Tapia syndrome after orthognathic surgery: a case report.

Introduction and importance: Tapia syndrome is a cranial neuropathy. It involves the hypoglossal and recurrent laryngeal nerves. The syndrome may follow airway manipulation or prolonged intubation. We report a case of Tapia syndrome, its presentation, management, and outcome. Presentation: A 45-year-old man with skeletal Class III malocclusion underwent orthognathic surgery. Nasotracheal intubation was difficult and required repeated maneuvers and a second attempt. During extubation, the patient developed laryngospasm and hoarseness, which necessitated re-intubation and 24 hours of mechanical ventilation. After successful re-extubation, he manifested complete tongue immobility and dysarthria. Electromyography performed on postoperative day 10 demonstrated partial right and complete left hypoglossal nerve paralysis. These findings are consistent with Tapia syndrome and correlate with clinical leftward tongue deviation. Discussion: Management included corticosteroid therapy and initiation of speech and language therapy. We added an adjunctive local low-level laser therapy. Serial clinical photographs and examinations documented steady improvement within 3 months. Conclusion: Early electrodiagnostic confirmation and multidisciplinary care were associated with near-complete functional recovery by 3 months. The report underscores the importance of careful airway techniques, vigilance for early postoperative bulbar signs, and early rehabilitation to optimize outcomes in iatrogenic cranial nerve injury.