Trigeminocardiac Reflex During Temporomandibular Joint Surgery: A Systematic Review and Update for the Surgeons.

PURPOSE: Temporomandibular joint (TMJ) surgery is being increasingly performed globally with considerable success leading to improved quality of life for patients affected with disabling temporomandibular disorders. One of the most unusual phenomena noted during maxillofacial surgery due to stimulation of the trigeminal nerves is the Trigeminocardiac reflex (TCR), which causes sudden bradycardia and hypotension causing alarm and distress to the surgical and anesthetic team. The purpose of this systematic review is to identify the frequency and discuss the pathophysiology of the TCR especially during TMJ surgery. METHODS: The authors performed a systematic review by searching PubMed, Embase, Ovid, and Cochrane databases between 1946 and 2023 to identify studies that reported on the development of TCR during TMJ surgery. Non-English publications and those with inadequate details were excluded. RESULTS: Thirty-six papers reporting on the development of the TCR during oral and maxillofacial procedures were noted. Six papers reported specifically on TCR during TMJ surgery. A total of 25 subjects developed TCR during TMJ surgery. The mean age of the subjects was 31 (standard deviation 17.16) years. Twenty-three subjects (92%) developed bradycardia while 2 subjects (8%) developed asystole. All subjects recovered. The most common stimulant noted in these papers leading to TCR was manipulation and distraction of the TMJ. CONCLUSION: Although TCR is uncommon, it can occur during TMJ surgery, and it behooves the surgeon and anesthesia team to be aware of the potential for TCR to ensure adequate and timely treatment.

Did the COVID-19 pandemic have an effect on oral cancer staging? A single-centre retrospective observational study.

Introduction This study aims to assess if the COVID-19 pandemic impacted upon oral cancer staging in a single centre in the UK.Materials and methods Data were collected from the head and neck cancer database of a teaching hospital in London. Oral cancer diagnosis and staging in the peak period of the pandemic (March 2020-2021) were assessed against the one-year period (March 2019-2020) before the pandemic.Results In total, 25 cases of oral cancer were diagnosed in the pre-COVID-19 group compared to 26 in the COVID-19 cohort. Referrals from dentists accounted for 30% of cases of confirmed oral cancer in the COVID-19 class in comparison to 48% the year prior. Higher rates of overall TNM (tumour, lymph node, metastasis) staging at level 4a and above were observed in the COVID-19 cohort at 68% in comparison to 48% the year before.Conclusion Marginal non-statistically significant differences were noted of worsening stages of oral cancer presentations in the first year of the COVID-19 pandemic in this unit. Long-term studies on the outcomes of those diagnosed with oral cancer during the pandemic at a regional and national level will facilitate greater analysis on the impact the pandemic had on this cohort.