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Case Report/Case Series |

A Case of Trigeminocardiac Reflex During Infrastructure Maxillectomy

Suresh Mohan, BS1; Daniel W. Flis, MD2; Miriam A. O'Leary, MD2
[+] Author Affiliations
1Medical student at Warren Alpert Medical School of Brown University, Providence, Rhode Island
2Department of Otolaryngology–Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. 2014;140(6):563-564. doi:10.1001/jamaoto.2014.562.
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Importance  The trigeminocardiac reflex refers to the sudden development of bradycardia or even asystole with arterial hypotension from manipulation of any sensory branches of the trigeminal nerve. Although it has only rarely been associated with morbidity and tends to be self-limited with removal of the stimulus, it is an important phenomenon for head and neck surgeons to recognize and respond to.

Observations  We present the case of a woman in her late 60s with maxillary alveolar ridge squamous cell carcinoma who developed episodes of asystole and bradycardia during posterior maxillary manipulation for an infrastructure maxillectomy at a tertiary academic medical center. Administration of atropine and removal of the inciting stimulus sufficed to extinguish the episodes and allow procedure completion.

Conclusions and Relevance  The trigeminocardiac reflex can be provoked by a number of head and neck and skull base procedures including parotidectomy and posterior maxillectomy. Surgeons and anesthesiologists should be wary of inciting the reflex during manipulation of trigeminal branches. Careful dissection for prevention and early intervention with stimulus removal and anticholinergic use as needed are paramount to ensure good outcomes.

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