Skip to main content
SpringerLink
Log in

Tapia-Syndrom

Seltene Komplikation der Atemwegssicherung

Tapia’s syndrome

Rare complication of securing airways

  • Kasuistiken
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Nervenschäden sind eine seltene Komplikation der Atemwegssicherung. Es wird über 2 Fälle eines Tapia-Syndroms (ipsilaterale Schädigung des N. hypoglossus und des N. laryngeus recurrens) nach orotrachealer Intubation berichtet. Im ersten Fall unterzog sich der Patient einem Hals-Nasen-Ohren(HNO)-ärztlichen Eingriff in Intubationsnarkose. Am dritten postoperativen Tag wurde die Diagnose eines linksseitigen Tapia-Syndroms gestellt. Im zweiten Fall wurde bei einem Patienten eine linksseitige Schulteroperation in kombinierter Intubationsnarkose/N.-suprascapularis-Blockade durchgeführt. Am Nachmittag des ersten postoperativen Tages wurde ein rechtsseitiges Tapia-Syndrom diagnostiziert. In beiden Fällen verblieb eine dauerhafte Schädigung beider Nerven. Auf der Basis einer umfassenden Literaturübersicht werden die Ursachen für das Tapia-Syndrom diskutiert. Eine Kontrolle und Dokumentation von „Cuff“-Position (Tubuseinführtiefe) und Cuff-Druck unmittelbar nach Intubation wird angeraten. Ebenso sollte notiert werden, ob die Operation eine überstreckte Kopflagerung erfordert.

Abstract

Nerve injuries are a rare complication of airway management. Two cases of Tapia’s syndrome following orotracheal intubation are reported. Case 1: a 23-year-old male patient underwent an otorhinolaryngology (ENT) surgical procedure with orotracheal intubation. A left-sided Tapia’s syndrome was verified 3 days later. Case 2: a 67-year-old patient developed a right-sided Tapia’s syndrome following an arthroscopic intervention of the left shoulder in the beach-chair position. In both cases there was permanent damage of both nerves. On the basis of a comprehensive literature survey the reasons for an intubation-induced Tapia’s syndrome are discussed. In order to avoid a glottis or immediate subglottic position it is recommended to check and to document the position of the cuff (depth of intubation) and the measured cuff pressure immediately after intubation. It also seems to be advisable to document an overstretched head position if required for the operation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Ahmad NS, Yentis SM (1996) Laryngeal mask airway and lingual nerve injury. Anaesthesia 51:707–708

    Article  CAS  PubMed  Google Scholar 

  2. Bachmann G, Streppel M (1996) Hypoglossusparese nach endonasaler Nasennebenhöhlenoperation in Intubationsnarkose. Laryngo Rhino Otol 75:623–624

    Article  CAS  Google Scholar 

  3. Baumgarten V, Jalinski W, Böhm S, Galle E (1997) Hypoglossusparese nach Septumkorrektur in Intubationsnarkose. Anaesthesist 46:34–37

    Article  CAS  PubMed  Google Scholar 

  4. Boga I, Aktas S (2010) Treatment, classification and review of Tapia syndrome. J Craniofac Surg 21:278–280

    Article  PubMed  Google Scholar 

  5. Boisseau N, Rabarijaona H, Grimaud D, Raucoules-Aimé M (2002) Tapia’s syndrome following shoulder surgery. Br J Anaesth 88:869–870

    Article  CAS  PubMed  Google Scholar 

  6. Bramer S, Koscielny S, Witte O, Terborg C (2005) Bilaterale Hypoglossusparese nach Intubationsnarkose. Nervenarzt 77:204–207

    Article  Google Scholar 

  7. Braun U (2002) Sind bei den gängigen elektiven Methoden der Atemwegsfreihaltung Nervenläsionen möglich? Anaesth Intensivmed 43:282–286

    Google Scholar 

  8. Chan TV, Grillone G (2005) Vocal cord paralysis after laryngeal mask airway ventilation. Laryngoscope 115:1436–1439

    Article  PubMed  Google Scholar 

  9. Cinar SO, Seven H, Cinar U, Turgut S (2005) Isolated bilateral paralysis of the hypoglossal and recurrent laryngeal nerves (Bilateral Tapia’s syndrome) after transoral intubation for general anesthesia. Acta Anaesth Scand 49:98–99

    Article  CAS  PubMed  Google Scholar 

  10. Daya H, Fawcett WJ, Weir N (1996) Vocal cord paralysis after use of the laryngeal mask airway. J Laryngol Otol 110:383–384

    Article  CAS  PubMed  Google Scholar 

  11. Domino KB, Posner KL, Caplan RA, Cheney FW (1999) Airway injury during anesthesia: a closed claims analysis. Anesthesiology 91:1703–1711

    Article  CAS  PubMed  Google Scholar 

  12. Dralle H, Kruse E, Hamelmann WH et al (2004) Nicht jeder Stimmlippenstillstand nach Schilddrüsenoperation ist eine chirurgisch bedingte Recurrensparese. Chirurg 75:810–822

    CAS  PubMed  Google Scholar 

  13. Dziewas R, Lüdemann P (2002) Hypoglossal nerve palsy as complication of oral intubation, bronchoscopy and use of the laryngeal mask airway. Eur Neurol 47:239–243

    Article  PubMed  Google Scholar 

  14. Ellis PD, Pallsiter WK (1975) Recurrent laryngeal nerve palsy and endotracheal intubation. J Laryngol Otol 89:823–826

    Article  CAS  PubMed  Google Scholar 

  15. Friedrich T, Hänsch U, Eichfeld U et al (2000) Die Recurrensparese als Intubationsschaden? Chirurg 71:539–544

    Article  CAS  PubMed  Google Scholar 

  16. Gaylard D (1999) Lingual nerve injury following the use of the laryngeal mask airway. Anaesth Intensive Care 27:668

    CAS  PubMed  Google Scholar 

  17. Gelmers HJ (1983) Tapia’s syndrome after thoracotomy. Arch Otolaryngol 109:622–623

    Article  CAS  PubMed  Google Scholar 

  18. Gevorgyan A, Nedzelski JM (2013) A late recognition of Tapia syndrome: a case report and literature review. Laryngoscope 123:2423–2427

    PubMed  Google Scholar 

  19. Hack G (2002) Zur Genese von Recurrensparesen. Anaesth Intensivmed 43:280

    Google Scholar 

  20. Haslam B, Collins S (2013) Unilateral hypoglossal neurapraxia following endotracheal intubation for total shoulder arthroplasty. AANA J 81:233–236

    PubMed  Google Scholar 

  21. Heinemann M, Kalff G (1982) Mögliche Mechanismen, Differentialdiagnose und Prophylaxe bei Stimmlippenlähmungen nach endotrachealer Intubation. Anaesthesist 31:353–358

    CAS  PubMed  Google Scholar 

  22. Hempel V (1999) Schäden und Gefahren durch Einsatz der Kehlkopfmaske. Anaesthesist 48:399–402

    Article  CAS  PubMed  Google Scholar 

  23. Hong SJ, Lee JY (2009) Isolated unilateral paralysis of the hypoglossal nerve after transoral intubation for general anesthesia. Dysphagia 24:354–356

    Article  PubMed  Google Scholar 

  24. Johnson TM, Moore HJ (1999) Cranial nerve X and XII paralysis (Tapia’s syndrome) after an interscalene brachial plexus block for a left shoulder Mumford procedure. Anesthesiology 90:311–312

    Article  CAS  PubMed  Google Scholar 

  25. Kapoor S (2013) Tapia’s syndrome: a rare complication of airway trauma. Anesth Analg 117:1261

    Article  PubMed  Google Scholar 

  26. Kashyap SA, Patterson AR, Loukota RA, Kelly G (2010) Tapia’s syndrome after repair of a fractured mandible. Br J Oral Maxillofac Surg 48:53–54

    Article  PubMed  Google Scholar 

  27. Kikura M, Suzuki K, Itagaki T et al (2007) Age and comorbidity as risk factors for vocal cord paralysis associated with tracheal intubation. Br J Anaesth 98:524–530

    Article  CAS  PubMed  Google Scholar 

  28. Kim SW, Kim MS, Choi JH, Kim CD (2013) A case of bilateral peripheral Tapia’s syndrome subsequent to coronary artery bypass graft. Korean J Otorhinolaryngol Head Neck Surg 56:535–537

    Article  Google Scholar 

  29. Larsen R (2013) Anästhesie, 10. Aufl. Urban & Fischer, München, S 495–552

  30. Laursen RJ, Larsen KM, Molgaard J, Kolze V (1998) Unilateral vocal cord paralysis following endotracheal intubation. Acta Anaesthesiol Scand 42:131–132

    Article  CAS  PubMed  Google Scholar 

  31. Laux G (2012) Sicherung der Atemwege. In: Rossaint R, Werner C, Zwissler B (Hrsg) Die Anästhesiologie, 3. Aufl. Springer, Berlin Heidelberg New York Tokio, S 546–573

  32. Laxton CH, Kipling R (1996) Lingual nerve paralysis following the use of the laryngeal mask airway. Anaesthesia 51:869–870

    Article  CAS  PubMed  Google Scholar 

  33. Lim KJ, Kim MH, Kang MH et al (2013) Tapia’s syndrome following cervical laminoplasty – a case report. Korean J Anesthesiol 64:172–174

    Article  PubMed Central  PubMed  Google Scholar 

  34. Lykoudis EG, Seretis K (2012) Tapia’s syndrome: an unexpected but real complication of rhinoplasty: case report and literature review. Aesthetic Plast Surg 36:557–559

    Article  PubMed  Google Scholar 

  35. Majumder S, Hopkins PM (1998) Bilateral lingual nerve injury following the use of the laryngeal mask. Anaesthesia 53:184–186

    Article  CAS  PubMed  Google Scholar 

  36. Mullins RC, Drez D Jr, Cooper J (1992) Hypoglossal nerve palsy after arthroscopy of the shoulder and open operation with the patient in the beach-chair position. A case report. J Bone Joint Surg Am 74:137–139

    CAS  PubMed  Google Scholar 

  37. Nagai K, Sakuramoto C, Goto F (1994) Unilateral hypoglossal nerve paralysis following the use of the laryngeal mask airway. Anaesthesia 49:603–604

    Article  CAS  PubMed  Google Scholar 

  38. Nalladaru Z, Wessels A, DuPreez L (2012) Tapia’s syndrome – a rare complication following cardiac surgery. Interact Cardiovasc Thorac Surg 14:131–132

    Article  PubMed Central  PubMed  Google Scholar 

  39. Olthoff D, Schaffranietz L (2002) Intubationsbedingte Recurrensparese. Anaesth Intensivmed 43:281

    Google Scholar 

  40. Ostergaard M, Kristensen BB, Mogensen TS (1997) Reduced sense of taste as a complication of the laryngeal mask use. Ugeskr Laeger 159:6835–6836

    CAS  PubMed  Google Scholar 

  41. Park CK, Lee DC, Park CJ, Hwang JH (2013) Tapia’s syndrome after posterior spine surgery under general anesthesia. J Korean Neurosurg Soc 54:423–425

    Article  PubMed Central  PubMed  Google Scholar 

  42. Paulsen F, Waschke J (2010) Sobotta Atlas der Anatomie des Menschen, 23. Aufl. Elsevier, München

  43. Pothmann W, Georgi R, Adams HA (2009) Atemwegssicherung. In: Kochs E, Adams HA, Spies C (Hrsg) Anästhesiologie, 2. Aufl. Thieme, Stuttgart, S 181–205

  44. Quattrocolo G, Giobbe D, Baggiore P (1986) Tapia’s syndrome caused by a neurilemmoma of vagus and hypoglossal nerves in the neck. Acta Neurol (Napoli) 8:535–540

    Google Scholar 

  45. Reber A, Hauenstein L, Echternach M (2007) Pharyngolaryngeale Beschwerden nach Allgemeinanästhesien – anästhesiologische und laryngologische Aspekte. Anaesthesist 56:177–192

    Article  CAS  PubMed  Google Scholar 

  46. Rieger A (2001) Intubationsschäden: Inzidenz, Komplikationen, Konsequenzen. In: Krier C, Georgi R (Hrsg) Airway management. Thieme, Stuttgart, S 139–153

  47. Rotondo F, De Paulis S, Modoni A, Schiavello R (2010) Peripheral Tapia’s syndrome after cardiac surgery. Eur J Anaesthesiol 27:575–576

    PubMed  Google Scholar 

  48. Rubio-Nazábal E, Marey-Lopez J, Lopez-Facal S et al (2002) Isolated bilateral paralysis of the hypoglossal nerve after transoral intubation for general anesthesia. Anesthesiology 96:245–247

    Article  PubMed  Google Scholar 

  49. Sacks MD, Marsh D (2000) Bilateral recurrent laryngeal nerve neuropraxia following laryngeal mask insertion: a rare cause of serious upper airway morbidity. Paediatr Anaesth 10:435–437

    Article  CAS  PubMed  Google Scholar 

  50. Schaffartzik W, Hachenberg T, Neu J (2011) Anästhesiezwischenfälle. Atemwegsmanagement und Schäden in der Anästhesie – „closed claims“ der Norddeutschen Schlichtungsstelle. Anasthesiol Intensivmed Notfallmed Schmerzther 46:32–37

    Article  PubMed  Google Scholar 

  51. Sommer M, Schuldt M, Runge U et al (2004) Bilateral hypoglossal nerve injury following the use of the laryngeal mask without the use of nitrous oxide. Acta Anaesthesiol Scand 48:377–378

    Article  CAS  PubMed  Google Scholar 

  52. Sotiriou K, Balanika M, Anagnostopoulou S et al (2007) Postoperative airway obstruction due to Tapia’s syndrome after coronary bypass grafting surgery. Eur J Anaesthesiol 24:378–379

    Article  CAS  PubMed  Google Scholar 

  53. Stewart A, Lindsay WA (2002) Bilateral hypoglossal nerve injury following the use of laryngeal mask airway. Anaesthesia 57:264–265

    Article  CAS  PubMed  Google Scholar 

  54. Stöhr M (1996) Iatrogene Nervenläsionen. Thieme, Stuttgart, S 103–104

  55. Streppel M, Bachmann G, Stennert E (1997) Hypoglossal nerve palsy as a complication of transoral intubation for general anesthesia. Anesthesiology 86:1007

    Article  CAS  PubMed  Google Scholar 

  56. Striebel HW (2014) Die Anästhesie, 3. Aufl. Bd. 1. Schattauer, Stuttgart, S 233–235, S 248–249

  57. Sung JH, Jin YL (2009) Isolated unilateral paralysis of the hypoglossal nerve after transoral intubation for general anesthesia. Dysphagia 24:354–356

    Article  Google Scholar 

  58. Tapia AG (1906) Un nouveau syndrome; quelque cas d’hémiplégie du larynx et de la langue avec ou sans paralysie du sternocleïdo-mastoïdien et du trapèze. Arch Int Laryngol Otol Rhinol 22:780–785

    Google Scholar 

  59. Tesei F, Poveda LM, Strali W et al (2006) Unilateral laryngeal and hypoglossal paralysis (Tapia’s syndrome) following rhinoplasty in general anaesthesia: case report and review of the literature. Acta Otorhinolaryngol Ital 26:219–221

    PubMed Central  CAS  PubMed  Google Scholar 

  60. Una E, Gandia F, Duque JL (2009) Tongue paralysis after orotracheal intubation in a patient with primary mediastinal tumor: a case report. Cases J 2:9301

    Article  PubMed Central  PubMed  Google Scholar 

  61. Venkatesh B, Walker D (1997) Hypoglossal neurapraxia following endotracheal intubation. Anaesth Intensive Care 25:699–700

    CAS  PubMed  Google Scholar 

  62. Wadelek J, Kolbusz J, Orlicz P, Staniaszek A (2012) Tapia’s syndrome after arthroscopic shoulder stabilization under general anesthesia and LMA. Anaesthesiol Intens Ther 44:31–34

    Google Scholar 

  63. Yavuzer R, Basterzi Y, Ozköse Z et al (2004) Tapia’s syndrome following septorhinoplasty. Aesthetic Plast Surg 28:208–211

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. L. Brandt gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. -, Ernst-Udet-Str. 9, 85764, Oberschleißheim, Deutschland

    L. Brandt

Authors
  1. L. Brandt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Brandt.

Additional information

Prof. Dr. L. Brandt ist Mitglied der Gutachterkommission für ärztliche Behandlungsfehler bei der Ärztekammer Nordrhein.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brandt, L. Tapia-Syndrom. Anaesthesist 64, 122–127 (2015). https://doi.org/10.1007/s00101-014-2397-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-014-2397-5

Schlüsselwörter

Keywords

Search

Navigation