Bradycardia and hypotension associated with trigeminocardiac reflex during orthognathic surgery: two case reports

The trigeminocardiac reflex (TCR) is an uncommon but significant complication that can arise during orthognathic surgery.

We present two cases of TCR-induced bradycardia and hypotension during such procedures. In the first case, bradycardia was noted following a controlled downward fracture of the maxilla. In the second case, both bradycardia and hypotension occurred while the left mandibular ramus was split with a separator.

In both instances, interruption of the surgical procedure led to normalization of heart rate and blood pressure, indicating that TCR was likely triggered by stimulation of the second and third branches of the trigeminal nerve. Moreover, to the best of our knowledge, this is the first reported case of TCR during Le Fort I osteotomy in Japan.

Given that TCR can potentially lead to cardiac arrest, surgeons must anticipate this reflex and communicate closely with the anesthesiologist to ensure prompt management.