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Bradycardia after orbital injury. Case report
Bradycardia after orbital injury
D. Hirjak, J. Zajko, I. Satko Department of Maxillofacia~ Surgery, Fakultnfi Nemocnica, Bratislava, Czechoslovakia
Case rep0rt D. Hirjak, J. Zajko, L Satko: Bradycardia after orbital injury. Case report. Int. J. Oral Maxillofac. Surg. 1993; 22: 26-27. © M u n k s g a a r d 1993 Abstract. A case of severe bradycardia following orbital trauma is described. This complication caused by the oculocardiac reflex deserves attention when patients are referred for orbital trauma.
Bradycardia has been described in connection with reduction of zygomatic complex fractures, repair of blowout fractures, Le F o r t I osteotomies, and other surgical operations in the orbital region 2,~6. A case of severe bradycardia occurring during arthroscopy of the t e m p o r o m a n d i b u l a r joint (TMJ) has also been described 4. This report describes an unusual case in relation to trauma to the orbit.
Case report A 33-year-old man in good health presented in the emergency room because of an orbital injury. A fi'agment of grindstone had entered the left orbit through the skin between the eyeball and medial orbital wall (Fig. 1). He was alert but showing some anxiety. His pulse rate was 30 beats/min and his blood pressure 75/40 mmHg. Atropine sulfate was administered intravenously, and the pulse rate rose progressively to 80 beats/min. There was no evidence of massive bleeding or other injuries. The patient was taken to the operating room and placed under general anesthesia.
The foreign body, a fragment of Carborundum grindstone measuring 5.2 x 3.0 cm, was removed (Fig. 2). There were no further episodes of dysrhythmia or bradycardia during this procedure.
Descussion The oculocardiac reflex was first described simultaneously by ASCHNER and DAGNINI 1 and has been well documented in relation to stimuli in and around the orbit. The reflex consists of an afferent pathway from the globe through the long and short ciliary nerves and ophthalmic division of the trigeminal nerve. Fibers in the reticular formation connected with the efferent pathway from the m o t o r nucleus o f the vagus nerve to the heart may slow the sinus
Key words: bradycardia; oculocardiac reflex; orbital injury. Accepted for publication 6 October 1992
rhythm, depress the intracardiac conduction system, and decrease the myocardial contractibility 4'8'9. The sites of stimulation of this phenomenon, however, are diverse. M a n y authors have suggested that the reflex may occur during manipulation of various facial bones ~'2'7'9. Increasing the pressure within the T M J space stimulates the sensory innervation o f the T M J capsule, and this may activate the reflex arc 4. The case presented is probably an example of the oculocardiac reflex, a narrower definition of the trigeminovagal reflex as proposed by BAINTON et al. 1. The bradycardia was probably caused by direct orbital trauma. Patients brought to the emergency r o o m with orbital trauma ought to be observed for this rare complication. The oculocardiac reflex is a risk when performing maxillofacial operations and should be taken into consideration in indicated cases.
References 1. BAINTONRE, BARNARDNA, WILBS JR, BItE J. Sinus arrest complicating a bitemporal approach to the treatment of panfacial fractures. Br J Oral Maxillofac Surg 1990: 28: 109. 2. BARNARD N A , BAINTON R. Bradycardia
and the trigeminal nerve. J Cranio-MaxFac Surg 1990: 18: 359-60. 3. CHESLEY L, SHAPIRO R. Oculocardiac reflex during treatment of an orbital blow-
Fig. 1. Facial appearance showing entrance wound between eye and nose.
Fig. 2. Foreign body removed.
out fracture. J Oral Maxillofac Surg 1989: 47: 522-3. 4. GOMEZ TM, GILDER JW. Reflex bradycardia during TMJ arthroscopy: case report. J Oral Maxillofac Surg 1991: 49: 543-4. 5. LOEWINGERJ, COHENM, LEVI E. Bradycardia during elevation of a zygomatic
Bradycardia after orbital injury arch fracture. J Oral Maxillofac Surg 1987: 45: 710. 6. PRECIOUSDS, SKULSKYFG. Cardiac dysrhythmias complicating maxillofacial surgery. Int J Oral Maxillofac Surg 1990: 19: 27%82. 7. RANGO JR, MARCOOT RM, TAYLOR
SE. Asystole during Le Fort I osteotomy. J Oral Maxillofac Surg 1989: 47: 1082-4. 8. ROBIDEAUXV. Oculocardiac reflex caused by midface disimpaction. Anesthesiology 1978: 99: 433. 9. STOTT DG. Reflex bradycardia in facial surgery. Br J Plast Surg 1989: 42: 595.
Address:
Dr D. Hirjak II. Stomatologickdt Klinika Fakultnd Nemocnica Miczkiewiczova 13 813 69 Bratislava Czechoslovakia
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D. Hirjak, J. Zajko, I. Satko Department of Maxillofacia~ Surgery, Fakultnfi Nemocnica, Bratislava, Czechoslovakia
Case rep0rt D. Hirjak, J. Zajko, L Satko: Bradycardia after orbital injury. Case report. Int. J. Oral Maxillofac. Surg. 1993; 22: 26-27. © M u n k s g a a r d 1993 Abstract. A case of severe bradycardia following orbital trauma is described. This complication caused by the oculocardiac reflex deserves attention when patients are referred for orbital trauma.
Bradycardia has been described in connection with reduction of zygomatic complex fractures, repair of blowout fractures, Le F o r t I osteotomies, and other surgical operations in the orbital region 2,~6. A case of severe bradycardia occurring during arthroscopy of the t e m p o r o m a n d i b u l a r joint (TMJ) has also been described 4. This report describes an unusual case in relation to trauma to the orbit.
Case report A 33-year-old man in good health presented in the emergency room because of an orbital injury. A fi'agment of grindstone had entered the left orbit through the skin between the eyeball and medial orbital wall (Fig. 1). He was alert but showing some anxiety. His pulse rate was 30 beats/min and his blood pressure 75/40 mmHg. Atropine sulfate was administered intravenously, and the pulse rate rose progressively to 80 beats/min. There was no evidence of massive bleeding or other injuries. The patient was taken to the operating room and placed under general anesthesia.
The foreign body, a fragment of Carborundum grindstone measuring 5.2 x 3.0 cm, was removed (Fig. 2). There were no further episodes of dysrhythmia or bradycardia during this procedure.
Descussion The oculocardiac reflex was first described simultaneously by ASCHNER and DAGNINI 1 and has been well documented in relation to stimuli in and around the orbit. The reflex consists of an afferent pathway from the globe through the long and short ciliary nerves and ophthalmic division of the trigeminal nerve. Fibers in the reticular formation connected with the efferent pathway from the m o t o r nucleus o f the vagus nerve to the heart may slow the sinus
Key words: bradycardia; oculocardiac reflex; orbital injury. Accepted for publication 6 October 1992
rhythm, depress the intracardiac conduction system, and decrease the myocardial contractibility 4'8'9. The sites of stimulation of this phenomenon, however, are diverse. M a n y authors have suggested that the reflex may occur during manipulation of various facial bones ~'2'7'9. Increasing the pressure within the T M J space stimulates the sensory innervation o f the T M J capsule, and this may activate the reflex arc 4. The case presented is probably an example of the oculocardiac reflex, a narrower definition of the trigeminovagal reflex as proposed by BAINTON et al. 1. The bradycardia was probably caused by direct orbital trauma. Patients brought to the emergency r o o m with orbital trauma ought to be observed for this rare complication. The oculocardiac reflex is a risk when performing maxillofacial operations and should be taken into consideration in indicated cases.
References 1. BAINTONRE, BARNARDNA, WILBS JR, BItE J. Sinus arrest complicating a bitemporal approach to the treatment of panfacial fractures. Br J Oral Maxillofac Surg 1990: 28: 109. 2. BARNARD N A , BAINTON R. Bradycardia
and the trigeminal nerve. J Cranio-MaxFac Surg 1990: 18: 359-60. 3. CHESLEY L, SHAPIRO R. Oculocardiac reflex during treatment of an orbital blow-
Fig. 1. Facial appearance showing entrance wound between eye and nose.
Fig. 2. Foreign body removed.
out fracture. J Oral Maxillofac Surg 1989: 47: 522-3. 4. GOMEZ TM, GILDER JW. Reflex bradycardia during TMJ arthroscopy: case report. J Oral Maxillofac Surg 1991: 49: 543-4. 5. LOEWINGERJ, COHENM, LEVI E. Bradycardia during elevation of a zygomatic
Bradycardia after orbital injury arch fracture. J Oral Maxillofac Surg 1987: 45: 710. 6. PRECIOUSDS, SKULSKYFG. Cardiac dysrhythmias complicating maxillofacial surgery. Int J Oral Maxillofac Surg 1990: 19: 27%82. 7. RANGO JR, MARCOOT RM, TAYLOR
SE. Asystole during Le Fort I osteotomy. J Oral Maxillofac Surg 1989: 47: 1082-4. 8. ROBIDEAUXV. Oculocardiac reflex caused by midface disimpaction. Anesthesiology 1978: 99: 433. 9. STOTT DG. Reflex bradycardia in facial surgery. Br J Plast Surg 1989: 42: 595.
Address:
Dr D. Hirjak II. Stomatologickdt Klinika Fakultnd Nemocnica Miczkiewiczova 13 813 69 Bratislava Czechoslovakia
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