Oculocardiac Reflex Induced by an Orbital Floor Fracture: Report of a Case and Review of the Literature
Identifieur interne : 000304 ( Main/Exploration ); précédent : 000303; suivant : 000305Oculocardiac Reflex Induced by an Orbital Floor Fracture: Report of a Case and Review of the Literature
Auteurs : Beomjune B. Kim [États-Unis] ; Clement Qaqish [États-Unis] ; Jennifer Frangos [États-Unis] ; John F. Jr Caccamese [États-Unis]Source :
- Journal of oral and maxillofacial surgery [ 0278-2391 ] ; 2012.
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Abstract
There are very few indications for the urgent treatment of facial fractures, in particular orbital floor fractures. Confirmed entrapment of an extraocular muscle is a well-known indication, and ruling out entrapment is an essential part of the assessment of orbital trauma.1 An uncommon, yet arguably more emergency indication for orbital floor fracture repair is a dysrhythmia associated with the oculocardiac reflex (OCR). The OCR, also known as the Aschner phenomenon,2-4 is a physiologic response to physical stimulation of the eye or adnexa.5 This is a vagally mediated reflex with afferent tracts derived mainly from the ophthalmic division of the trigeminal nerve. Increased stimulation results in decreased activity of the sinoatrial node.2 In addition to bradycardia, nausea/vomiting, vertigo, syncope, gastric hypermotility, and orbital pain are classic findings.1-3,5-10 The OCR is quite commonly elicited and has been well documented during ocular surgery, in particular strabismus surgery, in the pediatric population.2,4,5,8 Heart block, junctional rhythms, asystole, and, rarely, death have also been described.1-3,5,6,8,9,11.
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Kim</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Oral and Maxillofacial Surgery, University of Maryland Medical System</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Qaqish, Clement" sort="Qaqish, Clement" uniqKey="Qaqish C" first="Clement" last="Qaqish">Clement Qaqish</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Oral and Maxillofacial Surgery, University of Maryland Medical System</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Frangos, Jennifer" sort="Frangos, Jennifer" uniqKey="Frangos J" first="Jennifer" last="Frangos">Jennifer Frangos</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Oral and Maxillofacial Surgery, University of Maryland Medical System</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Caccamese, John F Jr" sort="Caccamese, John F Jr" uniqKey="Caccamese J" first="John F. 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Kim</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Oral and Maxillofacial Surgery, University of Maryland Medical System</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Qaqish, Clement" sort="Qaqish, Clement" uniqKey="Qaqish C" first="Clement" last="Qaqish">Clement Qaqish</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Oral and Maxillofacial Surgery, University of Maryland Medical System</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Frangos, Jennifer" sort="Frangos, Jennifer" uniqKey="Frangos J" first="Jennifer" last="Frangos">Jennifer Frangos</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Oral and Maxillofacial Surgery, University of Maryland Medical System</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Caccamese, John F Jr" sort="Caccamese, John F Jr" uniqKey="Caccamese J" first="John F. Jr" last="Caccamese">John F. Jr Caccamese</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Oral and Maxillofacial Surgery, University of Maryland Medical System</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of oral and maxillofacial surgery</title><title level="j" type="abbreviated">J. oral maxillofac. surg.</title><idno type="ISSN">0278-2391</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of oral and maxillofacial surgery</title><title level="j" type="abbreviated">J. oral maxillofac. surg.</title><idno type="ISSN">0278-2391</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Bibliographic review</term><term>Case study</term><term>Floor of the orbit</term><term>Fracture</term><term>Human</term><term>Oculocardiac reflex</term><term>Review</term><term>Stomatology</term><term>Surgery</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Fracture</term><term>Chirurgie</term><term>Réflexe oculocardiaque</term><term>Plancher orbitaire</term><term>Etude cas</term><term>Article synthèse</term><term>Revue bibliographique</term><term>Stomatologie</term><term>Homme</term><term>Traitement</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">There are very few indications for the urgent treatment of facial fractures, in particular orbital floor fractures. Confirmed entrapment of an extraocular muscle is a well-known indication, and ruling out entrapment is an essential part of the assessment of orbital trauma.<sup>1</sup> An uncommon, yet arguably more emergency indication for orbital floor fracture repair is a dysrhythmia associated with the oculocardiac reflex (OCR). The OCR, also known as the Aschner phenomenon,<sup>2-4</sup> is a physiologic response to physical stimulation of the eye or adnexa.<sup>5</sup> This is a vagally mediated reflex with afferent tracts derived mainly from the ophthalmic division of the trigeminal nerve. Increased stimulation results in decreased activity of the sinoatrial node.<sup>2</sup> In addition to bradycardia, nausea/vomiting, vertigo, syncope, gastric hypermotility, and orbital pain are classic findings.<sup>1-3,5-10</sup> The OCR is quite commonly elicited and has been well documented during ocular surgery, in particular strabismus surgery, in the pediatric population.<sup>2,4,5,8</sup> Heart block, junctional rhythms, asystole, and, rarely, death have also been described.<sup>1-3,5,6,8,9,11</sup>.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Maryland</li></region></list><tree><country name="États-Unis"><region name="Maryland"><name sortKey="Kim, Beomjune B" sort="Kim, Beomjune B" uniqKey="Kim B" first="Beomjune B." last="Kim">Beomjune B. Kim</name></region><name sortKey="Caccamese, John F Jr" sort="Caccamese, John F Jr" uniqKey="Caccamese J" first="John F. Jr" last="Caccamese">John F. Jr Caccamese</name><name sortKey="Frangos, Jennifer" sort="Frangos, Jennifer" uniqKey="Frangos J" first="Jennifer" last="Frangos">Jennifer Frangos</name><name sortKey="Qaqish, Clement" sort="Qaqish, Clement" uniqKey="Qaqish C" first="Clement" last="Qaqish">Clement Qaqish</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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