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Asystole during Le Fort I osteotomy.

J R Ragno1, R M Marcoot, S E Taylor

  • 1US Army Dental Corps, Walter Reed Army Medical Center, Washington, DC.

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
|October 1, 1989
PubMed
Summary

A rare case of cardiac arrest (asystole) occurred during a Le Fort I osteotomy. This highlights the trigeminovagal reflex, a serious complication during jaw surgery.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Cardiovascular Physiology
  • Anesthesia

Background:

  • Le Fort I osteotomy is a common surgical procedure for correcting midface hypoplasia and other maxillofacial deformities.
  • The trigeminovagal reflex is a known, albeit uncommon, phenomenon that can occur during certain surgical manipulations.
  • This reflex involves the trigeminal nerve and the vagus nerve, potentially leading to bradycardia, hypotension, or asystole.

Observation:

  • A case report details a patient experiencing asystole during the down-fracture of the maxilla.
  • This event occurred specifically during the intraoperative manipulation of the maxilla in a Le Fort I osteotomy.
  • The patient's cardiac rhythm was monitored throughout the procedure.

Findings:

  • The asystole was directly linked to the manipulation of the maxilla, suggesting a potent trigeminovagal reflex.
  • This case represents an extreme manifestation of the trigeminovagal reflex during maxillofacial surgery.
  • Prompt recognition and management of the cardiac event were crucial.

Implications:

  • This case underscores the importance of vigilance for the trigeminovagal reflex in Le Fort I osteotomies.
  • Anesthesiologists and surgeons must be prepared for rare but severe cardiovascular events during these procedures.
  • Understanding the trigeminovagal reflex can improve patient safety and surgical outcomes in maxillofacial surgery.

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