Definition and Overview
Glossectomy is the partial or complete removal of the tongue. It is performed to treat tongue cancer and other forms of oral cancer that affect or have already spread to the tongue, particularly its base. It is performed by an oncological surgeon specialising in head, neck, and throat cancers.
Glossectomy is considered as one of the most challenging surgical procedures not just because the tongue is a highly muscular organ but also because it performs a variety of crucial functions that are necessary for digestion and speech. Therefore, the surgeon has to take all the precautions to ensure that the tongue’s functions are retained as much as possible. This can be achieved by ensuring that the removal is limited to the diseased area while reducing the likelihood of the spread of the disease. In cases wherein two-thirds of the tongue is resected, the surgeon needs to follow the procedure up with reconstructive surgery.
Who Should Undergo and Expected Results
There are two major reasons for glossectomy: tongue cancer and other types of oral cancer.
Tongue cancer is a type of oral cancer that affects either the base (the part of the tongue that is closer to the throat) or the oral (the part of the tongue that is visible when speaking or eating). Although there are many different kinds of tongue cancer, the most common is squamous cell carcinoma, which may also vary depending on where it originates. Some common signs and symptoms of tongue cancer are pain when swallowing, change in voice quality (e.g., becoming hoarse), the presence of red or white patches on the tongue that persist for weeks), bleeding of the tongue, and ulcerations.
Since the tongue is part of the oral cavity, it can also be affected by other forms of oral cancer such as throat, mouth, and lips cancers.
Glossectomy can be the primary and only treatment if tongue cancer is limited to a very small area or the disease has been detected in the early stages. However, if it has already spread to other parts of the oral cavity as well as the neck, the surgery is often combined with other treatments like chemotherapy and radiotherapy.
The results of the surgery can differ depending on the exact procedure performed. In partial glossectomy, it is possible for the patient to retain or restore speech, as well as the ability to swallow and position food. However, if it’s complete glossectomy, these activities may be severely limited even after tongue prosthesis has been attached.
How Does the Procedure Work?
Tongue resection is usually an inpatient procedure performed in a hospital under general anaesthesia.
Surgeons can choose different approaches based on the location of the lesions or cancer. For example, if the cancer is found in the oral tongue, the lesion can be accessed directly through the mouth. However, if it is located in the base, the surgeon may opt for robot-assisted surgery, laser microsurgery, or mandibulotomy. In robot-assisted surgery, the mouth is kept wide open while robotic arms, which are controlled by the surgeon, are used to remove cancer in a more precise manner. In laser microsurgery, the surgeon uses a laryngoscope, a probe that is inserted into the larynx to get real-time visuals of the throat including the base of the tongue, and uses laser technology to remove the lesions. Mandibulotomy is more complex since it involves creating an incision in the jaw and putting it on the side so the surgeon can see and operate on the tongue.
The removed tongue samples will be sent for biopsy to check for any presence of cancer, and depending on the result, the resection may continue until the samples come back clear. After the tongue removal, the surgeon may proceed to reconstruct the tongue using different flap techniques or by attaching tongue prosthesis.
The surgery may take at least an hour to complete, after which the patient is wheeled into the recovery room. In the majority of cases, the patient is connected to a feeding tube for about a week.
Possible Risks and Complications
Tongue resection has many possible risks and complications, which explains why the patient has to stay in the hospital for a few days. These include common surgical risks such as bleeding and infection. In some cases, the patient may also experience difficulty in swallowing or speaking, leaking of saliva from the mouth to the neck (saliva fistula), and pneumonia.
- Eusterman VD. History and Physical Examination, Screening and Diagnostic Testing. Otolaryngol Clin North Am. Feb 2011;44(1):1-29. PMID: 21093621 www.ncbi.nlm.nih.gov/pubmed/21093621.