{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T07:38:36Z","timestamp":1778312316925,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Introduction: The trigeminocardiac reflex (TCR) is a brainstem reflex in which trigeminal stimulation precipitates abrupt vagally mediated cardiovascular changes, ranging from bradycardia to asystole. While classically described during down-fracture or pterygomaxillary disjunction in Le Fort I osteotomy, rhinocardiac events from lateral nasal wall manipulation are less emphasized in orthognathic surgery. Case presentation: A 32-year-old man undergoing Le Fort I osteotomy developed ventricular asystole during lateral nasal osteotomy. The maneuver was stopped immediately; chest compressions and a single dose of epinephrine were administered, with return of spontaneous circulation within approximately one minute. Surgery was aborted and the patient was transferred to the surgical ICU. Clinical discussion: The temporal association with lateral nasal wall manipulation, in the setting of controlled hypotension and multimodal anesthesia, is most compatible with a peripheral (V2) TCR-type event, although drug-related and hemodynamic contributors cannot be excluded. A mini review of orthognathic TCR reports underscores recurring high-risk steps (down-fracture, pterygomaxillary disjunction, mandibular maneuvers) and highlights lateral nasal osteotomy as a potential additional trigger. Management principles remain the immediate cessation of the stimulus, optimization of oxygenation and ventilation, anticholinergics for bradycardia, and epinephrine\/advanced cardiac life support for instability or arrest. Conclusion: Lateral nasal osteotomy may trigger a TCR-like event with severe bradyarrhythmia or asystole during Le Fort I osteotomy, particularly in hemodynamically vulnerable patients. Anticipation, swift recognition, and prompt, protocolized management are essential for favorable outcomes.<\/jats:p>","DOI":"10.3390\/clinpract16010013","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:46:43Z","timestamp":1767786403000},"page":"13","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ventricular Asystole During Le Fort I Orthognathic Surgery: A Case Consistent with Trigeminocardiac Reflex and a Mini Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1053-6522","authenticated-orcid":false,"given":"Sucharu","family":"Ghosh","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, NYCHHC\/Lincoln Medical Center, 234 E 149th St, Bronx, NY 10451, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Armanious","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, NYCHHC\/Lincoln Medical Center, 234 E 149th St, Bronx, NY 10451, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anirudh","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, NYCHHC\/Lincoln Medical Center, 234 E 149th St, Bronx, NY 10451, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeynep","family":"Ulku","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, NYCHHC\/Lincoln Medical Center, 234 E 149th St, Bronx, NY 10451, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Sultan","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, NYCHHC\/Lincoln Medical Center, 234 E 149th St, Bronx, NY 10451, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Pellecchia","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, NYCHHC\/Lincoln Medical Center, 234 E 149th St, Bronx, NY 10451, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Meuwly, C., Chowdhury, T., Sandu, N., Golanov, E., Erne, P., Rosemann, T., and Schaller, B. 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