J Korean Neurosurg Soc.  2013 Nov;54(5):423-425. 10.3340/jkns.2013.54.5.423.

Tapia's Syndrome after Posterior Cervical Spine Surgery under General Anesthesia

• Park CK
• Lee DC
• Park CJ
• Hwang JH

• KMID: 2138360
• DOI: http://doi.org/10.3340/jkns.2013.54.5.423

Abstract

We present a case report to remind surgeons of this unusual complication that can occur in any surgery, even posterior cervical spine surgery under general anesthesia and discuss its causes, treatment methods, and the follow-up results in the literature. The peripheral Tapia's syndrome is a rare complication of anesthetic airway management. Main symptoms are hoarseness of voice and difficulty of tongue movement. Tapia's syndrome after endotracheal general anesthesia is believed to be due to pressure neuropathy of the vagus nerve and the hypoglossal nerve caused by the endotracheal tube. To our knowledge, no report has been published or given an explanation for Tapia's syndrome after posterior cervical spine surgery. Two patients who underwent posterior cervical surgery complained hoarseness and tongue palsy postoperatively. There is no direct anatomical relation between the operation, the vagus nerves and the hypoglossal nerves, and there is no record of displacement or malposition of the endotracheal tube. After several months, all symptoms are resolved. To avoid this problem in posterior cervical spine surgery, we suggest paying special attention to the position of the endotracheal tube to avoid excessive neck flexion before and during the positioning of the patient.

Keyword

Tapia's syndrome; Posterior cervical spine surgery; Hypoglossal nerve; Vagus nerve

MeSH Terms

Airway Management
Anesthesia, General*
Follow-Up Studies
Hoarseness
Humans
Hypoglossal Nerve
Methods
Neck
Paralysis
Spine*
Tongue
Vagus Nerve

Figure

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  Fig. 1 Case 1. Right oblique T2-weighted magnetic resonance image showing a root compression due to the right C4/5 (arrow) foraminal ruptured disc.

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  Fig. 2 Case 2. Sagittal T2-weighted magnetic resonance image showing cord compression due to the right C2/3 ossified yellow ligament and the ossified posterior longitudinal ligament.

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  Fig. 3 Preoperative X-ray images of Case1 and line drawings of the extracranial course of the hypoglossal nerve (A), the vagus nerve (B) and the imaginary endotracheal tube (C). Compared with the image with the neutral neck position (left), the image with the flexed neck position (right) shows the ramus of mandible moving posterior.

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  Fig. 4 A sectioned drawing of the oropharynx (A) and C2 vertebral body level shows that the hypoglossal nerve and the vagus nerve in carotid sheath (C) are entrapped amid the ramus of mandible (B), the transverse process of the C2 vertebra and the laterally-deviated endotracheal tube (E). In addition, the drawing shows that the ramus of mandible moves posterior (arrow) when the neck is flexed so that the compression of two nerves increases in comparison with the normal neck position where the endotracheal tube is also in normal position (D).

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