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Kharia A, Janardhana Rao S, Dubey V, Bhatt S, Bhatt D, Baig F. Oculocardiac Reflex in a Patient With Maxillofacial Trauma: A Case Study and Literature Review. Cureus 2024; 16:e59528. [PMID: 38827001 PMCID: PMC11144039 DOI: 10.7759/cureus.59528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Oculocardiac reflex (OCR), presenting as bradycardia and asystole, is a potential intraoperative complication that may occur during maxillofacial trauma surgery. Bradycardia is the most common symptom of this phenomenon. Surgeons should be aware of its long-term effects, such as arrhythmias and even cardiac arrest. We report the case of a 40-year-old male patient with a fracture of the floor of the orbit. During a surgical exploration of the orbital floor, the patient exhibited sudden symptoms of OCR. It was managed by withholding the surgery and administering atropine. The article also highlights the mechanism, types, incidence, and management of OCR in patients with maxillofacial trauma.
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Affiliation(s)
- Ayush Kharia
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Center, Bhopal, IND
| | | | - Vertika Dubey
- Department of Oral and Maxillofacial Surgery, Private Dental Clinic, Bhopal, IND
| | - Sumit Bhatt
- Department of Oral and Maxillofacial Surgery, Rajasthan Dental College and Hospital, Jaipur, IND
| | - Drishti Bhatt
- Department of Oral and Maxillofacial Surgery, Divya Jyoti College of Dental Sciences and Research Centre, Modinagar, IND
| | - Fawaz Baig
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, SAU
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Xi L, Liu X, Shi H, Han W, Gao L, Wang L, Liu J, Ren Y, Du Y, Liu G. Comparative safety and efficacy of percutaneous radiofrequency thermocoagulation and percutaneous balloon compression in CT-guided and local anesthesia for recurrent trigeminal neuralgia. Front Neurol 2024; 14:1336261. [PMID: 38249730 PMCID: PMC10797886 DOI: 10.3389/fneur.2023.1336261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Background There are several ways to treat trigeminal neuralgia (TN); however, TN may recur after treatment. Although microvascular decompression (MVD) is considered an effective treatment for trigeminal neuralgia, patients with recurrence may not be willing to undergo craniotomy. Objective This study compared the safety and efficacy of percutaneous radiofrequency thermocoagulation and percutaneous balloon compression for treating recurrent trigeminal neuralgia. Methods This was a prospective non-randomized controlled study. A total of 52 with recurrent TN were scheduled to undergo surgery in our Hospital from January-June 2021. The patients were classified into percutaneous radiofrequency thermocoagulation (PRT) and percutaneous balloon compression (PBC) groups based on the treatment. All surgeries were performed under computed tomography guidance and local anesthesia. Post-operative complications were also observed. Pain was assessed using the visual analog scale (VAS) and Barrow Neurological Institute (BNI) scale. Efficacy indices were evaluated at 3, 6, 12, and 18 months after surgery. Results During follow-up, the efficacy rates of the two methods within 18 months were 76.0 and 88.9%, respectively. All patients had hypoesthesia on the affected side, and no severe complications. Notably, 5 patients (20%) in the PRT group with multiple-branch pain, including the first branch of the trigeminal nerve (V1) pain in the PRT group, received radiofrequency therapy for the supraorbital notch (foramen) after puncture of the foramen ovale. However, multiple pain episodes resolved with only one operation in the PBC group. Conclusion CT-guided percutaneous radiofrequency thermocoagulation and percutaneous balloon compression under local anesthesia may be good options for treating recurrent trigeminal neuralgia. Percutaneous balloon compression may be recommended when multiple branches are involved, particularly in cases of V1 neuralgia.
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Affiliation(s)
- Lulu Xi
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaohui Liu
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hongchen Shi
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wenbiao Han
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liqin Gao
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li Wang
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Junpeng Liu
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yue Ren
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuanyuan Du
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Guangzhao Liu
- Department of Pain, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Pitak-Arnnop P, Meningaud JP, Neff A. Supramuscular upper blepharoplasty approach to orbital roof and/or lower anterior table frontal sinus fractures: A meta-narrative review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:645-654. [PMID: 35605961 DOI: 10.1016/j.jormas.2022.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND An approach to orbital roof fractures (ORFs) and/or lower anterior table frontal sinus fractures (LATFSFs) is a challenging task. The conventional coronal approach (CCA) appears to suit multiple/complex fractures of the upper face, while periorbital transcutaneous incisions (PTIs), e.g. gull wing, open sky, butterfly, and Lynch incisions, often impair aesthetic outcomes. The aims of this paper were to provide an overview of the supramuscular upper blepharoplasty approach (SUBA) to ORFs/LATFSFs. METHODS Using a meta-narrative review study design, the investigators enrolled published data extracted from PubMed/Medline, Embase, Cochrane Library, and Google Scholar concerning SUBA to ORFs/LATFSFs. Only publications with the highest and most recent level of evidence (LoE) in English, French or German available until 6 May 2022 were included. The LoE were evaluated using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM)'s classification. RESULTS In total, 70 articles were included; however, most contained low LoE. Under general and local anaesthesia, SUBA to ORFs/LATFSFs can be performed safely and appeared to be superior to its submuscular counterpart in terms of fewer risks of adjacent tissue injuries, and speedy operative time (maximal 5 min. in experienced hands). CONCLUSIONS In contrast to CCA and PTIs, the SUBA is a minimally invasive approach to the ORF/LATFSF with favourable aesthetic outcomes, direct visualisation of the fracture, quick operative time, rare complications, and easy learning.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Anto R, Riju J, Vidya K, Tirkey AJ. Trigeminocardiac Reflex as a Complication of Excision of Schwannoma of the Trigeminal Nerve - A Rare Clinical Case Report. Ann Maxillofac Surg 2022; 12:216-218. [PMID: 36874786 PMCID: PMC9976868 DOI: 10.4103/ams.ams_141_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 01/12/2023] Open
Abstract
Rationale Trigeminal schwannoma (TS) is a very rare tumour in the head-and-neck region and the occurrence of intraoperative trigeminocardiac reflex (TCR), during surgery, should not be underestimated. The physiological function of this rare brainstem reflex is yet to be fully established. Patient Concerns TCR occurs in a variety of surgeries, such as neurosurgical, maxillofacial, dental and skull base surgeries with bradycardia as the presenting sign. Diagnosis This is a clinical profile of two patients who presented with schwannoma of the trigeminal nerve. Outcomes Intraoperatively, during dissection of tumour, both patients had bradycardia with hypotension. Treatment The first patient had a spontaneous recovery but the other required intervention with vasopressors. Take-Away Lessons One must be aware of the rare occurrence of TCR mainly while operating on a rare occurring TS. Ceaseless intraoperative monitoring and being prepared with adequate measures while manipulating close to the nerve will prevent serious complications.
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Affiliation(s)
- Ronald Anto
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jeyashanth Riju
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Konduru Vidya
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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Mhamunkar PA, Kolari V, Sequeira J. Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures. Cureus 2022; 14:e22281. [PMID: 35350519 PMCID: PMC8932403 DOI: 10.7759/cureus.22281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Aim Trigeminocardiac reflex (TCR) manifests as typical hemodynamic perturbations including a sudden lowering of heart rate, mean arterial blood pressure (MABP), cardiac arrhythmias, and asystole. In literature, TCR has been seen during ocular surgeries, Lefort fractures, and craniofacial surgeries. However, the prevalence of the TCR has not been studied in zygomatic complex fractures . The aim of this study was to assess the prevalence of TCR in patients undergoing elevation with/without fixation of zygomatic complex fractures and isolated zygomatic arch fractures under local anesthesia and general anesthesia and to evaluate the prevalence of TCR in different age groups. Materials and methods The study comprised 26 participants diagnosed with zygomatic fractures indicated for surgical intervention. The aim of the study was to find the prevalence of TCR in patients undergoing surgical intervention (elevation of zygomatic complex fractures with/without fixation) under local anesthesia and general anesthesia. The heart rate and blood pressure were measured preoperatively, intraoperatively and postoperatively. Results Variation in heart rate was seen in patients undergoing surgery under local anesthesia and general anesthesia. However, a decrease in the heart rate i.e., bradycardia was noted intra-operatively in 75% of the patients operated under local anesthesia. The prevalence of TCR was noted intra-operatively in 23% of cases operated under general anesthesia. No significant changes were seen in the blood pressure of the patients. Conclusion In our study, we found out that the prevalence of TCR was more in the patients operated under local anesthesia i.e., 75% of patients. Out of the patients operated under general anesthesia i.e., 23% of patients showed TCR. No significant variations in blood pressure were observed in patients operated under local anesthesia or general anesthesia. The prevalence of TCR was found more often in the age group of 31-45 years in our study.
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Maurya H, Singh V, Mohammad S, Singh G, Aggrawal A, Gautam S, Tiwari T. Perioperative trigeminocardiac reflex in patients undergoing surgical treatment of temporomandibular joint ankylosis: A study. Natl J Maxillofac Surg 2022; 13:248-253. [PMID: 36051797 PMCID: PMC9426709 DOI: 10.4103/njms.njms_334_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/10/2021] [Accepted: 07/23/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose The behavior of trigeminocardiac reflex (TCR) is limited to few case reports only in maxillofacial surgery, especially for temporomandibular joint (TMJ) ankylosis cases. The present study aims to find out the incidence of bradycardia due to TCR during intraoperative forceful mouth opening in TMJ ankylosis patients. Materials and Methods A prospective, unicentric observational study was conducted selecting those patients who were planned for osteoarthrectomy with interpositional gap arthroplasty under general anesthesia. Sixty cases of TMJ ankylosis were randomly selected from December 2018 to-03-2020. Predictor variables were patient age, gender, and type of ankylosis, and outcome variables were pulse rate, mean arterial blood pressure (MABP), and oxygen saturation level (SPO2). Data were recorded at baseline and during intraoperative mouth opening via heister jaw stretcher. A Chi-square test was used for testing the association between variables. P values were considered statistically significant at <0.05. Results The sample size of 60 subjects has been divided into two age groups (10-19) years and (20-40) years. The mean standard deviation age of the patients was 18.32 ± 6.81 years. About 63.3% were male. Out of 60 cases, 14 patients developed bradycardia. The frequency of bradycardia was found 23.3%. According to logistic regression analysis, age and type of ankylosis were the significant predictors of bradycardia. Conclusion We conclude that bradycardia due to TCR in TMJ ankylosis patients is not an uncommon entity. Incidences are more prevalent in the age group of 10-19 years and type IV bony ankylosis. Male had a high incidence of bradycardia though P value was nonsignificant.
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Affiliation(s)
- Harshita Maurya
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vibha Singh
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Vibha Singh, Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow - 226 003, Uttar Pradesh, India. E-mail:
| | - Shadab Mohammad
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Geeta Singh
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amiya Aggrawal
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shefali Gautam
- Department of Anaesthesia and Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tanmay Tiwari
- Department of Anaesthesia and Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Hoshijima H, Takeuchi R, Kikuchi K, Mizuta K. Asystole Triggered by the Mouth Opening With a Dental Mouth Gag Under General Anesthesia During Pediatric Oral Surgery: Report of a Rare Case. J Oral Maxillofac Surg 2021; 79:1862-1865. [PMID: 33939962 DOI: 10.1016/j.joms.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
The trigeminovagal reflex manifests as a sudden onset of bradycardia, hypotension, and cardiac arrest in response to the stimulation of the trigeminal nerve. The incidence of trigeminovagal reflex in maxillofacial surgical procedures is approximately 1.6%. We report a case of asystole in a pediatric patient in whom a dental mouth gag triggered the trigeminovagal reflex during oral surgery. The patient was a 5-year-old boy who was scheduled to undergo extraction of maxillary supernumerary teeth. After tracheal intubation, anesthesia was maintained with sevoflurane and remifentanil. At the beginning of the surgery, his mouth was opened with a dental mouth gag, and electrocardigram showed asystole for 20 seconds. Thereafter, his heart rate spontaneously returned to basal value within 60 seconds. Since sufficient mouth opening was required to conduct the surgery, his mouth was opened again with the gag. When the interincisal distance exceeded about 40 mm, his heart rate suddenly decreased, but spontaneously returned to baseline within 60 second. The subsequent anesthetic course was uneventful.
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Affiliation(s)
- Hiroshi Hoshijima
- Associate Professor, Division of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry Sendai, Miyagi, Japan.
| | - Risa Takeuchi
- Chief Anesthesiologist, Bunkoukai Special Needs Center, Sakura, Tochigi, Japan
| | - Kimiharu Kikuchi
- Chief Dentist, Bunkoukai Special Needs Center, Sakura, Tochigi, Japan
| | - Kentaro Mizuta
- Chief Professor, Division of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
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8
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Zoizner-Agar G, Frants A, Puzzuti J, Kameyama M, Rickert S. Bradycardia and hypotension necessitating CPR in a healthy adolescent following injection of a local anesthetic into the nasal septum: A case report, review of the literature and suggested immediate management. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2020.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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9
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Brasileiro BF, Sickels JEV, Cunningham LL. Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis. J Korean Assoc Oral Maxillofac Surg 2020; 46:428-434. [PMID: 33377469 PMCID: PMC7783186 DOI: 10.5125/jkaoms.2020.46.6.428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/31/2018] [Accepted: 11/17/2018] [Indexed: 11/07/2022] Open
Abstract
Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos and restriction of ocular movement; yet the timing of surgery can be delayed up to two weeks with good functional outcomes. In contrast, an orbital trapdoor defect with entrapment of the inferior rectus muscle usually elicits pain with marked restriction of the upward gaze and activation of the oculocardiac reflex without significant dystopia or enophthalmos. When autonomic cardiac derangement is diagnosed along with an orbital floor fracture, it has been suggested that the fracture should be treated immediately. Otherwise, it will result in continued hemodynamic instability and muscular injury and may require a second surgery. This article reports the management of an unusual presentation of a trapdoor blowout orbital floor fracture surgery with oculocardiac response in an adult, with emphasis on its pathophysiology, management, and differential diagnosis.
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Affiliation(s)
| | - Joseph E Van Sickels
- Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, Lexington, KY, USA
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Flannery KM, Yu JW, Resnick CM, Evans FM. Bradycardia and asystole during temporomandibular joint reconstruction. Paediatr Anaesth 2020; 30:1146-1148. [PMID: 32741014 DOI: 10.1111/pan.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 11/28/2022]
Abstract
Anesthesia providers are familiar with the oculocardiac reflex, one type of trigeminocardiac reflex. While less common, arrhythmias associated with manipulation of other trigeminal nerve branches can occur. We report the presentation and management of bradycardia and asystole from stimulation of the mandibular branch of the trigeminal nerve during temporomandibular joint reconstruction.
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Affiliation(s)
- Kaitlin M Flannery
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jason W Yu
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cory M Resnick
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Faye M Evans
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Maharaj K, Cedrola R, Mirza T. Asystole during Le Fort 1 osteotomy: the trigeminovagal reflex. Ann R Coll Surg Engl 2020; 102:e1-e3. [PMID: 32513016 DOI: 10.1308/rcsann.2020.0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The trigeminovagal reflex is a phenomenon that occurs rarely during maxillofacial surgery. Previously described as the oculocardiac reflex, this reflex can occur during ocular and periocular surgery. To be more anatomically precise, it was renamed the trigeminocardiac or trigeminovagal reflex, since stimulation of any part of the trigeminal nerve can elicit this reflex arc. We describe a case of asystole during mobilization of a maxilla following a Le Fort 1 osteotomy.
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Affiliation(s)
- K Maharaj
- Bedfordshire Hospitals NHS Foundation Trust, UK
| | - R Cedrola
- Bedfordshire Hospitals NHS Foundation Trust, UK
| | - T Mirza
- Bedfordshire Hospitals NHS Foundation Trust, UK
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Dos Santos DM, Politti F, de Azevedo LMA, de Cassia das Neves Martins R, Ricci FC, Masuda KSY, do Nascimento EMM, Spinato IL, de Paula Gomes CAF, Biasotto-Gonzalez DA. Association between convergence insufficiency and temporomandibular disorder cross-sectional study. Clin Oral Investig 2020; 25:851-858. [PMID: 32500402 DOI: 10.1007/s00784-020-03372-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Evaluate whether there is an association between convergence insufficiency and temporomandibular disorder (TMD) and whether there is an association between pain and range of motion in different degrees of TMD. METHODS We evaluated 138 individuals with TMD and 46 without TMD using the Research Diagnostic Criteria for temporomandibular disorders, the Fonseca Anamnestic Index (FAI), Numeric Pain Rating Scale, and the measurement of mandibular range of motion (ROM). Convergence insufficiency was diagnosed using the convergence test and Convergence Insufficiency Symptom Survey. Analysis of variance was used to compare age and mandibular ROM. The Kruskal-Wallis was used to compare mandibular ROM and pain between groups. The chi-square test was used to evaluate associations between TMD subgroups and the FAI, sex, and ocular convergence. RESULTS The majority of individuals without TMD did not exhibit convergence insufficiency. The frequency convergence insufficiency was significantly higher among individuals with severe TMD (p < 0.003). Mean pain severity differed between individuals with and without TMD. Mandibular ROM diminished with the increase in TMD severity. CONCLUSIONS Convergence insufficiency, age, the increase in pain, and the reduction in mandibular range of motion were associated with the degrees of TMD severity. Despite the significant associations between convergence insufficiency and both pain and TMD severity, these variables cannot be indicated as predictive factors due to the low variability in the linear regression analysis. CLINICAL RELEVANCE The present findings can assist in decision making regarding the treatment of severe TMD and the evaluation of ocular convergence.
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Affiliation(s)
- Douglas Meira Dos Santos
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho-UNINOVE, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Fabiano Politti
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho-UNINOVE, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Ludmila Menezes Alves de Azevedo
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho-UNINOVE, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Rita de Cassia das Neves Martins
- Physical Therapy Department, Universidade Nove de Julho-UNINOVE, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Felipe Cunha Ricci
- Physical Therapy Department, Universidade Nove de Julho-UNINOVE, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Kelly Sayuri Yun Masuda
- Physical Therapy Department, Universidade Nove de Julho-UNINOVE, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, 01504-001, Brazil
| | | | - Itana Lisane Spinato
- Postgraduate Program in Morphofunctional Sciences, Universidade Federal do Ceará, Av. da Universidade, 2853, Benfica, Fortaleza, CE, 60020-181, Brazil
| | - Cid Andre Fidelis de Paula Gomes
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho-UNINOVE, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Daniela Aparecida Biasotto-Gonzalez
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho-UNINOVE, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, 01504-001, Brazil.
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Aggarwal K, Prasad V, Singh AK. Bradycardia in Maxillofacial Surgery. Indian J Plast Surg 2020; 53:166-168. [PMID: 32367940 PMCID: PMC7192689 DOI: 10.1055/s-0040-1709918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Krittika Aggarwal
- Department of Plastic Surgery, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Veerendra Prasad
- Department of Plastic Surgery, King George Medical College, Lucknow, Uttar Pradesh, India
| | - A K Singh
- Department of Plastic Surgery, King George Medical College, Lucknow, Uttar Pradesh, India
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Bloch M. Oculocardiac reflex: 'My heart just stopped'. Emerg Med Australas 2018; 30:592-593. [PMID: 29797424 DOI: 10.1111/1742-6723.13113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mathew Bloch
- Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Hamarat Y, Bartusis L, Deimantavicius M, Siaudvytyte L, Januleviciene I, Ragauskas A, Bershad EM, Fandino J, Kienzler J, Remonda E, Matijosaitis V, Rastenyte D, Petrikonis K, Berskiene K, Zakelis R. Graphical and statistical analyses of the oculocardiac reflex during a non-invasive intracranial pressure measurement. PLoS One 2018; 13:e0196155. [PMID: 29672564 PMCID: PMC5909620 DOI: 10.1371/journal.pone.0196155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/06/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study aimed to examine the incidence of the oculocardiac reflex during a non-invasive intracranial pressure measurement when gradual external pressure was applied to the orbital tissues and eye. METHODS Patients (n = 101) and healthy volunteers (n = 56) aged 20-75 years who underwent a non-invasive intracranial pressure measurement were included in this retrospective oculocardiac reflex analysis. Prespecified thresholds greater than a 10% or 20% decrease in the heart rate from baseline were used to determine the incidence of the oculocardiac reflex. RESULTS None of the subjects had a greater than 20% decrease in heart rate from baseline. Four subjects had a greater than 10% decrease in heart rate from baseline, representing 0.9% of the total pressure steps. Three of these subjects were healthy volunteers, and one was a glaucoma patient. CONCLUSION The incidence of the oculocardiac reflex during a non-invasive intracranial pressure measurement procedure was very low and not associated with any clinically relevant effects.
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Affiliation(s)
- Yasin Hamarat
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Laimonas Bartusis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Mantas Deimantavicius
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Lina Siaudvytyte
- Eye Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Arminas Ragauskas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Eric M. Bershad
- Department of Neurology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Jenny Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Elke Remonda
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Vaidas Matijosaitis
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Rastenyte
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kestutis Petrikonis
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Berskiene
- Sports Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rolandas Zakelis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
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Bush B, Tobias JD, Lin C, Ruda J, Jatana KR, Essig G, Cooper J, Tumin D, Elmaraghy CA. Postoperative bradycardia following adenotonsillectomy in children: Does intraoperative administration of dexmedetomidine play a role? Int J Pediatr Otorhinolaryngol 2018; 104:210-215. [PMID: 29287870 DOI: 10.1016/j.ijporl.2017.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Dexmedetomidine is a novel pharmacologic agent that has become a frequently used adjunct during care of pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy. While generally safe and effective, dexmedetomidine is associated with adverse effects of hypotension and bradycardia from its central sympatholytic effects. Due to safety concerns, our institution routinely admits patients with OSA for overnight cardiorespiratory monitoring following tonsillectomy. With such monitoring, we have anecdotally noted bradycardia in our patients and sought to investigate whether this was related to the increased use of intra-operative dexmedetomidine. METHODS We retrospectively reviewed records over an 11-month period to compare the incidence of postoperative bradycardia following hospital admission for tonsillectomy in patients who received dexmedetomidine versus those who did not. RESULTS The study cohort included 921 patients (371 received dexmedetomidine and 550 did not). Bradycardia was asymptomatically noted in 66 patients (7.2%). No patient required medical intervention for the bradycardia or developed clinical symptoms. There was no association of bradycardia with the intra-operative administration of dexmedetomidine (8.9% of patients who received dexmetomidine vs. 9.4% who did not). In multivariable analysis, bradycardia was more common among older patients, with the administration of topical or injected lidocaine, and with specific associated procedures (inferior turbinate coblation with out-fracture or direct laryngoscopy and bronchoscopy). CONCLUSION The increased incidence of asymptomatic bradycardia in our post-adenotonsillectomy patients seemed to relate more to increased utilization of postoperative cardiac telemetry, and did not appear associated with the use of dexmedetomidine use intra-operatively.
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Affiliation(s)
- Benjamin Bush
- Department of Otolaryngology, Baptist Health System, Jacksonville, FL, United States
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, United States; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Chen Lin
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, United States
| | - James Ruda
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, United States; Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center and The Ohio State University College of Medicine, Columbus, OH, United States
| | - Kris R Jatana
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, United States; Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center and The Ohio State University College of Medicine, Columbus, OH, United States
| | - Garth Essig
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, United States; Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center and The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jennifer Cooper
- The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, OH, United States
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, United States.
| | - Charles A Elmaraghy
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, United States; Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center and The Ohio State University College of Medicine, Columbus, OH, United States
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Sokolov AY, Murzina AA, Osipchuk AV, Lyubashina OA, Amelin AV. Cholinergic mechanisms of headaches. NEUROCHEM J+ 2017. [DOI: 10.1134/s1819712417020131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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18
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Zou J, Luo C, Liu Z, Cheng C. Cardiac arrest without physical cardiac injury during Nuss repair of pectus excavatum. J Cardiothorac Surg 2017; 12:61. [PMID: 28738822 PMCID: PMC5525361 DOI: 10.1186/s13019-017-0624-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 07/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac arrest is a lethal complication of Nuss repair of pectus excavatum which is strongly related to heart or big vessels injury. A rare case developed cardiac arrest without direct cardiac injury during Nuss procedure is presented in this article. CASE PRESENTATION In July 2015, a previously healthy 18-year-old man undergoing Nuss repair for pectus excavatum developed cardiac arrest while the Nuss bar was being inserted into the chest. After successful resuscitation and exclusion of direct cardiac injury, the Nuss procedure was continued. The patient suffered a second cardiac arrest during rotation of the Nuss bar. This time, the patient had poor initial response to resuscitation and defibrillation until the retrosternal bar was removed. He ultimately recovered well from the episodes of cardiac arrest, but was unable to receive surgical correction of his pectus excavatum deformity. CONCLUSIONS The possible mechanisms of cardiac arrest and lessons we can learn from this complication are discussed.
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Affiliation(s)
- Jianyong Zou
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Canqiao Luo
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Zhenguo Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China
| | - Chao Cheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China.
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Trigeminocardiac reflex. Br J Oral Maxillofac Surg 2017; 55:445-446. [DOI: 10.1016/j.bjoms.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022]
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Joshi UM, Munnangi A, Shah K, Patil SG, Thakur N. Trigemino-Cardiac Reflex: A Phenomenon Neglected in Maxillofacial Surgery? J Maxillofac Oral Surg 2016; 16:181-185. [PMID: 28439158 DOI: 10.1007/s12663-016-0959-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 09/01/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Trigemino-cardiac reflex is a physiologic response of the body to pressure effects in the region of distribution of the trigeminal nerve. Oral and maxillofacial surgical procedures can induce the development of this reflex, which leads to significant changes in the heart rate and sinus rhythms. This study intends to evaluate the effects of this reflex in patients with facial fractures and its subsequent management. PATIENTS AND METHODS A total of thirty-seven patients with facial fractures who reported to the Department of Oral and Maxillofacial Surgery at Basaveswar Teaching and General Hospital, Gulbarga during a period from July 2015-March 2016 were considered for the study. RESULTS A male preponderance is observed with the most susceptible age group being 21-30 years. Twenty-three patients sustained mid-facial fractures alone, nine patients had isolated mandible fractures and five patients had fractures of both the mid-face and mandible. A relative bradycardia was observed in the patients with mid-facial trauma, both at the time of presentation and also during the surgical reduction of midfacial fractures which improved after completion of procedure in most of the patients. However, in two patients, the bradycardia progressed to a cardiac asystole during midface manipulation which required immediate halt of the procedure and intravenous administration of atropine. CONCLUSION Trigeminocardiac reflex though physiologic, which usually tends to subside without complications is not to be neglected in the surgeries of the maxillofacial skeleton. A propensity for unforeseen complications due to this reflex has to be avoided by meticulous monitoring of the ECG.
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Affiliation(s)
- Udupikrishna M Joshi
- Department of Oral and Maxillofacial Surgery, HKES S. Nijalingappa Institute of Dental Science and Research, Gulbarga, India
| | - Ashwini Munnangi
- Department of Oral and Maxillofacial Surgery, HKES S. Nijalingappa Institute of Dental Science and Research, Gulbarga, India
| | - Kundan Shah
- Department of Oral and Maxillofacial Surgery, HKES S. Nijalingappa Institute of Dental Science and Research, Gulbarga, India
| | - Satishkumar G Patil
- Department of Oral and Maxillofacial Surgery, HKES S. Nijalingappa Institute of Dental Science and Research, Gulbarga, India
| | - Nitin Thakur
- Department of Oral and Maxillofacial Surgery, HKES S. Nijalingappa Institute of Dental Science and Research, Gulbarga, India
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Marchili N, Ortu E, Pietropaoli D, Cattaneo R, Monaco A. Dental Occlusion and Ophthalmology: A Literature Review. Open Dent J 2016; 10:460-468. [PMID: 27733873 PMCID: PMC5045971 DOI: 10.2174/1874210601610010460] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/01/2016] [Accepted: 07/30/2016] [Indexed: 11/22/2022] Open
Abstract
Stomatognathic system is strictly correlated to other anatomical regions; many studies investigated relationship between temporomandibular joint and posture, several articles describe cranio-facial pain from dental causes, such as trigger points. Until now less interest has been given to connections between dental occlusion and ophthalmology, even if they are important and involving. Clinical experience in dental practice claims that mandibular latero-deviation is connected both to eye dominance and to defects of ocular convergence. The trigeminal nerve is the largest and most complex of the twelve cranial nerves. The trigeminal system represents the connection between somitic structures and those derived from the branchial arches, collecting the proprioception from both somitic structures and oculomotor muscles. The intermedius nucleus of the medulla is a small perihypoglossal brainstem nucleus, which acts to integrate information from the head and neck and relays it on to the nucleus of the solitary tract where autonomic responses are generated. This intriguing neurophysiological web led our research group to investigate anatomical and functional associations between dental occlusion and vision. In conclusion, nervous system and functional pathways strictly connect vision and dental occlusion, and in the future both dentists and oculists should be more and more aware of this correlation for a better diagnosis and therapy.
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Affiliation(s)
- Nicola Marchili
- University of L'Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital-Via Vetoio 67100 L'Aquila, Italy
| | - Eleonora Ortu
- University of L'Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital-Via Vetoio 67100 L'Aquila, Italy
| | - Davide Pietropaoli
- University of L'Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital-Via Vetoio 67100 L'Aquila, Italy
| | - Ruggero Cattaneo
- University of L'Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital-Via Vetoio 67100 L'Aquila, Italy
| | - Annalisa Monaco
- University of L'Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital-Via Vetoio 67100 L'Aquila, Italy
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