TRIGEMINO CARDIAC REFLEX IN ORAL & MAXILLOFACIAL SURGERY – A REVIEW

Abstract

Trigemino cardiac reflex (TCR) which was originally called as OCCULOCARDIAC REFLEX is a physiological response due to the pressure effect on the largest cranial nerve, the trigeminal nerve. Oral and maxillofacial procedures can induce the development of this reflex. TCR is a triad of bradycardia , bradypnea and gastric motility changes due to the efferent activation of the vagal nerve in response to the pressure distribution in Trigeminal nerve. TCR may be generated as a result of procedures or conditions that increase intraocular pressure, strabismus surgery, nasal packing after rhinoplasty, the reduction of zygoma and zygomatic arch fractures, elevation of bone flap or osteotomies, reflection of a palatal flap for removal of a mesiodens, during Le Fort I downfractures, sagittal split ramus retraction, midface disimpaction, cutting maxillary tuberosity, and temporomandibular joint arthroscopy. The purpose of this paper is to discuss the pathophysiology and to review the main risk factors , treatment, prevention and management with emphasis on the role of maxillofacial surgeons and attending anesthetist. Maxillofacial surgeons should be familiar with presentations, preventive measures for the effective management of this complication.