Background: Tapia syndrome is a rare postoperative complication characterized by the simultaneous paralysis of the hypoglossal and recurrent laryngeal nerves, resulting in tongue weakness, dysphonia, and dysphagia. It is most commonly associated with airway manipulation during general anesthesia, particularly, orotracheal intubation. Awareness of this condition is crucial for early diagnosis and optimal recovery from the disease.
Case presentation: We report the case of a 42-year-old woman who developed Tapia syndrome following elective breast explantation and reconstruction under general anesthesia with orotracheal intubation. The surgery proceeded uneventfully with adherence to the standard anesthetic protocols. On postoperative day 19, the patient presented with right-sided tongue deviation, dysphonia, and dysphagia. Laryngoscopic and neurological evaluations revealed right hypoglossal and recurrent laryngeal nerve palsies, consistent with Tapia syndrome, likely secondary to trauma related to intubation. Suspected mechanisms include mechanical compression of the hypoglossal nerve against the hyoid bone and the recurrent laryngeal nerve within the piriform fossa, possibly aggravated by cuff overinflation or intraoperative head repositioning. The patient received conservative management, including speech and swallowing therapy, resulting in complete resolution of symptoms within four months.
Conclusion: Tapia syndrome should be considered in the differential diagnosis of postoperative neurological deficits involving the tongue and voice, even when intubation appears uneventful. Early recognition, multidisciplinary rehabilitation, and preventive strategies, such as careful airway management and monitoring of endotracheal cuff pressure, are essential to minimize the risk of this rare but potentially debilitating complication.
Tapia syndrome, hypoglossal nerve palsy, recurrent laryngeal nerve palsy, orotracheal intubation, postoperative complication
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