Abstract
Lesions of the hypoglossal and laryngeal nerve, recurrent in its unilateral or bilateral extracranial pathways, cause a motor deficit in the tongue with transient, partial or total loss of speech, which may be associated with mild or severe dysphagia, characterizing Tapia syndrome. This unusual condition is usually related to airway manipulation during anesthetic-surgical surgery, and few cases in the literature are correlated with maxillofacial surgeries, which partly explains the ignorance of this complication by a significant number of professionals. We describe a case report of bilateral Tapia syndrome established after a procedure for maxillomandibular advancement. This is a 55-year-old male patient diagnosed with retrognatism and retromaxillism. The patient underwent a maxillomandibular advancement with nasotracheal intubation. He evolved with bilateral Tapia syndrome, recovering from the signs and symptoms of this complication, being reoperated to correct aesthetic results obtained in the first intervention that was below acceptable, not evolving after this second surgery with the syndrome. We conclude that preventive measures should be taken, such as avoiding sudden movements in the head region and prolonged hyperextension of the neck during surgery, minimizing the trauma of the tracheal cannula on the tissues covering the hypoglossal and recurrent laryngeal nerves.
Highlights
Tapia Syndrome is an extremely rare complication first reported in 1904 by Antonio Garcia Tapia, an otolaryngologist physician (VAREDI et al, 2003). It is usually associated with airway manipulation for general anesthesia, characterized by lesions in the extracranial pathways of the hypoglossal nerve and the recurrent laryngeal nerve, causing neuropraxia of these nerves with greater unilateral frequency, but may be bilateral, compromising tongue movement due to hypoglossal nerve injury and speech difficulty due to recurrent laryngeal nerve injury (VAREDI et al, 2003; FARHAD; SAEID; HAMIDREZA, 2019)
Ota et al (2013) described the etiology of Tapia Syndrome as a mechanical trauma, producing damage to the recurrent laryngeal nerve, branch of the vagus nerve, and on the hypoglossal nerve, which are close to the base of the tongue, and this place where the vagus and hypoglossal nerves cross can be compressed by the endotrachertube
There are reported cases whose proximity of the tracheal tube to the surgery site is very large, such as after repair of mandible fracture, rhinoplasty, surgery for fixation of zigoma fracture, orthognathic surgery and removal of the upper third molar retained under general anesthesia (KASHYAP et al, 2010; LYKOUDIS; SERETIS, 2012; VAREDI et al, 2013; OTA et al, 2013; MUMTAZ; HENRY; SINGH, 2018)
Summary
Tapia Syndrome is an extremely rare complication first reported in 1904 by Antonio Garcia Tapia, an otolaryngologist physician (VAREDI et al, 2003). We establish precautions to reduce the chances of a recurrence of the signs and symptoms of this syndrome, such as: performing nasotracheal intubation with as little trauma as possible, controlling the pressure in the tube cuff, not using oropharyngeal packing, reducing surgical time as much as possible and avoiding excessive manipulation or hyperextension of the neck during surgery. This time we performed a surgery only in the maxilla associated with a mentoplasty, whose objective was to reduce the extension and duration of the surgery. The aesthetic results that motivated the indication for the second surgery were considered adequate by the team and the patient
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