Two Episodes of Trigeminocardiac Reflex During a Pan facial Fracture Surgery, a Rare Phenomenon - Case Report and Review of Literature.

Trigeminocardiac reflex is a sudden physiologic response due to mechanical manipulation of any of the branches of trigeminal nerve. Trigeminocardiac reflex occurs due to pressure effect or stretching of trigeminal nerve which causes fall in blood pressure and decrease in heart rate. In this reflex arc, the trigeminal nerve serves as afferent pathway and vagus nerve, which is cardio inhibitory in nature, serves as efferent pathway. Two episodes of trigeminocardiac reflex during maxillofacial trauma surgery is not a common phenomenon. The present case report describes a case of 40-year-old male patient, diagnosed with pan facial fracture in which two episodes of trigeminocardiac reflex were seen intraoperatively during fracture reduction and fixation of left zygomaticomaxillary complex fracture and inferior orbital rim fracture. Intraoperative management of trigeminocardiac reflex was done by withholding the stimulus and administration of atropine.

THE STUDY FOR HEMODYNAMIC CHANGE ON CORONAL APPROACH TO ZYGOMATICO-MAXILLARY COMPLEX FRACTURE

BACKGROUND: The coronal incision is versatile surgical approach to upper and middle region of the facial skeletal including the zygomatic arch. The advantages of coronal approach are minimal injury of facial tissue including facial nerve and satisfactory cosmetic result by hidden scar at hair. But wide exposure of scalp, its disadvantages are operation time and massive blood loss. METHODS: Thirty patients undergoing elective surgery were divided 3 groups. Group I used only coronal approach, group II used coronal with subciliary approach and group III used coronal with subciliary and intraoral approach. And then retrospected of the preoperative, postoperative red blood cell count, hemoglobin(Hb), hematocrit, transfused red blood cell units and platelet cell units, and the amount of infused crystalloids and colloids, and postoperative hemovac count was estimated. RESULTS: 1. Red blood cell count were decreased in all groups at immediated postoperation and decreased in all group of postoperative first day and decreased in group I, II but increased group III of postoperative third day. 2. Hemoglobin and hematocrit were decreased in all group at immediated postoperation and decreased in all group of postoperative first day and decreased in group I, II., but increased group III postoperative third day. 3. Platelet was decreased in all group at immediated postoperation, and decreased in group II, III but increased in group I of postoperative first day and decreased in group I but increased group II, III of postoperative third day. 4. Mean postoperative hemovac mean drainage group I of first day is 48.63+/-21.12ml and second day is 23.92+/-19.53ml and third day is 7.82+/-5.32ml and group II of first day 60.45+/-22.65ml and second day is 22.14+/-13.21ml and third day is 7.32+/-6.25ml. III group of first day 58.16+/-10.13ml and second day is 21.27+/-11.72ml and third day is 7.13+/-4.90ml. 5. Infusion of group I is mean PRC 1.08+/-0.91 pint, FFP 1.03+/-0.75 pint, crystalloid 2562.23+/-1345.53ml and group II is mean PRC 1.05+/-0.89 pint, FFP 1.71+/-0.78, crystalloid 2650.47+/-1096.36ml and group III is mean PRC 1.79+/-1.45 pint, crystalloid 3295.43+/-1472.432ml.