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In the light of the subsequent occurrence, we report an equal size of the patient's pupils (isocoria) on the day before surgery, and the pathological case history did not reveal previous vascular disorders or traumas of the intracranial district. In this case, preoperative examinations did not reveal noteworthy clinical conditions.

In the 24 hours before surgery, the patient was monitored with hematological examinations (Complete blood count, hemocoagulative pattern, phlogosis indexes and serum protein electrophoresis), Electrocardiogram, Orthopantomography of dental arches, chest radiography (with the patient seated) and intraoral and extraoral examination. 1).īeing a disabled and non-collaborating patient, the Authors prepared oral surgery under general anesthesia. The intraoral examination revealed destructive decay of tooth number 12 and necrotic residues of teeth 15 and 27 (Fig. We present a case of a 47-year-old man, suffering from spastic tetraparesis. Knowing this clinical event and the rapid identification of the trigger factor is the basis of a correct and timely therapeutic approach, which, in severe cases, could save the patient's life. In the clinical practice, an intraoperative or postoperative anisocoria is assessed according to its cause. 3Ī rather rare occurrence is intravascular embolization of local anesthetics containing vasoconstrictors. Local causes reported in Literature are synechia, congenital iris disorders (coloboma and aniridia) and pharmacological effects. Systemic causes are neurological or vascular disorders, usually associated with raised intracranial pressure or a consequence of traumatic or hypoxemic lesions of the Parasympathetic and Orthosympathetic Nervous System. 1Įtiologies of this clinical manifestation usually include local and systemic causes. Besides, a pupillary diameter difference less than 1 mm is often a physiological condition occurring in about 20% of the population. INTRODUCTIONĪnisocoria indicates a difference in pupil diameter in common clinical manifestations, if anisocoria is more marked in bright light, the large pupil is abnormal, while if anisocoria is more marked with reduced illumination, the small pupil is abnormal. Keywords: Anisocoria, Pupils reactions in Oral surgery, Emergencies in Oral Surgery. Anisocoria can manifest in more or less evident forms: therefore, it is clear that knowing this clinical condition is of crucial importance for a correct and timely resolution. Literature shows that the cases of anisocoria reported during or after oral surgery are rare occurrences, especially in cases of simple tooth extraction. The pupils returned to their physiological condition (isocoria) after about 180 minutes.ĭiscussion and Conclusions. These instrumental examinations did not show vascular or neurological diseases. We performed Computed Tomography (CT) in the emergency setting, Nuclear magnetic resonance (NMR) of the brain and Magnetic Resonance Angiography of intracranial vessels. After the oral surgery under general anesthesia, the patient developed severe anisocoria: in particular, a ~4mm diameter increase of the left pupil compared to the right pupil. Etiologies of this clinical manifestation usually include systemic causes as neurological or vascular disorders, and local causes as congenital iris disorders and pharmacological effects.Ĭase Report. Anisocoria indicates a difference in pupil diameter. Select the file that you have just downloaded and select import option Reference Manager (RIS).

Image of unequal pupil size download#

Available fromĬlick on Go to download the file. Severe Anisocoria after Oral Surgery under General Anesthesia. Inchingolo F, Tatullo M, Abenavoli FM, Marrelli M, Inchingolo AD, Villabruna B, Inchingolo AM, Dipalma G.