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Glossectomy

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

The base of the tongue (part of the oropharynx, which is the throat) is considered separately from the oral tongue—part of the oral cavity or mouth. See Tongue Cancer for more information on the anatomy of the tongue.

A glossectomy is performed mainly for cancers of the tongue. However, cancers from other parts of the mouth and throat that grow to involve the tongue may require a glossectomy, especially floor of mouth cancers.

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Preparing for surgery

Your doctor and care team will let you know what you need to do to prepare for surgery. In general, you should not eat or drink anything except essential medications anytime after midnight prior to surgery. You should inform your doctor if you have a fever, productive cough or any other signs of infection. Your doctor will give you a medical clearance evaluation and give recommendations to optimize all the other organs in your body prior to undergoing general anesthesia and surgery.

On the day of surgery, you will need to arrive at the hospital or surgery center a few hours before the scheduled operation. This allows the nurses and anesthesiologist to confirm everything is in order for you to have as safe a surgery as possible. You will see your surgeon before receiving the anesthesia and falling asleep, and you can ask any last-minute questions at that time.

For a glossectomy specifically, you should be prepared for changes in the way you speak and swallow. The extent of the change will depend on a number of factors such as how much of the tongue is removed, where the tongue is removed and what type of reconstruction is performed.

What to expect

In almost all cases, you will be put completely to sleep with general anesthesia. You might or might not require a tracheotomy and/or a feeding tube, depending on the extent of the glossectomy and reconstruction.

There are a few different types of glossectomies, including:

  • Partial glossectomy: This is the removal of any part of the tongue, from a small part of the side or tip, an entire half of the tongue or even more.
  • Total glossectomy: This is the removal of the entire tongue, including the base of the tongue. This results in severe dysfunction with swallowing and resultant aspiration (food and liquids falling into the lungs). A total glossectomy is performed along with a total laryngectomy in order to prevent aspiration and pneumonia. A total glossectomy will require a major reconstructive surgery.

Associated procedures might include a tracheotomy, feeding tube placement, neck dissection, floor of mouth resection or mandibulectomy. A neck dissection is indicated for tongue/oral cavity cancers that go deeper than 3 or 4mm. In addition, the extent of the reconstruction will depend on the amount of tongue and adjacent structures that are extracted. Reconstructive options might be healing by secondary intention (letting it heal on its own), primary closure (placing stitches to close up the tongue that was removed) or a flap reconstruction.

The glossectomy can be done via a few different approaches depending on what part of the tongue needs to be removed, how much of the tongue needs to be removed and what associated procedures might be required.


Different Approaches to Performing a Glossectomy


Transoral
For small cancers of the oral tongue, the entire surgery can be done through the mouth.

Transoral robotic-assisted surgery (TORS)
For tumors at the base of tongue, or oropharynx, a robotic-assisted surgical removal through the mouth might be an option.

Transoral laser microsurgery (TLM)
In this technique, a laryngoscope placed through the mouth exposes various parts of the base of tongue. A laser is then used to cut around the tumor to remove it.

Mandibulotomy
 
For tumors in the base of the tongue or the back part of the oral tongue, your surgeon might recommend a mandibulotomy. This involves making a cut at or near the middle of the lower jawbone and swinging the jaw to the side to expose the back part of the tongue or the floor of mouth.

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Transcervical with pharyngotomy
This is another method to access the back part of the tongue and the base of the tongue. In this technique, an incision is made in the neck, and the neck is connected with the oropharynx through what is known as a lateral or medical pharyngectomy approach. The tongue is pulled down into the neck, and the tumor from the back part of the tongue can be removed without having to cut the jawbone.

Once the tumor is removed, your surgeon will send the margins for immediate frozen section analysis to see if there are any cancerous cells along the margin of the resection. Once the margins are reported as clear, the reconstruction will begin. At the end of the procedure, you will wake up from anesthesia.

Recovery and aftercare

The recovery course will depend on the extent of the surgery and reconstruction. With some surgeries, you could go home after a few hours of observation in the recovery room. Others might require a stay in the hospital for one to two weeks. A stay longer than two weeks is usually due to some sort of post-operative complication that your doctors are working to improve.

If you do stay in the hospital for recovery, the recovery course can happen in a few different parts of the hospital. Your pathway might include the recovery room, intensive care unit, step-down unit and a shared or private “floor” bed. As soon as possible and when the time is right for each step, you will progress from having your tubes and drains removed to being disconnected from the lines, and eventually getting up and out of bed. Asking for assistance to get out of bed to move around will help your recovery. If a tracheotomy is performed, the goal will be to have it removed prior to discharge, but that might depend on a number of factors including how quickly the swelling recedes.

Once your doctors determine that you no longer need in-patient level care, you will be ready for discharge. The discharge planning process begins well before you are ready to leave the hospital. While some patients can go home from the hospital with or without visiting nurses or receiving home care, others might go to a rehabilitation or skilled nursing facility for a short while before returning home. Your discharge planning team, which includes your doctors, social workers, nurses and physical therapists, along with you and your family, will determine the best place for you to go once you’re ready to leave the hospital.

Any additional reconstruction, cosmetic procedures or treatments are usually planned after discharge. This gives you time to recover from the initial surgery, get the pathology results of the surgery and make appropriate arrangements for the next steps.

Risks

As with any procedure, there are risks in undergoing a glossectomy that you need to be aware of. The smaller the region of the removed tongue, the lesser the chance of many of these complications, especially difficulty with speaking and swallowing:

  • Bleeding, including hematoma: If there is severe bleeding after the procedure, your surgeon might need to quickly take you back to the operating room to stop the bleeding.
  • Infection: The tongue has a wonderful blood supply and infections of the tongue are extremely uncommon. Still, as with any surgical procedure, there is always risk of an infection after the surgery, particularly if the glossectomy is associated with additional procedures that might connect the mouth with the neck. This might require antibiotics and/or drainage of the infection.
  • Dysarthria, or difficulty speaking: The extent your speech is affected will depend on how much and what part of the tongue is removed. You might work with a speech and swallowing therapist to improve your function.
  • Dysphagia, or difficulty swallowing: The extent your swallowing is affected will depend on how much and what part of the tongue is removed. You might work with a speech and swallowing therapist to improve your function.
  • Aspiration: After removal of a large part of your tongue, particularly the base of the tongue, it might be difficult to control your swallow mechanism. This can lead to saliva, drinks and food falling into your voice box and into your lungs, which can lead to pneumonia. You should work with a speech and swallowing therapist to improve your function.
  • Salivary fistula: This term is used to describe when saliva is leaking from the mouth into the neck. The chances of this increase if you have had previous treatment, including radiation and/or chemotherapy, because healing of wounds might be impaired in these cases. Typical treatment for this is to place a drain to divert the saliva away from critical structures in the neck and later to place packing into that diverted tract to let the body heal it up on its own. In some cases, an additional surgical procedure might be required to close the leak.