Background: The trigeminocardiac reflex (TCR) is a rare but clinically significant phenomenon characterized by bradycardia, hypotension, or asystole triggered by trigeminal nerve stimulation during maxillofacial surgery. It necessitates prompt recognition and management to ensure patient safety. TCR has been reported in orthognathic surgery, particularly during specific surgical maneuvers.
Material and methods: We report the case of a 36-year-old male who experienced TCR during bimaxillary orthognathic surgery. Detailed documentation of the patient's clinical characteristics, intraoperative events, and management strategies was included. Additionally, we conducted a systematic review of the literature using Medline, Embase, Web of Science, and Scopus databases to identify cases of TCR in orthognathic surgery published from 1989 onward. Keywords included "trigeminocardiac reflex," "orthognathic surgery," "Le Fort I," and "bilateral sagittal split osteotomy".
Results: We present the case of a patient who experienced transient bradycardia and asystole during mandibular manipulation and pterygomaxillary disjunction. The episode was successfully managed with atropine and cessation of triggering maneuvers. Additionally, a systematic review identified 10 cases of TCR in orthognathic surgery, most of which occurred during Le Fort I osteotomies, particularly during maxillary downfracture, followed by bilateral sagittal split osteotomies. Common manifestations included bradycardia and asystole. Management strategies involved cessation of surgical stimuli, administration of anticholinergic agents, and, in one severe case, cardiopulmonary resuscitation.
Conclusions: TCR in orthognathic surgery is a significant risk requiring vigilance and prompt management. Understanding its triggers, maintaining intraoperative monitoring, and employing preventive strategies, such as gentle manipulation and proper anesthesia protocols, are essential for optimizing patient safety.
背景：三叉神经心脏反射（TCR）是颌面外科手术中由三叉神经刺激引起的心动过缓、低血压或心脏骤停，是一种罕见但具有临床意义的现象。需要及时识别和管理，以确保患者安全。TCR在正颌手术中有报道，特别是在特定的手术操作中。材料和方法：我们报告一例36岁男性患者在双颌正颌手术中经历了TCR。详细记录了患者的临床特征、术中事件和处理策略。此外，我们使用Medline， Embase， Web of Science和Scopus数据库对文献进行了系统回顾，以确定1989年以来发表的正颌手术中TCR的病例。关键词包括“三叉心反射”、“正颌手术”、“Le Fort I”、“双侧矢状劈裂截骨”。结果：我们提出的情况下，病人经历短暂性心动过缓和心脏停止在下颌骨操作和翼颌分离。用阿托品和停止触发动作成功地控制了这一事件。此外，系统回顾了10例正颌手术中的TCR，其中大多数发生在Le Fort I截骨术中，特别是上颌下骨折，其次是双侧矢状面劈开截骨术。常见表现为心动过缓和心脏骤停。治疗策略包括停止手术刺激，给予抗胆碱能药物，在一个严重的病例中，心肺复苏。结论：正颌手术中发生TCR的风险较大，需要警惕并及时处理。了解其触发因素，保持术中监测，并采取预防策略，如轻柔操作和适当的麻醉方案，对于优化患者安全至关重要。
期刊介绍：
1. Oral Medicine and Pathology:
Clinicopathological as well as medical or surgical management aspects of
diseases affecting oral mucosa, salivary glands, maxillary bones, as well as
orofacial neurological disorders, and systemic conditions with an impact on
the oral cavity.
2. Oral Surgery:
Surgical management aspects of diseases affecting oral mucosa, salivary glands,
maxillary bones, teeth, implants, oral surgical procedures. Surgical management
of diseases affecting head and neck areas.
3. Medically compromised patients in Dentistry:
Articles discussing medical problems in Odontology will also be included, with
a special focus on the clinico-odontological management of medically compromised patients, and considerations regarding high-risk or disabled patients.
4. Implantology
5. Periodontology
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