Takotsubo Syndrome Following Surgical And Non-Surgical Oral And Maxillofacial Events: Review Of Published Cases

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): John K. Brooks, Gary Warburton, Brian C. Clark

Abstract

Purpose

Takotsubo syndrome (TS) is an acute and potentially serious cardiac disorder and often attributed to an exuberant catecholaminergic response to a severely physical or emotional event. There is a paucity of information in the dental literature on TS, therefore, this article will provide an overview of this uncommon syndrome, including clinical presentation, demographics, etiopathogenesis, diagnosis, management, and recovery, particularly emphasizing its occurrence with oral and maxillofacial procedures.

Methods

A PubMed search with the keyword takotsubo, published from 1991 through May 2018, yielded 3,778 articles. Cases reports and case series of TS associated with surgical and nonsurgical procedures of the oral and maxillofacial region were reviewed. Other cases were identified using a defined search strategy.

Results

The literature search identified 28 documented episodes of TS that occurred with head and neck surgeries, mostly sinus, carotid, nasal, cancer reconstruction surgeries, and, notably, 3 cases were concurrent with dental extractions. All of the featured patients developed some degree of cardiovascular impairment and demonstrated phenotypic overlap with acute occlusive coronary disease. The majority of patients recovered within 2 weeks and the remainder extended up to 3 months.

Conclusion

On rare occasions, TS has been reported in association with oral and maxillofacial procedures. As stress appears to be a precipitating factor in the development of TS, perioperative efforts should be instituted to reduce an adrenergic cascade.

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