Int J Med Sci 2010; 7(5):314-318. doi:10.7150/ijms.7.314 This issue

Case Report

Severe Anisocoria after Oral Surgery under General Anesthesia

Francesco Inchingolo1,4 , Marco Tatullo2, Fabio M. Abenavoli3, Massimo Marrelli4, Alessio D. Inchingolo1, Bruno Villabruna4, Angelo M. Inchingolo5, Gianna Dipalma4

1. Department of Dental Sciences and Surgery, General Hospital, Bari, Italy
2. Department of Medical Biochemistry, Medical Biology and Physics, General Hospital, Bari, Italy
3. Department of “Head and Neck diseases”, Hospital “Fatebenefratelli”, Rome, Italy
4. Department of Maxillofacial Surgery, Calabrodental, Crotone, Italy
5. Department of Surgical, Reconstructive and Diagnostic Sciences, General Hospital, Milano, Italy

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Inchingolo F, Tatullo M, Abenavoli FM, Marrelli M, Inchingolo AD, Villabruna B, Inchingolo AM, Dipalma G. Severe Anisocoria after Oral Surgery under General Anesthesia. Int J Med Sci 2010; 7(5):314-318. doi:10.7150/ijms.7.314. Available from

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Introduction. Anisocoria indicates a difference in pupil diameter. Etiologies of this clinical manifestation usually include systemic causes as neurological or vascular disorders, and local causes as congenital iris disorders and pharmacological effects.

Case Report. We present a case of a 47-year-old man, suffering from spastic tetraparesis. 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.

We performed Computed Tomography (CT) in the emergency setting, Nuclear magnetic resonance (NMR) of the brain and Magnetic Resonance Angiography of intracranial vessels. These instrumental examinations did not show vascular or neurological diseases. The pupils returned to their physiological condition (isocoria) after about 180 minutes.

Discussion and Conclusions. Literature shows that the cases of anisocoria reported during or after oral surgery are rare occurrences, especially in cases of simple tooth extraction. 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.

Keywords: Anisocoria, Pupils reactions in Oral surgery, Emergencies in Oral Surgery.