• 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

• Flexible endoscopic evaluation of swallowing (FEES)
• Hypoglossal nerve palsy
• Recurrent laryngeal nerve palsy
• Speech and language therapy
• Tapia’s syndrome

• Humans
• Male
• Middle Aged
• Intubation, Intratracheal/adverse effects
• Deglutition Disorders/etiology
• Vocal Cord Paralysis/etiology
• Vocal Cord Paralysis/physiopathology
• Hypoglossal Nerve Diseases/etiology
• Deglutition/physiology

• Hangman's fracture
• Head trauma
• Neck trauma
• Tapia syndrome

• dysphagia
• dysphonia
• hypoglossal nerve
• intensive care
• orotracheal intubation
• paralysis
• recurrent laryngeal nerve
• tapia's syndrome

• Male
• Humans
• Aged
• Cervical Vertebrae/surgery
• Glossopharyngeal Nerve
• Spinal Fusion/adverse effects
• Paralysis/etiology
• Decompression/adverse effects

• CN palsy
• Laminoplasty
• Tapia syndrome

• Bilateral hypoglossal palsy
• Ependymoma
• Hypoglossal nucleus
• Hypoglossal trigone
• Medullary infarct

• Hypoglossal nerve
• Tapia’s syndrome
• cervical spine
• recurrent laryngeal nerve
• trauma

• breast reconstruction
• position
• tapia's syndrome
• unilateral

• Adult
• Anesthesia, General/adverse effects
• Deglutition Disorders/etiology
• Female
• Glucocorticoids/therapeutic use
• Humans
• Hypoglossal Nerve Injuries/etiology
• Intubation, Intratracheal/adverse effects
• Mammaplasty/adverse effects
• Mastectomy/adverse effects
• Prednisolone/therapeutic use
• Recovery of Function
• Vocal Cord Paralysis/etiology

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

• Anesthetic management
• Bilateral hypoglossal nerve paralysis
• Elongated styloid process

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

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

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