Trigemino-cardiac reflex is occurrence of hypotension and bradycardia upon surgical manipulation of areas supplied by the trigeminal nerve, and has been reported during craniofacial maxillofacial and ocular surgeries. Communication between the anaesthetic and surgical team is essential, and cessation of the precipitating stimulus is the first and most important therapeutic step. We report a case of immediate, reproducible, and reflexive response of Bradycardia and dysrhythmia upon manipulation of orbital fracture during orbital floor reconstruction in a 65-year-old man. Upon recognition of the reproducible relationship between falcine stimulation and increased vagal tone, the patient was given atropine in an effort to block cholinergic hyperactivity. After atropine administration, no further dysrhythmias occurred and surgery was carried uneventfully.

Background: Chronic facial pain owing to myofacial pain dysfunction syndrome (MPDS) remains a therapeutic problem. Multiple modalities have been used to manage this condition including pharmacotherapy, behavioral medicine, and corrective dental procedures. Objectives: The objective of our study was to evaluate the efficacy of transcutaneous electric nerve stimulation (TENS) as an adjuvant to pain relief in myofascial pain dysfunction syndrome. Methods, 30 patients were treated with TENS therapy for three months. Results: 28 patients out of the 30 had reduction in pain following TENS therapy. 2 among the 28 were completely relieved from pain. The mean reduction on the visual analog scale was found to be 4.5. 18 patients among the 21 patients who consumed analgesics pre-TENS therapy showed reduction in analgesic consumption post-TENS. Conclusion: TENS is one of the many modalities for pain relief, and its role as an adjuvant modality in the management of MPDS is commendable.

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