This man in his 50s experienced left sided tongue paralysis along with dysphonia and dysphagia on awakening in the intensive care unit after a mixed overdose (fig 1). He required respiratory support and needed intubation on four separate occasions, including once after self-extubating. Laryngoscopy showed reduced movement of the left vocal cord with pooling of saliva in the left pyriform sinus. Further imaging did not identify a central neurological cause of these symptoms.bmj;384/feb22_6/e077782/F1F1f1Fig 1Tapia’s syndrome was diagnosed on the basis of the concurrent unilateral hypoglossal and recurrent laryngeal nerves palsies. This condition is thought to be caused by compression or stretching of these nerves between the endotracheal tube and stiff structures, such as the cervical vertebrae, thyroid, or hyoid cartilage.1 Risk factors include over-inflation of the endotracheal tube, inflation of the cuff during extubation, placement of a throat pack, and neck manipulation intraoperatively.2 This patient received neurological rehabilitation, but took…
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