Tapia's syndrome following cervical laminoplasty -A case report-
A 64-year-old man (height 169 cm, weight 70 kg) was presented for laminoplasty C3-7 due to incomplete cervical spinal cord injury. He started taking antihypertensive medication daily a year ago. Except that, the patient was in good health until he fell from a three-meter-high cliff. Four weeks ago, he had an emergency operation, anterior cervical discectomy and fusion (ACDF) C3-7, under general anesthesia, and no specific events happened during the perioperative period. Anesthesia was induced using a propofol and remifentanil, and the paralysis was facilitated with rocuronium. Endotracheal intubation was achieved using a light-wand and a reinforced endotracheal tube of the inner-diameter 7.5 mm was successfully placed. Anesthesia was maintained with sevoflurane and 50% oxygen in the air. A three-pin head holder was affixed to the patient's head. After the patient was turned prone, the surgeons slightly moved his neck to find an appropriate position and fixed the holder with the head in a neutral position. The total anesthetic and operation time was 405 min and 310 min, respectively, and the blood loss was estimated to be 700 ml. The patient was extubated after a full recovery of respiration and consciousness, and was transferred to the general ward.\nOn the first postoperative day, the patient began to complain of dysphagia and recurrent aspiration, and the symptoms have persisted for two days. A rigid fiberoptic laryngoscope showed the deviation of the tongue to the left on protrusion, the absent movement of the left vocal cord and the pooling of saliva in the left pyriform sinus. Neurologic examination revealed the palsy of the left hypoglossal and recurrent laryngeal nerves. Video fluoroscopic swallowing study (VFSS) showed the impairment of pharyngeal contraction on swallowing and left side deviation and atrophy of the tongue. There was no uvula deviation or abnormality of the soft palate elevation. On neurologic examination, there were palsy of the left hypoglossal and recurrent laryngeal nerve, and the remainder was normal. On a magnetic resonance imaging of the brain and neck, there was no evidence to suspect central neurologic or vascular involvement. These findings suggested a peripheral type of Tapia's syndrome. Conservative management included intravenous corticosteroid, electrical stimulation therapy aimed at a restoration of swallowing ability and the nasogastric tube feeding to reduce the risk of aspiration. VFSS-guided balloon dilation of the esophagus was also performed. Seven weeks after the operation, the patient's symptoms began to improve and he started a soft diet. He gradually recovered thereafter, and was discharged three months later.