Co-presentation of Tapia's syndrome and pressure alopecia--A rare event after septorhinoplasty: A case report and literature review

Tapia's Syndrome After Cardiac Surgery: A Case Report and Review of Literature

Tapia's syndrome is considered a neuropraxic injury of the recurrent laryngeal nerve and hypoglossal nerve which commonly presents after postoperative general anesthesia as hoarseness and dysphagia. Clinicians should consider this diagnosis in those presenting with symptoms of cranial nerve X and cranial nerve XII injury in the post-extubation setting for prompt diagnosis and management. Here, we report a rare case of Tapia's syndrome following cardiac surgery which was then treated with carboxymethylcellulose gel implant injection.

Tapia's Syndrome: keep it in mind!

INTRODUCTION

The aim of this study was to revise the etiologic features about Tapia's Syndrome (TS), a condition to particularly consider in the era of the COVID-19 pandemic.

EVIDENCE ACQUISITION

A systematic review was performed according to the PRISMA criteria. The Medline and Embase databases were searched from January 1, 1990, to December 31, 2020. Initially the search yielded 399 manuscripts, which were reduced to 50, upon the application of inclusion criteria.

EVIDENCE SYNTHESIS

A total of 65 patients were included in the present review. Mean age was 44±17.5 (DS) years (15-95); M:F ratio was 2.3:1. TS involved mainly the left side (3:2) and was rarely bilateral. Only 2 TS reported cases were due to central causes. Peripheral causes were mainly due to postintubation edema (77%), extrinsic compression (15%), vascular disease (3%), other/not defined (5%).

CONCLUSIONS

TS is a rare syndrome that has been related to a combined cranial nerve palsy; while TS due to central causes is very rare, it is mainly related to peripheral causes. A particular attention to TS should be given during the SARS-CoV-2 pandemic, either since the correlation between Tapia's syndrome, airway management and anesthetic procedures, since the possible implication of the viral infection itself.

Tapia's syndrome as an uncommon complication after cervical spine surgery with tracheostomy: a case report and literature review

PURPOSE

The aim of the present work is to present a rare case of Tapia's syndrome (hypoglossal and recurrent laryngeal nerve apraxia) following cervical spine surgery with tracheostomy.

METHODS

Clinical data were collected from patient's medical records.

RESULTS

After uneventful cervical spine surgery with tracheostomy, the patient reported mild dysphagia and dysphonia. Clinical examination and electromyography confirmed unilateral hypoglossal and recurrent laryngeal disfunction, contralateral to surgical access. Neural damage was transitory and full functional recovery was achieved within 12 months.

CONCLUSION

Tapia's syndrome can be a rare complication of cervical spine surgery with tracheostomy, due to multiple factors, including tracheostomy cuffed cannula and cervical spine position during surgery.

Tongue Tied after Shoulder Surgery: A Case Series and Literature Review

This article presents three cases of cranial nerve palsy following shoulder surgery with general anesthesia in the beach chair position. All patients underwent preoperative ultrasound-guided interscalene nerve block. Two cases of postoperative hypoglossal and one case of combined hypoglossal and recurrent laryngeal nerve palsies (Tapia's syndrome) were identified. Through this case series, we provide a literature review identifying postoperative cranial nerve palsies in addition to the discussion of possible etiologies. We suggest that intraoperative patient positioning and/or airway instrumentation is most likely causative. We conclude that the beach chair position is a risk factor for postoperative hypoglossal nerve palsy and Tapia's syndrome.

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

AIM

To describe one case of bilateral Tapia’s syndrome in a liver transplanted patient and to review the literature.

METHODS

We 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.

RESULTS

Several 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.

CONCLUSION

Tapia’s syndrome is almost always a transient complication after airway manipulation. Although bilateral Tapia’s syndrome after general anesthesia is exceptionally rare, this complication should be recognized in patients reporting respiratory obstruction with complete dysphagia and dysarthria after prolonged intubation. Both anesthesiologists and surgeons should be aware of the importance of its preventing measurements, prompt diagnosis and intensive speech and swallowing rehabilitation program.

Unintentional Complications After Uneventful Rhinoplasty Operations: Case Reports and a Review of the Literature

INTRODUCTION

No surgical procedure is free of complications; however, some of these complications are unintentional. Plastic surgeons may be unfamiliar with certain complications after rhinoplasty operations. In this study, we aimed to present four unintentional complications that have occurred in our patients and review the literature related to these complications.

MATERIALS AND METHODS

In this study, we conducted a review of 1400 patients who were operated on from 2007 to 2015. The medical recordings of all patients were investigated. Four patients with unintentional complications after rhinoplasty operations are presented and the related literature was reviewed.

CASES

Cases 1 and 2: These patients included a 26-year-old woman and a 30-year-old man who developed herpes simplex virus (HSV) infections after a primary septorhinoplasty. Case 3: This was a 25-year-old woman who developed periorbital emphysema after a primary rhinoplasty operation. Case 4: This was a 22-year-old woman who developed a second-degree burn on the nasal dorsum. All patients healed without sequel or scars.

DISCUSSION

Many unexpected complications have been reported in the literature. Some of these complications include bleeding disorders, allergic reactions, dermatitis, visual loss, gastric bleeding, benign paroxysmal positional vertigo, false aneurysm after rhinoplasty, pneumocephalus, Tapia's syndrome, cavernous sinus syndrome, and skin reactions to prolene.

CONCLUSION

Meticulous patient histories, consistent surgical routines, careful radiologic examinations, and frequent patient visits can help surgeons control these types of complications.

NO LEVEL ASSIGNED

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Tapia's syndrome in the intensive care unit: a rare cause of combined cranial nerve palsy following intubation

Tapia's syndrome is characterized by unilateral paralysis of the tongue and vocal cord, and is caused by a concurrent lesion of both the recurrent laryngeal and hypoglossal nerves. The proposed mechanism in most patients is compression or stretching of these nerves on their extracranial course due to airway manipulation under general anaesthesia. As Tapia's syndrome is a rare and possibly devastating condition, recognition of the presence of concurrent paralyses is an important step in diagnosis and treatment. We report two cases of Tapia's syndrome as a complication of intubation in the intensive care unit.

Postoperative permanent pressure alopecia

A 49-year-old Chinese female underwent elective laparoscopic assisted Whipple's surgery lasting 12 h. This was complicated by postoperative pressure alopecia at the occipital area of the scalp. Pressure-induced hair loss after general anaesthesia is uncommon and typically temporary, but may be disconcerting to the patient. We report this case of postoperative permanent pressure alopecia due to its rarity in the anaesthesia/local literature, and review the risk factors for its development.