{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:28:44Z","timestamp":1787149724082,"version":"build-2736575974"},"reference-count":13,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,12]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>The trigeminocardiac reflex (TCR) occurs when branches of the trigeminal nerve are stimulated by physical and\/or chemical triggers, leading to cardiac changes. It is commonly associated with midface manipulation, especially in the orbital region and similar incidents with mandibular procedures are not frequently reported. A girl in her late teens with no significant medical history or concurrent medications developed asystole during a bilateral sagittal split osteotomy (BSSO) under general anaesthesia. Prompt cardiopulmonary resuscitation led to the return of spontaneous circulation. The surgery was successfully completed post resuscitation.<\/jats:p>\n                  <jats:p>Although uncommon, similar episodes associated with manipulation of the mandibular division of the trigeminal nerve have been reported previously. This case describes a clinical presentation consistent with TCR during BSSO. Awareness of this potential association, prompt recognition, effective communication between the surgical and anaesthesiology teams, and timely management are essential for favourable outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2025-270796","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:00:39Z","timestamp":1787148039000},"page":"e270796","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative asystole during bilateral sagittal split osteotomy: An insight into the trigeminocardiac reflex"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2046-3058","authenticated-orcid":false,"given":"Somakshi","family":"Pise","sequence":"first","affiliation":[{"name":"Oral and Maxillofacial Surgery, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayatri","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archit","family":"Dhawan","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9829-905X","authenticated-orcid":false,"given":"Nikhil","family":"Kothari","sequence":"additional","affiliation":[{"name":"Anaesthesiology and Critical Care, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankita","family":"Chugh","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"2026081907002351000_19.8.e270796.1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1999.90.2.0215"},{"key":"2026081907002351000_19.8.e270796.2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.wneu.2018.05.208","article-title":"Evidences in Neurological Surgery and a Cutting Edge Classification of the Trigeminocardiac Reflex: A Systematic Review","volume":"117","author":"Leon-Ariza","year":"2018","journal-title":"World Neurosurg"},{"key":"2026081907002351000_19.8.e270796.3","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-232784","article-title":"Sudden arrhythmia followed by bradycardia during sagittal split ramus osteotomy: trigeminocardiac reflex","volume":"12","author":"Kim","year":"2019","journal-title":"BMJ Case Rep"},{"key":"2026081907002351000_19.8.e270796.4","doi-asserted-by":"crossref","first-page":"2316","DOI":"10.1016\/j.joms.2011.01.026","article-title":"Trigeminocardiac reflex, bilateral sagittal split ramus osteotomy, Gow-Gates block: a randomized controlled clinical trial","volume":"69","author":"Bohluli","year":"2011","journal-title":"J Oral Maxillofac Surg"},{"key":"2026081907002351000_19.8.e270796.5","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S0901-5027(05)80420-5","article-title":"Cardiac dysrhythmias complicating maxillofacial surgery","volume":"19","author":"Precious","year":"1990","journal-title":"Int J Oral Maxillofac Surg"},{"key":"2026081907002351000_19.8.e270796.6","doi-asserted-by":"publisher","DOI":"10.4103\/0028-3886.55577"},{"key":"2026081907002351000_19.8.e270796.7","first-page":"1","article-title":"Trigeminal cardiac reflex in oral and maxillofacial surgery: a systematic review","volume":"12","author":"Fatani","year":"2026","journal-title":"Int J Otorhinolaryngol Head Neck Surg"},{"key":"2026081907002351000_19.8.e270796.8","doi-asserted-by":"crossref","unstructured":"Chowdhury T , Arasho B , Sandu N , et al . The trigeminocardiac reflex \u2014 an example of reflexive heart rhythm change. In: Abnormal heart rhythms. InTech, 2015.","DOI":"10.5772\/60215"},{"key":"2026081907002351000_19.8.e270796.9","unstructured":"Hendrix JM , Kramer J . Anesthesia inhalation agents and their cardiovascular effects. In: StatPearls. 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