Trigeminocardiac reflex: sudden severe bradycardia during open reduction for temporomandibular joint dislocation: A case report

BACKGROUND: The trigeminocardiac reflex (TCR), which occurs after stimulation of the territory of the trigeminal nerve, is very rarely reported to be caused by stimulation of the mandibular branch. We report a case of TCR in open reduction for temporomandibular joint (TMJ) dislocation. CASE: A 74-year-old female presented for TMJ dislocation. During open reduction of TMJ under general anesthesia, severe bradycardia (15 beats/min) occurred. Immediately 0.5 mg atropine was administered intravenously, and the surgical manipulation was stopped. After 30 seconds, heart rate normalized. During surgery, severe bradycardia occurred one more time. It disappeared spontaneously as soon as surgical manipulation was stopped. The surgery was completed uneventfully. CONCLUSIONS: Because of the possibility of profound bradycardia, asystole, or even death when evoked, it is important to be aware of the trigeminocardiac reflex during manipulation of the mandibular divisions, especially during surgical stimulation of the TMJ.

Acute neck pain due to crowned dens syndrome: A case report

Crowned dens syndrome (CDS) is a cause of neck pain characterized by calcium deposition in the periodontoid tissues. Clinical features of the syndrome are acute onset of neck pain and headache with fever. Computed tomographic imaging is necessary for diagnosis. The prognosis of CDS is excellent. Symptoms disappear within several weeks and calcifications may be absorbed. We report a case of CDS with acute onset of severe neck pain, facial pain, and pharyngeal pain provoked by swallowing.