[Treatment of sequelae due to surgical treatment of cervical and skull base paragangliomas]. / Tratamiento de las secuelas por el tratamiento quirúrgico de los paragangliomas cervicales y de base de cráneo.

The most common sequelae in the treatment of head and neck chemodectomas are cranial nerve lesions; of these, the most frequently affected are the trigeminal, facial, glossopharyngeal, vagus and hypoglossus nerves. The lesions of the lower cranial nerves (IX, X, XI and XII) affect the oral and pharyngeal phases of swallowing and frequently lead to aspiration. The frequency with which these nerves are affected varies according to several factors, being 30% in glomus vagale tumors and 20% in carotid tumors. If the V and VII cranial nerves are affected, defects in oral preparation, bolus transport and drooling may occur. Lesions of the XI and X cranial nerves are associated with delayed initiation of the pharyngeal phase, nasal reflux, dysphonia, retained secretions in the piriform sinus, and aspiration. Lesions of the XII cranial nerves affect the oral phase of swallowing. Treatment of dysphagia and aspiration will often be managed with maneuvers to aid swallowing, and changes in food bolus consistency and/or volumes. The remaining complications that can be produced are facial palsy, cerebrospinal fluid fistula, and vascular complications. Facial palsy can be produced by two mechanisms: on the one hand, by central involvement, as a complication of preoperative embolization, and on the other, by direct involvement during surgery or during occasional treatment with radiotherapy. Treatment, whether functional or cosmetic, can be provided either during surgery or subsequently to treat the sequelae of facial palsy.

The diagnosis and management of globus: a perspective from Spain.

PURPOSE OF REVIEW: This article reviews literature on the diagnosis and management of globus. The maneuver of pulling the tongue forward is important in the diagnosis. RECENT FINDINGS: In some patients, physical examination will reveal findings that could be a possible cause of globus. The more frequent findings are tongue base hypertrophy and uvula hypertrophy. In these selected patients, surgical treatment such as partial epiglottectomy or uvulectomia can be offered. Treatment with a proton-pump inhibitor will be useful in some patients with globus. SUMMARY: The diagnosis of globus must be carried out by exclusion with an exhaustive clinical exploration of some anatomical factors that could result in surgical treatment.