Bilateral tapia syndrome after maxillomandibular advancement surgery

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.

Unilateral hypoglossal nerve palsy following orthognathic surgery: A case report and literature review

“…We conducted a literature review of studies related to HNP and maxillofacial surgery, and the review revealed several reports of the incidence of HNP following maxillofacial-related surgery ( Table 2 ). Six of the seven studies identified showed that the majority of patients with HNP or Tapia's syndrome have been male, with the age range 22–55 years [ [13] , [14] , [15] , [16] , [17] , [18] ]. Anatomical aspects are more likely to be a factor predisposing to HNP in male patients (in particular, the length of the greater cornu and a larger hyoid volume), and earlier ossification of the connection between the hyoid body and greater cornu was described in prior studies [ 19 , 20 ].…”

“…The onset of symptoms in HNP patients has been observed on the first postoperative day and has often been recognized ≥5 days postsurgery. Two of the reported patients showed clinical symptoms on the first and second postoperative days, respectively [ [14] , [15] , [16] , 18 ]. Delayed HNP symptoms can develop after a patient's discharge and remain undiagnosed for several reasons.…”

“…In terms of establishing the diagnosis of HNP, several investigations are highly recommended to differentiate this nerve injury from trauma to the skull base [ 3 ]. Computed tomography and MRI are radiographic investigations that are commonly performed [ 13 , 18 ]. In our patient's case, postoperative CT showed swelling of the right-side pharyngeal wall, but there was also a small amount of intraoperative bleeding, which was suspected to be caused by endotracheal intubation and gauze-packing pressure under general anesthesia, but its relation to this symptom was unclear.…”

“…Although in the majority of the reported cases HNP was suspected to be precipitated by endotracheal intubation under general anesthesia, the occurrence of nerve damage may also be influenced by nerve compression, hyperextension of the neck for laryngoscopy or the surgical position, and the surgical site [ 4 , 25 ]. It seems that many cases of HNP or Tapia's syndrome have occurred during oral and maxillofacial surgery [ [13] , [14] , [15] , [16] , [17] , [18] , 21 ]. In addition, excessive anterior-posterior and lateral flexion of the patient's head during surgery can cause nerve stretching or pressure on the nerves between the tube and hard tissues such as the hyoid bone, thyroid cartilage, and cervical vertebrae [ 16 ].…”