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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.
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.
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.