A case of neuroleptic malignant syndrome following surgery for maxillofacial fractures. Issue 5 (September 2018) - Shimada, Ken
Abstract: Neuroleptic malignant syndrome (NMS) is a severe adverse effect of antipsychotic drugs, which are typically used to treat neuroleptic symptoms. We report a case of NMS, which occurred after surgery for maxillofacial fractures. A 36-year-old woman was referred to our division for the treatment of zygomatic and mandibular bone fractures, and she underwent open reduction and intermaxillary fixation under general anesthesia. Because she complained of nausea, metoclopramide was administered immediately after extubation. After returning to the patient ward, she exhibited confusion; hence, haloperidol was administered to calm her down. Her symptoms did not improve, and muscle rigidity, hyperpyrexia, and loss of consciousness followed. Laboratory data showed elevation in the white blood cell count and creatine kinase level. Based on these findings, NMS was diagnosed, and dantrolene and bromocriptine were administered. NMS resolved; however, kidney failure resulted from hyper myoglobinemia, which necessitated hemodialysis. Other systemic problems, such as pulmonary edema, anemia, and disuse syndrome, followed; therefore, continuous treatments were required. Finally, the patient's condition was recovered and she was discharged 54 days after surgery. The present case suggests that oral surgeons need to be aware of the possibility of the onset of NMS in patients who have been administered neuroleptic drugs and that clinicians should be prepared for further problems that may occur even after the treatment of NMS.