Trigeminocardiac Reflex May Occur During Temporomandibular Joint Arthrocentesis

The trigeminocardiac reflex (TCR) has been described during various oral and maxillofacial procedures involving trigeminal nerve stimulation. However, TCR during temporomandibular joint (TMJ) arthrocentesis remains insufficiently investigated.

The purpose of this study was to estimate the frequency of TCR during TMJ arthrocentesis and to identify factors associated with TCR.

A prospective cohort study included consecutive patients presenting to the Department of Oral and Maxillofacial Surgery, Kırıkkale University, between January and May 2026 with TMJ intra-articular pain and dysfunction requiring TMJ arthrocentesis. Subjects with systemic disease, cardiovascular rhythm disorders, psychiatric diagnoses, or inability to complete anxiety scales were excluded.

Predictor variables included demographic variables (age, sex, education level, and employment status), anxiety-related variables (state and trait anxiety), and operative variables (procedure duration).

Not applicable.

The primary outcome was a TCR-related hemodynamic response, defined as a ≥10% decrease from baseline in pulse rate and/or mean arterial pressure.

Continuous variables were compared using the Welch t-test or Mann-Whitney U test and categorical variables using χ² tests. Linear mixed-effects models accounted for clustered observations, and multivariable logistic regression assessed factors associated with TCR. A P value < .05 was considered statistically significant.

The sample included 35 subjects undergoing 41 TMJ arthrocentesis procedures. The mean age was 38.3 years (SD, 13.2), and 22 subjects (62.9%) were female. TCR occurred in 16 of 35 subjects (45.7%) and in 19 of 41 arthrocentesis procedures (46.3%). Trait anxiety scores were higher in subjects with TCR than in those without TCR (median interquartile range, 43.5 [5.8] vs 37.0 [13.0]; P = .023), whereas state anxiety scores were similar between groups (mean ± SD, 38.9 ± 10.5 vs 38.6 ± 8.7; P = .9). In multivariable logistic regression analysis, procedure duration was associated with TCR occurrence (adjusted odds ratio = 1.41, P = .006), whereas anxiety measures were not.

TCR may occur during TMJ arthrocentesis at different procedural stages, and longer procedure duration was associated with TCR occurrence, whereas anxiety measures were not. Hemodynamic monitoring may be required throughout TMJ arthrocentesis, particularly during prolonged procedures.