Glossectomy
Glossectomy is a surgical procedure involving the removal of all or part of the tongue, primarily performed to treat cancers affecting this organ. The main objective is to excise the abnormal tissue, or tumor, along with sufficient surrounding tissue to ensure that cancer cells do not remain at the margins. The surgery is typically conducted under general anesthesia in a hospital setting by a specialized team that may include ear, nose, and throat surgeons, oral-maxillofacial surgeons, and plastic surgeons.
Patients undergo thorough preoperative preparations, including consultations with a speech-language pathologist to discuss potential impacts on speech and swallowing. Depending on the size of the tumor, techniques may vary from a simple biopsy to more complex grafting procedures, where skin is harvested from areas like the wrist or thigh to reconstruct the tongue. After the surgery, a hospital stay of around one week is common, and patients may require additional therapies, including rehabilitation and possibly radiation.
While glossectomy can have positive outcomes in terms of functionality, risks such as bleeding, difficulty with swallowing and speech, and complications related to skin grafts must be considered. The extent of tongue removal plays a significant role in determining the patient's recovery and ability to regain normal swallowing and speaking abilities.
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Subject Terms
Glossectomy
ALSO KNOWN AS: Hemiglossectomy, partial glossectomy
DEFINITION: A glossectomy is a surgical procedure to remove all or part of the tongue.
Cancers treated: Cancers of the tongue
Why performed: A glossectomy is performed to take out the abnormal tissue (tumor) and enough of the surrounding tissue so that the edges, or margins, around the tumor do not contain cancer cells.
Patient preparation: In addition to the usual preoperative preparation (physical examination, blood testing, and consultation with an anesthesiologist), the patient should meet with a speech-language pathologist for a consultation regarding the changes in speech and swallowing that happen when all or part of the tongue is removed. Glossectomies are done in a hospital, and the patient is given general anesthesia. The surgical team will be specialists in head and neck cancer surgeries, including an ear, nose, and throat surgeon, an oral-maxillofacial surgeon, and a plastic surgeon.
Steps of the procedure: Small cancers may require only a biopsy if the surgeon can remove enough tissue so that the edges around the tumor have no cancer cells. The tissue is tested tableside during the surgery to determine if the margins are negative (without cancer cells).
If the cancer is small, the surgeon sews up the tongue or uses a small skin graft to repair the tongue. For larger skin grafts, the skin is frequently taken from the wrist along with the surrounding blood vessels; this type of skin graft is a radial forearm-free flap. Skin may also be harvested from the chest or thigh. The graft is sewn into the hole in the tongue, and the blood vessels are connected to supply the graft. A total glossectomy is rarely done. In the 2020s, new reconstructive methods, such as free tissue transfer and submental artery island flaps, have shown promise in patients requiring the removal of over one-third of the tongue. The neck are tested to see if the cancer has spread. If lymph nodes are positive for cancer cells, then additional surgery may be done during the same operation for a limited dissection of the neck. New and more efficient surgical methods, including transoral glossectomy and lip-split mandibulotomy are being explored as more efficient and accurate glossectomy procedures.
After the procedure: An inpatient hospital stay of about a week after a glossectomy procedure is expected. A nasogastric tube (from the nose to the stomach) may be used for feeding until food can be taken orally. Subsequent reconstructive surgeries, fitting with prosthetic devices (an artificial tongue), radiation therapy, and rehabilitation therapy may be necessary.
Risks: Possible risks of a glossectomy include bleeding and swelling of the tongue, failure of the skin graft, formation of a new opening between the mouth and the skin (a fistula), and difficulty swallowing and talking.
Results: The results depend on the amount of the tongue that was removed; if one-third or more of the tongue remains, then good swallowing and talking function is expected.
Bibliography
Acher, Audrey, et al. "Speech Production after Glossectomy: Methodological Aspects." Clinical Linguistics and Phonetics, vol. 28.4, 2014, pp. 241–56.
Cho, Yong Hee, et al. "Functional Outcomes after Oral Tongue Cancer Surgery: Determination of Optimal Reconstruction Method." Oral Oncology, vol. 49.1, 2013, p. S82.
Huang, Chun, et al. "An Alternative Surgical Technique for Advanced Tongue/Tongue Base Cancer Without Free Flap Reconstruction." Journal of the Formosan Medical Association, vol. 121, no. 12, 2022, pp. 2626-2632, doi.org/10.1016/j.jfma.2022.07.007. Accessed 27 June 2024.
Joo, Young-Hoon, et al. "Functional Outcome after Partial Glossectomy with Reconstruction Using Radial Forearm Free Flap." Auris Nasus Larynx, vol. 40.3, 2013, pp. 303–7.
Lee, D. Y., et al. "Long-Term Subjective Tongue Function after Partial Glossectomy." Journal of Oral Rehabilitation, vol. 41.10, 2014, pp. 754–58.
Ryu, Yoon Jong, et al. "Morbidity of Partial Glossectomy in Patients with Mobile Tongue Cancers." Oral Oncology, vol. 49.1, 2013, p. S147.
Thompson, Joshua A., et al. “Advances in Oral Tongue Reconstruction: A Reconstructive Paradigm and Review of Functional Outcomes.” Current Opinion in Otolaryngology & Head and Neck Surgery, vol. 30.5, 2022, pp. 368-374, doi:10.1097/MOO.0000000000000828.
Van Lierop, A. C., O. Basson, and J. J. Fagan. "Is Total Glossectomy for Advanced Carcinoma of the Tongue Justified?" South African Journal of Surgery, vol. 46.1, 2008, pp. 22–25.