A Call for Vigilance: Trigeminocardiac Reflex Presenting As Ventricular Bigeminy During Marginal Mandibulectomy

The trigeminocardiac reflex (TCR) is an autonomic reflex elicited by stimulation of the trigeminal nerve and is most commonly characterized by bradycardia and hypotension. In oral and maxillofacial surgery, peripheral TCR may occur during manipulation of the maxillary or mandibular divisions, occasionally presenting with atypical cardiovascular responses. We report a rare case of peripheral TCR manifesting as sudden severe hypertension with ventricular bigeminy during wide local excision and marginal mandibulectomy in a 69-year-old male with carcinoma of the lower alveolus. The hemodynamic disturbance coincided with the traction and suturing of the mandibular alveolar margin and was refractory to pharmacological management. Prompt release of surgical traction resulted in immediate resolution of both hypertension and arrhythmia, with no postoperative cardiac sequelae. This case underscores the importance of recognizing atypical presentations of TCR in maxillofacial procedures and highlights the need for close anesthetic-surgical communication and gentle tissue handling to prevent potentially life-threatening complications.