Glossectomy

Definition

A glossectomy is the surgical removal of all or part of the tongue.

Purpose

A glossectomy is performed to treat cancer of the tongue. Removing the tongue is indicated if the patient has a cancer that does not respond to other forms of treatment. In most cases, however, only part of the tongue is removed (partial glossectomy). Cancer of the tongue is considered very dangerous due to the fact that it can easily spread to nearby lymph glands. Most cancer specialists recommend surgical removal of the cancerous tissue.

Demographics

According to the Oral Cancer Foundation, 30,000 Americans will be diagnosed with oral or pharyngeal cancer in 2003, or about 1.1 persons per 100,000. Of these 30,000 newly diagnosed individuals, only half will be alive in five years. This percentage has shown little improvement for decades. The problem is much greater in the rest of the world, with over 350,000 to 400,000 new cases of oral cancer appearing each year.

The most important risk factors for cancer of the tongue are alcohol consumption and smoking. The risk is significantly higher in patients who use both alcohol and tobacco than in those who consume only one.

Description

Glossectomies are always performed under general anesthesia. A partial glossectomy is a relatively simple operation. If the "hole" left by the excision of the cancer is small, it is commonly repaired by sewing up the tongue immediately or by using a small graft of skin. If the glossectomy is more extensive, care is taken to repair the tongue so as to maintain its mobility. A common approach is to use a piece of skin taken from the wrist together with the blood vessels that supply it. This type of graft is called a radial forearm free flap. The flap is inserted into the hole in the tongue. This procedure requires a highly skilled surgeon who is able to connect very small arteries. Complete removal of the tongue, called a total glossectomy, is rarely performed.

Diagnosis/Preparation

If an area of abnormal tissue has been found in the mouth, either by the patient or by a dentist or doctor, a biopsy is the only way to confirm a diagnosis of cancer. A pathologist, who is a physician who specializes in the study of disease, examines the tissue sample under a microscope to check for cancer cells.

If the biopsy indicates that cancer is present, a comprehensive physical examination of the patient's head and neck is performed prior to surgery. The patient will meet with the treatment team before admission to the hospital so that they can answer questions and explain the treatment plan.

Aftercare

Patients usually remain in the hospital for seven to 10 days after a glossectomy. They often require oxygen in the first 24–48 hours after the operation. Oxygen is administered through a face mask or through two small tubes placed in the nostrils. The patient is given fluids through a tube that goes from the nose to the stomach until he or she can tolerate taking food by mouth. Radiation treatment is often scheduled after the surgery to destroy any remaining cancer cells. As patients regain the ability to eat and swallow, they also begin speech therapy.

Risks

Risks associated with a glossectomy include:

• Bleeding from the tongue. This is an early complication of surgery; it can result in severe swelling leading to blockage of the airway.
• Poor speech and difficulty swallowing. This complication depends on how much of the tongue is removed.
• Fistula formation. Incomplete healing may result in the formation of a passage between the skin and the mouth cavity within the first two weeks following a glossectomy. This complication often occurs after feeding has resumed. Patients who have had radiotherapy are at greater risk of developing a fistula.
• Flap failure. This complication is often due to problems with the flap's blood supply.

Normal results

A successful glossectomy results in complete removal of the cancer, improved ability to swallow food, and restored speech. The quality of the patient's speech is usually very good if at least one-third of the tongue remains and an experienced surgeon has performed the repair.

Total glossectomy results in severe disability because the "new tongue" (a prosthesis) is incapable of movement. This lack of mobility creates enormous difficulty in eating and talking.

Morbidity and mortality rates

Even in the case of a successful glossectomy, the long-term outcome depends on the stage of the cancer and the involvement of lymph glands in the neck. Five-year survival data reveal overall survival rates of less than 60%, although the patients who do survive often endure major functional, cosmetic, and psychological burdens as a result of their difficulties in speaking and eating.

Alternatives

An alternative to glossectomy is the insertion of radioactive wires into the cancerous tissue. This is an effective treatment but requires specialized surgical skills and facilities.

Resources

books

"Disorders of the Oral Region: Neoplasms." Section 9, Chapter 105 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Johnson, J. T., ed. Reconstruction of the Oral Cavity. Alexandria, VA: American Academy of Otolaryngology, 1994.

Shah, J. P., J. G. Batsakis, and J. Shah. Oral Cancer. Oxford, UK: Isis Medical Media, 2003.

periodicals

Barry, B., B. Baujat, S. Albert, et al. "Total Glossectomy Without Laryngectomy as First-Line or Salvage Therapy." Laryngoscope 113 (February 2003): 373-376.

Chuanjun, C., Z. Zhiyuan, G. Shaopu, et al. "Speech After Partial Glossectomy: A Comparison Between Reconstruction and Nonreconstruction Patients." Journal of Oral and Maxillofacial Surgery 60 (April 2002): 404-407.

Furia, C. L., L. P. Kowalski, M. R. Latorre, et al. "Speech Intelligibility After Glossectomy and Speech Rehabilitation." Archives of Otolaryngology - Head & Neck Surgery 127 (July 2001): 877-883.

Kimata, Y., K. Uchiyama, S. Ebihara, et al. "Postoperative Complications and Functional Results After Total Glossectomy with Microvascular Reconstruction." Plastic Reconstructive Surgery 106 (October 2000): 1028-1035.

organizations

American Academy of Otolaryngology - Head and Neck Surgery. One Prince Street, Alexandria, VA 22314. (703) 806-4444. <www.entnet.org>.

American Cancer Society. National Headquarters, 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS -2345. <www.cancer.org>

Oral Cancer Foundation. 3419 Via Lido, #205, Newport Beach, CA 92663. (949) 646-8000. <www.oralcancer.org>

other

CancerAnswers.com. Tongue Base and Tonsil Cancer. <www.canceranswers.com/Tongue.Base.Tonsil.html>.

Cancer Information Network. Oral Cavity Cancer. <www.ontumor.com/oral/>.

Monique Laberge, Ph.D.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

A glossectomy is performed in a hospital by a treatment team specializing in head and neck oncology surgery. The treatment team usually includes an ear, nose & throat (ENT) surgeon, an oral-maxillofacial (OMF) surgeon, a plastic surgeon, a clinical oncologist, a nurse, a speech therapist, and a dietician.

QUESTIONS TO ASK THE DOCTOR

• Will the glossectomy prevent the cancer from coming back?
• What are the possible complications of this procedure?
• How long will it take to recover from the surgery?
• How will the glossectomy affect my speech?
• What specific techniques do you use?
• How many new cancers of the head and neck do you treat every year?

glossectomy (glos-ek-tŏmi) n. surgical removal of the tongue, an operation usually carried out for cancer in this structure.