Trigeminocardiac Reflex Complications During Orthognathic Surgery: Our Clinical Experience

Purpose: The trigeminocardiac reflex (TCR) is an extremely rare but potentially catastrophic complication during orthognathic surgery, warranting immediate recognition and precise intraoperative management. This article reports 2 cases of cardiac arrest during orthognathic surgery induced by TCR and shares the corresponding management experience. Methods: Two patients with severe obstructive sleep apnea (OSA) and mandibular retrognathia experienced cardiac arrest, one during nasal intubation (February 2025) and the other during mandibular elevation (August 2025). Both events were attributed to stimulation of the mandibular branch of the trigeminal nerve during surgical manipulation, eliciting the TCR. After receiving timely chest compressions and medications, both patients recovered spontaneous circulation rapidly, and surgeries finished smoothly with no postoperative complications. Conclusions: During dental and maxillofacial surgeries, vigilance for the occurrence of TCR is essential, as severe cases can be life-threatening. The authors’ experience indicates that prompt recognition and appropriate management can lead to favorable outcomes.