Sick sinus syndrome diagnosed after a sinus arrest during treatment for zygomatic fracture: a case report

Background: Intraoperative sinus arrest is rarely seen during zygomatic fracture treatment. The patient was diagnosed with sick sinus syndrome based on repeated postoperative sinus arrest, which could have resulted in death if diagnosed late, making this case very significant to report. Case presentation Sick sinus syndrome is caused by damage to the sinoatrial node or surrounding tissue, and is an arrhythmia associated with reduced automaticity of the sinoatrial node or impaired sinoatrial node conduction. We report the case of a 67-year-old man diagnosed with the syndrome after a sinus arrest that occurred during a zygomatic fracture treatment. The patient had cheek pain and mouth opening disorder, dizziness after fainting and sustaining a facial injury. Preoperative examination determined that the syncope was due to drug-induced arrhythmia, and surgery was authorized after drug withdrawal. Sinus arrest occurred during and after cheek bone open reduction. During the operation, sinus arrest was observed due to trigeminal vagal reflex, and heart rate was restarted by stopping the operation and chest compressions. After the surgery, the patient showed symptoms of dizziness and palpitations, and sinus arrest following atrial fibrillation and supraventricular tachycardia, which was diagnosed as sick sinus syndrome, and a pacemaker was implanted. Currently, 8 years have passed since the surgery, and there are no symptoms of mouth opening disorder, dizziness, or palpitations. Conclusions: The patient developed sinus arrest during treatment of a zygomatic fracture and was diagnosed as having sinus failure syndrome. In cases of cardiogenic syncope with injuries to the maxillofacial region, the cause of syncope should be thoroughly investigated to avoid complications due to abnormalities of the circulatory system.