The oculocardiac reflex occurring after orbital surgical procedures is a well recognised peri operative complication which has been well reported in the literature. In this reflex the ophthalmic branch of trigeminal nerve transmits the afferent impulse to the sensory nucleus of trigeminal nerve (V) in the brain stem via the gasserion ganglion. The efferent arc involves the motor nucleus of the vagus nerve through short internuntial fibres in the brain stem, stimulation of which is responsible for the bradycardia.

A similar reflex can be induced by the branches of the maxillary and mandibular divisions of V which is less common than the oculocardiac reflex. This has reported in the literature as the trigemino cardiac reflex.

We report a case of intra-operative asystole occurring during a Gillies lift procedure. The patient was a 40-year-old male, newly diagnosed with hypertension on beta blockers. He is otherwise fit and well. At the time of manipulation of the fracture the patient went into asystole. Following 10 chest compressions and the administration of atropine, sinus rhythm was restored. With further monitoring the procedure was completed and patient recovered without further complication.

This rare complication which is a variant of oculocardiac reflex has previously been documented in maxillofacial procedures such as orthognathic surgery. We believe this is the first reported case of trigemino cardiac reflex following a zygomatic arch fracture reduction.

Conflict of interest: None declared.