Tapia's syndrome: an unexpected but real complication of rhinoplasty: case report and literature review

Overview

Tapia's syndrome is damage to the recurrent laryngeal and hypoglossal nerves outside the skull, usually from pressure or stretch during airway management under general anesthesia. It causes a hoarse voice and a weak tongue on one side. The authors report a case after rhinoplasty, review the other reported cases, and discuss risk factors, causes, course, recovery and prevention.

Sections of note

• Single case report after an uncomplicated rhinoplasty, plus a literature review.
• Nine other cases of Tapia's syndrome had been reported; half of those patients had undergone rhinoplasty or septorhinoplasty.
• The syndrome is described as a rare complication of airway management under general anesthesia, not of the nasal surgery itself.
• The paper analyzes risk factors, etiology, clinical course, recovery potential and preventive measures; the abstract gives no figures for recovery.
• The authors call for both anesthetist and surgeon to be aware of it and to focus on prevention.

What it means for a patient

• Hoarseness and difficulty moving the tongue after rhinoplasty is very rare but recognized, and it relates to the breathing tube and head positioning during anesthesia.
• The abstract does not state how fully patients recover or how long recovery takes.
• One case and nine prior reports; no rate per operation can be calculated.

Why this paper matters

Rhinoplasty accounts for a disproportionate share of the few reported Tapia's cases, likely because of tube position and head manipulation. The paper puts it on the anesthesia checklist for nasal surgery. Its true incidence and the best preventive measures remain undefined.

Terms

• Tapia's syndrome: paralysis of the recurrent laryngeal and hypoglossal nerves on one side, causing vocal cord and tongue weakness.
• Recurrent laryngeal nerve: the nerve that moves the vocal cord.
• Hypoglossal nerve: the nerve that moves the tongue.
• Extracranial: outside the skull; here, injury along the nerves in the neck.
• Airway management: placing and securing the breathing tube during general anesthesia.
• Septorhinoplasty: rhinoplasty combined with straightening of the septum.