Maxillofacial Surgery and Diagnostic Science, College of Dentistry, Qassim University, Saudi Arabia; Dental Medicine for Girls, Al Azhar University, 11727, Nasr City, Cairo, Egypt.
Anaesthesia, Intensive Care, and Pain, Faculty of Medicine for Girls, Al Azhar University, 11727, Nasr City, Cairo, Egypt.
J Craniomaxillofac Surg. 2021 May;49(5):394-402. doi: 10.1016/j.jcms.2021.02.004. Epub 2021 Feb 12.
The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TVR), and neuropathophysiological pathway by which the efferent arc is activated. Material and methods: A retrospective study included patients who developed TVR during the surgical management of mandibular, midface, and orbital fractures. The reflex was divided into type I, II, III, and IV-TVR according to the following nerves: ophthalmic, maxillary, mandibular, and non-trigeminal nerves, respectively. The magnitude of hemodynamic drops was identified at the intraoperative baseline, during reflex, and postoperatively. The needed time to elicit the reflex, frequency and duration, need for medical intervention, and sequence of the drop were also recorded. P - values < 0.05 was considered significant. Out of 260 patients' files were reviewed, the TVR was observed in only 30 (11.55 %) patients. The ophthalmic nerve activation significantly caused the greatest intensity and magnitude of hemodynamic drop, followed by maxillary nerve, then mandibular division, and the lowest one was non-trigeminal nerves. The highest mean of drops in the mean arterial blood pressure (MABP) was 62.92 ± 2.39 with the type ITVR, whereas those of the type II, III, and IV were 75.5 ±3.98, 81.02±1.31, and 82.22±1.85, respectively. Also, the type I-TVR led to the greatest decrease in the heart rate (HR) with the mean equaled to 52.31± 3.91. The drop percentage in the MABP was -30.5, -17.5, -12, -10.08 for type I, II, III, and IV, whereas those of the HR were - 33.9, -27.13, -26.6, and -25 with type I, II, III, and IV, respectively. All results showed highly significant differences with p-values less than 0.001 when comparing between the baseline and intraoperative values of each TVR type. There is a positive correlation between the activated pathway of the TVR and the intensity of its efferent arc response due to the neural pathway of each division in the brainstem circuitry. Understanding of the pathophysiology and mechanism of the TVR, together with the rapid recognition and treatment could prevent serious negative outcomes, especially when the ophthalmic nerve is stimulated. 1Introduction.
研究目的在于探讨刺激神经与三叉-迷走反射（TVR）强度之间的相关性，以及传出弧激活的神经病理生理途径。
本回顾性研究纳入了在接受下颌骨、中面部和眼眶骨折手术治疗过程中发生 TVR 的患者。根据涉及的神经，将反射分为 I 型、II 型、III 型和 IV-TVR，分别为眼神经、上颌神经、下颌神经和非三叉神经。术中基线、反射期间和术后确定血流动力学下降幅度。还记录了诱发反射所需的时间、频率和持续时间、是否需要医疗干预以及下降的顺序。P 值<0.05 被认为具有统计学意义。在 260 名患者的档案中进行了回顾，仅在 30 名（11.55%）患者中观察到 TVR。眼神经激活显著引起最强的强度和最大幅度的血流动力学下降，其次是上颌神经，然后是下颌神经，最低的是非三叉神经。在平均动脉血压（MABP）中，I 型 TVR 的平均下降幅度最大，为 62.92±2.39，而 II 型、III 型和 IV 型的平均下降幅度分别为 75.5±3.98、81.02±1.31 和 82.22±1.85。此外，I 型 TVR 导致心率（HR）最大下降，平均为 52.31±3.91。MABP 的下降百分比为 I 型 30.5%、II 型 17.5%、III 型 12%、IV 型 10.08%，HR 的下降百分比为 I 型 33.9%、II 型 27.13%、III 型 26.6%和 IV 型 25%。当比较每种 TVR 类型的基线和术中值时，所有结果均显示出非常显著的差异，p 值均小于 0.001。TVR 的传出弧反应强度与激活途径之间存在正相关，这是由于脑干电路中每个分支的神经通路所致。了解 TVR 的病理生理学和机制，以及快速识别和治疗，可以预防严重的负面后果，特别是当刺激眼神经时。
