The Unknown but Benign Tapia Syndrome

Tapia syndrome is a rare complication of airway manipulation with an over-100-years-old history [1]. The syndrome is characterized by unilateral paralysis of the tongue and vocal cords, manifesting as dysphonia, tongue deviation, and dysphagia. This syndrome results from simultaneous unilateral paralysis of the hypoglossal nerve and the recurrent laryngeal branch of the vagus nerve, either due to intracranial or extracranial injury. Orotracheal intubation is the main risk factor [2, 3].

We describe the case of a 56-year-old woman who was admitted to the maxillofacial surgery service for cosmetic rhinoplasty with orotracheal intubation. She had no medical or surgical history. The preoperative routine investigations were unremarkable. In the immediate postoperative period, she noticed an unpleasant hoarseness, which she described as a man’s voice. At the time of the first meal, she noticed that the food bolus stagnated in the left part of the oral cavity, as if she could not mobilize it with her tongue. At the same time, she had a slight cough when swallowing. She denied motor or sensory complaints regarding the limbs or face. On the second postoperative day, due to the persistence of complaints, in-hospital collaboration with the neurology team was requested. The patient was stressed, but the postoperative complaints did not worsen. A physical examination did not reveal any facial or extremity paresis, with intact pain and vibratory sensitivity. Examination of the cranial nerves revealed marked dysphonia and left deviation of the tongue on protrusion (fig. 1). The patient was practically unable to touch her right cheek with her tongue and showed a marked asymmetry. The patient underwent magnetic resonance imaging (MRI) of the brain, which was normal. We requested the collaboration of the otolaryngology team, and a flexible laryngoscopy was performed, which confirmed a left vocal cord paresis (fig. 2). Tapia syndrome was assumed. The patient was reassured and discharged. She benefited from voice therapy and made a good recovery after six months.

Our patient had a rare but benign syndrome. It is a neuropraxia lesion of the recurrent laryngeal branch of the vagus nerve and the hypoglossal nerve in association with orotracheal intubation and cervical hyperextension. It is thought to be induced by direct pressure on the nerves [2]. Both nerves pass through the junction of the oropharynx and the hypopharynx in their course, an area particularly vulnerable to trauma during the protection of the airways [3].

I felt that my symptoms were undervalued after the surgery. On the second day, I was sure something was wrong. Understanding the mechanism of the disease and being reassured about its prognosis helped me overcome the situation and join the speech therapy program. I am grateful to the medical team and the rehabilitation team for being able to recover my voice.

With this case, we want to draw attention to this benign syndrome that has a significant impact on the patient and is unknown to many doctors. We highlight the importance of reassuring the patient. With fewer than 200 cases described in the literature, this is an old syndrome with a generally favorable prognosis in most cases.