Anesth Pain Med.  2019 Jul;14(3):255-258. 10.17085/apm.2019.14.3.255.

Trigeminocardiac reflex: sudden severe bradycardia during open reduction for temporomandibular joint dislocation: A case report

• Kim Y
• Ko Y
• Hong B
• Shin Y
• Noh C
• Lee S
• Hong S

• KMID: 2454808
• DOI: http://doi.org/10.17085/apm.2019.14.3.255

Abstract

BACKGROUND
The trigeminocardiac reflex (TCR), which occurs after stimulation of the territory of the trigeminal nerve, is very rarely reported to be caused by stimulation of the mandibular branch. We report a case of TCR in open reduction for temporomandibular joint (TMJ) dislocation. CASE: A 74-year-old female presented for TMJ dislocation. During open reduction of TMJ under general anesthesia, severe bradycardia (15 beats/min) occurred. Immediately 0.5 mg atropine was administered intravenously, and the surgical manipulation was stopped. After 30 seconds, heart rate normalized. During surgery, severe bradycardia occurred one more time. It disappeared spontaneously as soon as surgical manipulation was stopped. The surgery was completed uneventfully.
CONCLUSIONS
Because of the possibility of profound bradycardia, asystole, or even death when evoked, it is important to be aware of the trigeminocardiac reflex during manipulation of the mandibular divisions, especially during surgical stimulation of the TMJ.

Keyword

Bradycardia; Heart arrest; Temporomandibular joint; Trigeminal nerve; Trigeminocardiac reflex

MeSH Terms

Aged
Anesthesia, General
Atropine
Bradycardia*
Dislocations*
Female
Heart Arrest
Heart Rate
Humans
Reflex, Trigeminocardiac*
Temporomandibular Joint*
Trigeminal Nerve
Atropine

Figure

• 

  Fig. 1 Postoperative panoramic view shows Incision and wiring. White lines: skin incisions in both mandibular areas, white dashed lines: wiring in both mandibular angles.

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  Fig. 2 Trigeminocardiac reflex pathway. Stimulation of trigeminal branches triggers afferent signals to the Gasserian ganglion. This stimulation activates the trigeminal nucleus. Small internuncial nerve fibers connect premotor neurons in the nucleus ambiguus and the dorsal motor nucleus of the vagus nerve. V1: ophthalmic branch, V2: maxillary branch, V3: mandibular branch, T: trigeminal nucleus, A: nucleus ambiguus, X: vagus nerve.

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