Trigeminal cardiac reflex in oral and maxillofacial surgery: a systematic review

Abstract

The trigeminocardiac reflex (TCR) is a brainstem reflex triggered by stimulation of the trigeminal nerve, resulting in sudden cardiovascular disturbances such as bradycardia, hypotension, arrhythmias, and, in severe cases, asystole or cardiac arrest. This systematic review evaluated the clinical characteristics, triggering factors, management strategies, and outcomes of TCR in oral and maxillofacial surgery. A systematic search was conducted according to PRISMA guidelines using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for studies published between 2009 and 2022. Eligible studies included case reports, case series, observational studies, and reviews involving TCR during oral and maxillofacial procedures. Ten studies met the inclusion criteria. TCR was most associated with orbital, maxillary, and zygomatic manipulation, including Le Fort I osteotomy and zygomatic fracture reduction. Clinical manifestations ranged from transient bradycardia and hypotension to severe arrhythmias and intraoperative asystole. In most cases, immediate cessation of surgical stimulation, anesthetic adjustment, and administration of atropine successfully reversed the reflex. Although severe complications were uncommon, isolated cases of cardiac arrest were reported. Early recognition, careful surgical manipulation, continuous intraoperative monitoring, and prompt management are essential to minimize morbidity and improve patient safety during maxillofacial surgery.