Tapia's syndrome -- a rare complication following cardiac surgery

Nalladaru, Zubin; Wessels, Andre; DuPreez, Leon

doi:10.1093/icvts/ivr056

Cited by 37 publications

(24 citation statements)

References 8 publications

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“…5,16,37,46 During cardiac surgery, neck hyperextension and lateral flexion during sternotomy can compress the ETT cuff against the hypoglossal-recurrent laryngeal nerve, resulting in Tapia’s syndrome. 13,42,43,57 Similarly, unanticipated position changes resulting in accidental extubation, 36 LMA malposition, 28 or change in airway management 34 (e.g., switching from LMA to ETT) are associated with HNP.…”

Section: Resultsmentioning

confidence: 99%

Hypoglossal Nerve Palsy After Airway Management for General Anesthesia

Shah

Barnes

Spiekerman

2015

Anesthesia &Amp; Analgesia

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Isolated hypoglossal nerve palsy (HNP), or neurapraxia, a rare postoperative complication after airway management, causes ipsilateral tongue deviation, dysarthria, and dysphagia. We reviewed the pathophysiological causes of hypoglossal nerve injury and discuss the associated clinical and procedural characteristics of affected patients. Furthermore, we identified procedural factors potentially affecting HNP recovery duration and propose several measures that may reduce the risk of HNP. While HNP can occur after a variety of surgeries, most cases in the literature were reported after orthopedic and otolaryngology operations, typically in males. The diagnosis is frequently missed by the anesthesia care team in the recovery room due to the delayed symptomatic onset and often requires neurology and otolaryngology evaluations to exclude serious etiologies. Signs and symptoms are self-limited, with resolution occurring within 2 months in 50% of patients, and 80% resolving within 4 months. Currently, there are no specific preventive or therapeutic recommendations. We found 69 cases of HNP after procedural airway management reported in the literature from 1926–2013.

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Section: Resultsmentioning

confidence: 99%

Hypoglossal Nerve Palsy After Airway Management for General Anesthesia

Shah

Barnes

Spiekerman

2015

Anesthesia &Amp; Analgesia

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“…The administration of intravenous or oral steroids in combinations with B1, B6, B12 vitamins or hialuronic acid injection has been proposed by many authors in the acute setting. At least 4 patients[8,17,23] required percutaneous endoscopic gastrostomy and 2 a naso-gastric tube insertion[20,42] to ensure nutritional requirements while the oro-esofageal route was unable to be used. In two cases (Takimoto[43] and ours), where bilateral paralyses were discovered, reintubation with subsequent tracheotomy was necessary to prevent respiratory failure.…”

Section: Resultsmentioning

confidence: 99%

Isolated bilateral Tapia’s syndrome after liver transplantation: A case report and review of the literature

Bilbao¹,

Dopazo²,

Caralt³

et al. 2016

WJH

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AIMTo describe one case of bilateral Tapia’s syndrome in a liver transplanted patient and to review the literature.METHODSWe 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.RESULTSSeveral 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.CONCLUSIONTapia’s syndrome is almost always a transient complication after airway manipulation. Altho...

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“…The most frequently involved operations were septoplasty and septorhinoplasty [4,5,9,10]. However, Tapia's syndromes following a shoulder surgery [2], a repair of a fractured mandible [12] and thoracotomies including coronary artery bypass surgery [3,6,7,11] were also described. Although most of the cases are unilateral, bilateral Tapia's syndromes have been reported.…”

Section: Discussionmentioning

confidence: 99%

Tapia's syndrome following cervical laminoplasty -A case report-

Lim

Kim

Kang

et al. 2013

Korean J Anesthesiol

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Tapia's syndrome is the palsy of the 10th and 12th cranial nerves, resulting in ipsilateral paralysis of the vocal cord and tongue. It is a rare complication which is related to the anesthetic airway management and positioning of the patient's head during the surgery. We describe a patient with a postoperative unilateral Tapia's syndrome, after general anesthesia, with uncomplicated endotracheal intubation. The patient's symptoms improved gradually for three months.

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Tapia's syndrome -- a rare complication following cardiac surgery

Cited by 37 publications

References 8 publications

Hypoglossal Nerve Palsy After Airway Management for General Anesthesia

Hypoglossal Nerve Palsy After Airway Management for General Anesthesia

Isolated bilateral Tapia’s syndrome after liver transplantation: A case report and review of the literature

Tapia's syndrome following cervical laminoplasty -A case report-

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