Open Access Open Access  Restricted Access Subscription or Fee Access

Further evidence of a prolonged hypotensive and a bradycardic effect after mandibular extension in normal volunteers

C Del Seppia, S Ghione, Paola Foresi, E Fommei, D Lapi, A Colantuoni, R Scuri

Abstract


We previously reported that in normotensive humans submaximal mouth opening (mandibular extension) obtained by an ad hoc dilator (spring device), associated with partial masticatory movements and prolonged for 10 minutes is followed by a long-lasting reduction of blood pressure (BP) and heart rate (HR). Similar results were obtained by us in anesthetized rats. A recent independent study failed to confirm the results in the normotensive human. We reassessed, in 25 normotensive volunteers, the effects on BP and HR of mandibular extension obtained by the spring device associated with partial masticatory movements compared to a control procedure, consisting in keeping a tongue depressor between the incisor teeth. Both procedures were applied for 10 minutes and systolic BP (SBP), diastolic BP (DBP) and HR were measured every 10 minutes by an automatic recorder, for 30 minutes before and 120 minutes after the procedures in seated subjects watching nature documentary films on laptop screen.
Baseline levels (mean of the last 3 measurements before procedure) did not significantly differ between the experimental and control sessions. Two way repeated measures ANOVA on absolute (recorded) values did not reveal a significant main effect of treatment for SBP, DBP and HR, but a significant main effect of time (P<0.001) for BP and HR. In addition, a significant interaction of time and treatment was found for SBP (P<0.001) and DBP (P=0.005), but not for HR. In addition, two way repeated measures ANOVA was done on changes from baseline obtaining a significant main effect of treatment (P<0.001) and time (P<0.001) and a significant interaction of time and treatment for SBP (P<0.001) and DBP (P<0.01). Post-hoc comparisons revealed significantly lower values for SBP and DBP in experimental compared to control values at almost all times and this decrement was by about 5 mmHg. Furthermore, for both absolute values and changes from baseline, the interaction effect was, for BP, of a qualitative type as indicated by an opposite effect in the time-course between control and experimental sessions. This study thus provides confirmatory evidence that submaximal mouth opening for a relatively brief time is followed by prolonged albeit small reductions of BP in normotensive human volunteers.

Keywords


Trigeminocardiac reflex; Blood pressure; Heart rate; Humans; Mandibular extension.

References


Armitage P, Berry G, Matthews JNS. Statistical Methods in Medical Research. 1971, Blackwell Science Ltd, Massachusetts: Blackwell Publishing company.

Arnold RW. The human heart rate response profiles to five vagal maneuvers. Yale J Biol Med, 72: 237–244, 1999.

Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association. Hypertension, 61:1360–1383, 2013.

Brunelli M, Coppi E, Tonlorenzi D, Del Seppia C, Lapi D, Colantuoni A, et al. Prolonged hypotensive and bradycardic effects of passive mandibular extension: evidence in normal volunteers. Arch Ital Biol, 150: 231–237, 2012.

Cornelius JF, Sadr-Eshkevari P, Arasho BD, Sandu N, Spiriev T, Lemaitre F, et al. The trigeminocardiac reflex in adults: own experience. Expert Rev Cardiovasc Ther, 8: 895–898, 2010.

De Innocentiis C, Caputi CG, Pinto F, Quintiliani S, Meccariello A, Renda G, Di Nicola M, De Caterina R, D'Attilio M. Failure in evoking the trigeminal cardiac reflex by mandibular stretching in healthy volunteers. Arch Ital Biol. 153: 25-36, 2015.

Inder JD, Carlson DJ, Dieberg G, McFarlane JR, Hess NC, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Hypertens Res, 39: 88-94, 2016.

Kumada, M M, Dampney R, Reis D. The trigeminal depressor response: a novel vasodepressor response originating from the trigeminal system. Brain Res, 119: 305–326, 1977.

Lapi D, Colantuoni A, Del Seppia C, Ghione S, Tonlorenzi D, Brunelli M, et al. Persistent effects after trigeminal nerve proprioceptive stimulation by mandibular extension on rat blood pressure, heart rate and pial microcirculation. Arch Ital Biol, 151: 11–23, 2013.

Lapi D, Federighi G, Fantozzi MP, Del Seppia C, Ghione S, Colantuoni A, et al. Trigeminocardiac reflex by mandibular extension on rat pial microcirculation: role of nitric oxide. PloS One, 9: 1-22, 2014.

Lübbers H-T, Zweifel D, Grätz KW, Kruse A. Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg, 68: 1317–1321, 2010.

McCulloch PF, Faber KM, Panneton WM. Electrical stimulation of the anterior ethmoidal nerve produces the diving response. Brain Res, 830: 24–31, 1999.

Ohshita N, Nakajo N, Takemura M. Characteristics of the trigeminal depressor response in cats. J Neurosci Res, 76: 891–901, 2004.

Pescatello LS, Kulikowich JM. The aftereffects of dynamic exercise on ambulatory blood pressure. Med Sci Sports Exerc, 33:1855–1861, 2001.

Schaller B, Cornelius JF, Prabhakar H, Koerbel A, Gnanalingham K, Sandu N, et al. The trigeminocardiac reflex: an update of the current knowledge. J Neurosurg Anesthesiol, 21:187–195, 2009.

Schaller B, Probst R, Strebel S, Gratzl O. Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg, 90: 215–220, 1999.

Schaller B. Trigeminocardiac reflex. A clinical phenomenon or a new physiological entity? J Neurol, 251: 658–665, 2004.

Schaller BJ, Filis A, Buchfelder M. Trigeminocardiac reflex in humans initiated by peripheral stimulation during neurosurgical skull-base operations. Its first description. Acta Neurochir (Wien), 150: 715–717, 2008.

Van Brocklin MD, Hirons RR, Yolton RL. The oculocardiac reflex: a review. J Am Optom Assoc, 53: 407–413, 1982.


Full Text: PDF

Refbacks

  • There are currently no refbacks.