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A 68-year-old man admitted to the intensive care unit (ITU) was referred with dysphagia and dysphonia following decanulation of his tracheostomy. He had suffered acute cholecystitis requiring a prolonged ITU stay. He reported difficulty manipulating food when eating due to restricted tongue movements. On examination he had tongue deviation to the right consistent with a right hypoglossal nerve palsy and hoarse voice.Flexible nasendoscopy demonstrated right vocal cord paralysis. Contrast imaging of the brain and neck revealed atrophy of the right hemi-tongue but no compressive lesion. He was managed conservatively with input from Speech therapy. At 3-month follow-up his symptoms had largely resolved.30% of hypoglossal nerve injuries occur perioperatively as a complication of airway manipulation.1 Risk factors include male sex, use of an endotracheal tube rather than a supraglottic airway, repeated intubation attempts and increased cuff pressures.2 Co-occurrence of ipsilateral hypoglossal and recurrent laryngeal nerve palsies is eponymously named Tapia syndrome, or Matadors disease, after the Spanish physician who first described it in a bullfighter. Fewer than 100 cases have been reported.3 Most iatrogenic cases recover fully within six months without specific management. Modification of airway management techniques may reduce the incidence.References Stino AM, et al. Muscle & Nerve 2016;54(6):1050–1054.Shah AC, et al. Anesthesia & Analgesia 2015;120(1):105–120.Wei R, De Jesus O. Tapia syndrome. https://www.ncbi.nlm.nih.gov/books/NBK567747/ruth.wood11@nhs.net