Tapia's syndrome after surgery for recurrent pleomorphic adenoma of the parotid gland

Tapia's syndrome consists of concurrent injury to the recurrent laryngeal and hypoglossal nerves. Trauma as a result of direct pressure from inflated cuff of the tracheal anesthetic tube and/or overextension of the neck during surgery have been reported to be possible causes of this syndrome. Here, we report a case of Tapia's syndrome following surgical excision of a very large recurrent parotid tumor. The aim of this report is to draw the attention of head and neck surgeons and anesthetists to this often unexpected condition. A 30-year-old female presented to the surgical outpatient clinic of the Lagos University Teaching Hospital with a massive, multinodular, right facial swelling. There was no sensory or motor nerve paresis on presentation. The patient underwent surgical excision of the swelling under general anesthesia. Two hours after extubation, the patient had difficulty moving the entire tongue and had difficulty with phonation. A working diagnosis of Tapia's syndrome was made based on clinical presentation and assessment. The patient was reassured and placed on tablets neurobion three times daily and tablets prednisolone 20 mg daily. Fourteen days after surgery, hoarseness of voice had resolved completely and full tongue control returned after 2 months. Tapia's syndrome must be considered, especially by all head and neck surgeons and anesthetists even though it is usually a rare complication of surgery

Experience of wrong-site tooth extraction among Nigerian dentists

AbstractObjectiveTo report the experience of wrong-site tooth extraction among Nigerian dentists.Study designA self-administered questionnaire was distributed among a cross-section of Nigerian dentists. Information requested included personal experience on wrong-site tooth/teeth extraction and its after-effect, possible reasons for wrong-site tooth extraction and documentation of the event in patients’ case. Respondents were also asked if they were aware of any colleagues who had previously experienced wrong-site tooth extraction and possible legal implication of the event, and if they aware of the universal protocol for preventing wrong site, wrong procedure, and wrong person surgery.ResultsTwenty-two (13%) of the respondents reported having extracted a wrong tooth. The event occurred within 5years after graduation in most cases. Most respondents (53.6%) informed the patient immediately after the event. Only 68% of the respondents documented the event in patient’s case record. Most common reasons for wrong-site tooth extraction were heavy workload, presence of multiple condemned teeth and miscommunication between dentists. Fifty-five percent of respondents were aware of a colleague who had extracted a wrong tooth. The most probable legal implication of wrong-site tooth extraction according to the respondents was litigation by the patient. Only 25% of dentists were aware of a universal protocol for preventing wrong-site surgery.ConclusionsWrong tooth/teeth extraction is not an uncommon event in the studied environment. The need to be familiar with universal protocol on wrong-site surgery and its legal implications are highlighted