双颌正颌手术中的三叉神经心脏反射：病例回顾
Trigeminocardiac reflex in bimaxillary orthognathic surgery: case review.
作者信息
Ortiz-Peces L, Álvaro-Martínez M, Moreiras-Sánchez Á-D, Chacón-Ferrer G, Andura-Correas M, Castillo-Pardo de Vera J-L, Ortiz-González L, Cebrián-Carretero J-L
机构信息
La Paz University Hospital Oral and Maxillofacial Surgery Department 28046 Madrid, Spain
出版信息
Med Oral Patol Oral Cir Bucal. 2025 Jul 1;30(4):e523-e527. doi: 10.4317/medoral.27062.
BACKGROUND
The trigeminocardiac reflex (TCR) is a rare but clinically significant phenomenon characterized by bradycardia, hypotension, or asystole triggered by trigeminal nerve stimulation during maxillofacial surgery. It necessitates prompt recognition and management to ensure patient safety. TCR has been reported in orthognathic surgery, particularly during specific surgical maneuvers.
MATERIAL AND METHODS
We report the case of a 36-year-old male who experienced TCR during bimaxillary orthognathic surgery. Detailed documentation of the patient's clinical characteristics, intraoperative events, and management strategies was included. Additionally, we conducted a systematic review of the literature using Medline, Embase, Web of Science, and Scopus databases to identify cases of TCR in orthognathic surgery published from 1989 onward. Keywords included "trigeminocardiac reflex," "orthognathic surgery," "Le Fort I," and "bilateral sagittal split osteotomy".
RESULTS
We present the case of a patient who experienced transient bradycardia and asystole during mandibular manipulation and pterygomaxillary disjunction. The episode was successfully managed with atropine and cessation of triggering maneuvers. Additionally, a systematic review identified 10 cases of TCR in orthognathic surgery, most of which occurred during Le Fort I osteotomies, particularly during maxillary downfracture, followed by bilateral sagittal split osteotomies. Common manifestations included bradycardia and asystole. Management strategies involved cessation of surgical stimuli, administration of anticholinergic agents, and, in one severe case, cardiopulmonary resuscitation.
CONCLUSIONS
TCR in orthognathic surgery is a significant risk requiring vigilance and prompt management. Understanding its triggers, maintaining intraoperative monitoring, and employing preventive strategies, such as gentle manipulation and proper anesthesia protocols, are essential for optimizing patient safety.
背景
三叉神经心脏反射（TCR）是一种罕见但具有临床意义的现象，其特征为在颌面外科手术中，三叉神经受刺激引发心动过缓、低血压或心搏停止。必须迅速识别并处理，以确保患者安全。TCR已在正颌外科手术中被报道，尤其是在特定的手术操作过程中。
材料与方法
我们报告了一例36岁男性在双颌正颌手术中发生TCR的病例。其中包括对患者临床特征、术中情况及处理策略的详细记录。此外，我们使用Medline、Embase、科学网和Scopus数据库对文献进行了系统回顾，以确定1989年以来发表的正颌外科手术中TCR的病例。关键词包括“三叉神经心脏反射”“正颌外科手术”“勒福Ⅰ型截骨术”和“双侧矢状劈开截骨术”。
结果
我们呈现了一例患者在进行下颌骨操作和翼上颌分离时出现短暂心动过缓和心搏停止的病例。该发作通过阿托品及停止触发操作成功处理。此外，系统回顾确定了10例正颌外科手术中的TCR病例，其中大多数发生在勒福Ⅰ型截骨术期间，尤其是上颌骨向下折断时，其次是双侧矢状劈开截骨术。常见表现包括心动过缓和心搏停止。处理策略包括停止手术刺激、给予抗胆碱能药物，在一例严重病例中还进行了心肺复苏。
结论
正颌外科手术中的TCR是一个重大风险，需要保持警惕并迅速处理。了解其触发因素、维持术中监测以及采用预防策略，如轻柔操作和适当的麻醉方案，对于优化患者安全至关重要。
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