Glossectomy

Definition

Glossectomy is a surgery for the removal of total or a part of the tongue.
Glossectomy is always performed under general anesthesia.
A glossectomy is performed for the treatment cancer of the tongue. Removing the tongue is indicated if the patient has a cancer that does not respond to other forms of treatment.
Cancer of the tongue is considered very dangerous due to the reality that it can easily spread to nearby lymph glands. Most cancer specialists suggest surgical removal of the cancerous tissue.

 

Types

Partial Glossectomy
A partial glossectomy is rather a simple surgery. The hole is normally repaired by sewing up the tongue immediately after the surgery or by using a small graft of skin, if the "hole" left by the removal of the cancer is small.
Care is taken to repair the tongue so as to maintain its mobility, if the glossectomy is more extensive.

Radial Forearm Free Flap
A general approach is to use a piece of skin taken from the wrist together with the blood vessels that supply it. This type of implant is called a radial forearm free flap. The flap is inserted into the hole in the tongue.
This process requires a highly skilled surgeon who is able to connect very small arteries.

 

Total Glossectomy
Complete removal of the tongue, called a total glossectomy. Complete glossectomy is hardly performed.
Alcohol consumption and smoking are the most important risk factors for cancer of the tongue. The risk is notably higher in patients who use both alcohol and tobacco than in those who use only one.

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.

 

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have glossectomy, your doctor will review a list of possible complications, which may include:

• Tongue bleeding
• Infection
• Airway blockage from swelling and bleeding
• Trouble swallowing and aspiration of liquids
• Difficulty speaking
• Weight loss
• Failure of flap-occurs when transplanted skin or flap does not get enough blood flow
• Recurrence of cancer

Some factors that may increase the risk of complications include:

• Lung disease
• Large tumors
• Malnutrition
• Alcoholism
• Smoking
• Prior radiation
• Prior chemotherapy
• Diabetes

Be sure to discuss these risks with your doctor before the surgery.

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.

 

Post Glossectomy Care

After the performance of the glossectomy, patients usually remain in the hospital for 8 to 10 days. They often need oxygen in the first 24–48 hours after the surgery. Oxygen is administered through a facemask or through two small tubes placed in the nostrils.
Until the patient can accept taking food by mouth, he or she is given fluids through a tube that goes from the nose to the stomach. Radiation treatment is often scheduled after the surgery to demolish 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.

Nursing management after procedure

Gargle several times a day to prevent infection.
Take antibiotics as prescribed.
Take pain medicine to ease discomfort.
Slowly resume your normal diet.
Continue to work with a speech therapist.
Be sure to follow your doctor's instructions.

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