Combined unilateral palsy involving extracranial lesion of cranial nerves (CN) X and XII is known as Tapia’s syndrome; this is primarily caused by carcinoma, inflammation, or injuries and rarely occurs after general anesthesia [1, 2]. Mechanisms underlying anesthesia-related Tapia’s syndrome remain unclear. Several plausible explanations involve the path of CN X and XII in the lateral wall of the orohypopharynx, where these two nerves run in parallel, near the mucosa (Fig. 1) [3,4,5]. CN X and XII in this region might be vulnerable to direct compression by oropharyngeal instrumentation, including a laryngoscope blade, tracheal tube, supraglottic airway device, transesophageal echocardiography probe, or throat pack [1, 3,4,5,6,7,8,9,10]. Excessive head and neck displacement during airway manipulation and surgery might cause malpositioning of these instruments; it might also stretch CN X and XII against the transverse process of the first cervical vertebra, as these nerves cross each other near this process [1, 4, 5, 7,8,9,10,11,12,13]. Compression and/or stretching of CN X and XII could cause neurapraxia [1,2,3, 5, 9]. Concomitant CN X and XII neurapraxia could occur at anatomically separate sites, owing to compression by oropharyngeal instrumentation [1, 2, 8,9,10]. Most patients recover from neurological deficits, but some may require corticosteroid therapy [2, 7, 12]. Anesthesiologists and surgeons should consider the possibility of combined CN X and XII palsy occurring in various procedures not involving direct access to these nerves [7, 12]. Communication between anesthesiologists and surgeons about posture may prevent this complication. Moreover, close attention should be given to coexisting symptoms in patients with hoarseness, a common complication of general anesthesia; this will ensure the accurate and timely diagnosis of Tapia’s syndrome, possibly preventing poor recovery or a life-threatening outcome, such as aspiration [4, 11, 14].