• Tapia’s syndrome
• hypoglossal nerve
• intubation
• paralysis
• paresis
• recurrent laryngeal nerve
• vocal cord
• vocal cord injection

• Humans
• Anesthesia, General/adverse effects
• Carboxymethylcellulose Sodium/administration & dosage
• Carboxymethylcellulose Sodium/therapeutic use
• Cardiac Surgical Procedures/adverse effects
• Deglutition Disorders/etiology
• Hoarseness/etiology
• Hypoglossal Nerve Injuries/etiology
• Postoperative Complications/etiology
• Postoperative Complications/drug therapy
• Recurrent Laryngeal Nerve Injuries/etiology
• Syndrome

• Hypoglossal nerve palsy
• Orthognathic surgery

• Hypoglossal nerve
• TMJ ankylosis
• TMJ gap arthroplasty
• Tapia syndrome
• nerve paralysis
• recurrent laryngeal nerve

Tapia’s syndrome, a unilateral, extracranial combined lesion to the hypoglossal nerve (cranial nerve [CN] XII) and the recurrent laryngeal branch of the vagal nerve (CN X), has been observed to occur after general anesthesia for a variety of surgical procedures. Surgical intraoperative neck positioning and airway management are hypothesized as causative factors. The condition presents with ipsilateral motor paralysis of the tongue and vocal cords. Postoperatively, patients often present with dysphonia, dysphagia, and difficulty swallowing.

We discuss a unique case of Tapia’s syndrome occurring after retrosigmoid craniotomy for left vestibular schwannoma resection in a 42-year-old male. General anesthesia was uneventful with an atraumatic, grade 2a intubation and a normal endotracheal tube cuff pressure of 30 cm of water. The patient was positioned laterally, even though the exact head position was not documented. Institutional practice in these cases is for the head to be maintained neutral or with a slight turn. An uneventful subtotal resection of the tumor was performed after retrosigmoid exposure.

Postoperatively, the patient complained of left-sided mouth tingling, a hoarse voice, and tongue weakness which impacted his ability to chew and swallow. He had mild left-sided facial weakness and decreased sensation in the V1 and V2 distribution of the trigeminal nerve. Postoperative brain MRI showed postsurgical changes without evidence of neurological or vascular involvement.

Fiberoptic endoscopy performed in the otolaryngology clinic showed immobility of the right vocal cord. Consequently, Tapia’s syndrome was diagnosed. He later underwent a right vocal fold injection with Prolaryn gel (Merz North America, Inc, Greensboro, NC, USA) via flexible laryngoscopy with a slight improvement in his dysphonia. At his last visit, he declined further interventions based on acceptable voice quality.

Tapia’s syndrome can occur due to the close anatomical proximity of the hypoglossal and recurrent laryngeal nerves as they pass lateral to the oropharynx and hypopharynx. This predisposes the nerves to anesthetic and surgical insults such as over-stretching of the nerves during head manipulation and trauma to the nerve fibers following laryngoscopy.

Our case report highlights this potential rare complication to anesthetic and surgical teams. Awareness of this concurrent paralysis can assist practitioners to rapidly diagnose and treat patients who present in this way postoperatively. It can also enable avoidance of causative factors and remind practitioners of the importance of meticulous perioperative documentation.

• airway management
• diagnostic fibroscopy
• hoarseness
• hypoglossal nerve palsy
• orotracheal intubation
• recurrent laryngeal nerve palsy
• tapia's syndrome
• tongue deviation
• vocal cord paralysis

• CN palsy
• Laminoplasty
• Tapia syndrome

This article presents three cases of cranial nerve palsy following shoulder surgery with general anesthesia in the beach chair position. All patients underwent preoperative ultrasound-guided interscalene nerve block. Two cases of postoperative hypoglossal and one case of combined hypoglossal and recurrent laryngeal nerve palsies (Tapia's syndrome) were identified. Through this case series, we provide a literature review identifying postoperative cranial nerve palsies in addition to the discussion of possible etiologies. We suggest that intraoperative patient positioning and/or airway instrumentation is most likely causative. We conclude that the beach chair position is a risk factor for postoperative hypoglossal nerve palsy and Tapia's syndrome.

• Dysphonia
• Hoarseness
• Hypoglossal nerve palsy
• Tapia's
• Vagus nerve palsy

To describe one case of bilateral Tapia’s syndrome in a liver transplanted patient and to review the literature.

We report a case of bilateral Tapia’s syndrome in a 50-year-old man with a history of human immunodeficiency virus and hepatitis C virus child. A liver cirrhosis and a bi-nodular hepatocellular carcinoma, who underwent liver transplantation after general anesthesia under orotracheal intubation. Uneventful extubation was performed in the intensive care unit during the following hours. On postoperative day (POD) 3, he required urgent re-laparotomy due to perihepatic hematoma complicated with respiratory gram negative bacilli infection. On POD 13, patient was extubated, but required immediate re-intubation due to severe respiratory failure. At the following day a third weaning failure occurred, requiring the performance of a percutaneous tracheostomy. Five days later, the patient was taken off mechanical ventilation and severe dysphagia, sialorrea and aphonia revealed. A computerized tomography and a magnetic resonance imaging of the head and neck excluded central nervous injury. A stroboscopy showed bilateral paralysis of vocal cords and tongue and a diagnosis of bilateral Tapia’s syndrome was performed. With conservative management, including a prompt establishment of a speech and swallowing rehabilitation program, the patient achieved full recovery within four months after liver transplantation. We carried out MEDLINE search for the term Tapia’s syndrome. The inclusion criteria had no restriction by language or year but must provide sufficient available data to exclude duplicity. We described the clinical evolution of the patients, focusing on author, year of publication, age, sex, preceding problem, history of endotracheal intubation, unilateral or bilateral presentation, diagnostic procedures, type of treatment, follow-up, and outcome.

Several authors mentioned the existence of around 70 cases, however only 54 fulfilled our inclusion criteria. We found only five published studies of bilateral Tapia’s syndrome. However this is the first case reported in the literature in a liver transplanted patient. Most patients were male and young and the majority of cases appeared as a complication of airway manipulation after any type of surgery, closely related to the positioning of the head during the procedure. The diagnosis was founded on a rapid suspicion, a complete head and neck neurological examination and a computed tomography and or a magnetic resonance imaging of the brain and neck to establish the origin of central or peripheral type of Tapia’s syndrome and also the nature of the lesion, ischemia, abscess formation, tumor or hemorrhage. Apart from corticosteroids and anti- inflammatory therapy, the key of the treatment was an intensive and multidisciplinary speech and swallowing rehabilitation. Most studies have emphasized that the recovery is usually completed within four to six months.

Tapia’s syndrome is almost always a transient complication after airway manipulation. Although bilateral Tapia’s syndrome after general anesthesia is exceptionally rare, this complication should be recognized in patients reporting respiratory obstruction with complete dysphagia and dysarthria after prolonged intubation. Both anesthesiologists and surgeons should be aware of the importance of its preventing measurements, prompt diagnosis and intensive speech and swallowing rehabilitation program.

• Liver transplantation
• Follow-up
• Outcome
• Postoperative complications
• Bilateral Tapia’s syndrome

• Hypoglossal nerve
• Paralysis
• Paresis
• Recurrent laryngeal nerve
• Tapia’s syndrome
• Vocal cord paralysis

• Aged
• Airway Management/adverse effects
• Anesthesia, Inhalation/adverse effects
• Arthroscopy
• Humans
• Intubation, Intratracheal/adverse effects
• Laryngeal Nerve Injuries/etiology
• Laryngeal Nerve Injuries/therapy
• Male
• Otorhinolaryngologic Surgical Procedures/adverse effects
• Shoulder/surgery
• Syndrome
• Young Adult

• alopecia
• general anesthesia
• hypoglossal nerve injuries
• rhinoplasty
• vocal cord paralysis

• cortical breach
• guidewire
• neuropraxia
• pedicle screw
• tapia syndrome

• Adult
• Deglutition Disorders/etiology
• Follow-Up Studies
• Hoarseness/etiology
• Humans
• Hypoglossal Nerve Diseases/etiology
• Intubation, Intratracheal/adverse effects
• Male
• Paralysis/etiology
• Postoperative Complications
• Recovery of Function/physiology
• Speech Disorders/etiology
• Syndrome
• Tongue Diseases/etiology
• Vocal Cord Paralysis/etiology
• Zygomatic Fractures/surgery

• Airway management
• Tapia's syndrome

• Adult
• Anesthesia, General
• Cranial Nerve Diseases/etiology
• Humans
• Hypoglossal Nerve Diseases/etiology
• Male
• Recurrent Laryngeal Nerve
• Rhinoplasty/adverse effects
• Syndrome

• Bibliometrics
• Dental Records/statistics & numerical data
• Humans
• Internet
• Periodicals as Topic/standards
• Publishing
• Surgery, Oral/education
• United Kingdom