A glossectomy is a surgical procedure involving the removal of a portion or the entirety of the tongue, most often performed as a treatment for malignant lesions or cancer of the oral cavity. The tongue is a highly complex muscular organ, a muscular hydrostat, that is anchored to the floor of the mouth and is responsible for numerous coordinated functions far beyond merely tasting food. Its intricate network of intrinsic and extrinsic muscles allows for the precise movements necessary for human communication and safe nutritional intake. The extent of the resection, categorized as partial, subtotal, or total, dictates the severity of the functional deficits experienced post-operatively.
Immediate Consequences: Communication and Speech
The removal of the tongue severely compromises the ability to articulate speech, a condition known as dysarthria, because the tongue is the primary articulator for most speech sounds. Speech is produced by precisely modulating airflow from the lungs and shaping the sounds within the oral cavity through rapid, coordinated movements of the tongue against the palate, teeth, and lips. The intrinsic muscles of the tongue are responsible for changing its shape, while extrinsic muscles control its position, both of which are critical for forming consonants and vowels.
The loss of the anterior two-thirds of the tongue, referred to as the oral tongue, disproportionately affects speech clarity. This front portion is responsible for the rapid, subtle movements needed to produce lingual sounds, such as the alveolar consonants ‘t,’ ‘d,’ ‘s,’ ‘z,’ ‘l,’ and the palatal sound ‘y’. The inability to make contact between the tongue tip or blade and the alveolar ridge or hard palate results in these sounds being distorted, muffled, or completely absent.
A total glossectomy, where the entire tongue is removed, renders standard articulation virtually impossible because the muscular structure required to shape and propel sound has been eliminated. Even the production of vowel sounds, which depend on the tongue’s position to alter the size and shape of the pharyngeal and oral cavities, becomes significantly distorted. The resulting speech can be unintelligible, leading to profound difficulties in communication.
In cases where the tongue base (the posterior one-third) is preserved, articulation may be better maintained, but this preservation often leads to greater difficulty with swallowing. Surgical reconstruction using tissue flaps from other parts of the body can restore bulk to the oral cavity, but these flaps lack the volitional movement of the original tongue muscles. Therefore, the functional outcome for speech depends heavily on the amount of residual, innervated tongue tissue remaining after the procedure.
Impact on Swallowing and Nutritional Intake
The loss of the tongue causes severe difficulty with swallowing, a disorder called dysphagia, because the organ is central to the oral phase of deglutition. Before a swallow can begin, the tongue must work with the cheeks to manipulate and mix chewed food with saliva, forming a cohesive mass known as a bolus. The tongue then seals the bolus against the hard palate, preventing it from prematurely spilling into the throat, a function called oral containment.
Once the bolus is prepared, the tongue initiates the swallow by sweeping backward, like a piston, to propel the food mass into the pharynx, triggering the involuntary pharyngeal phase of swallowing. When a significant portion of the tongue is removed, the patient loses the ability to generate the necessary pressure and posterior propulsion to clear the oral cavity. This results in food residue remaining in the mouth after the swallow, and the bolus may not be safely or efficiently transferred.
The most concerning complication of this impaired mechanism is aspiration, which occurs when food or liquid enters the airway instead of the esophagus, potentially leading to aspiration pneumonia. Patients who undergo subtotal or total glossectomy often face extreme difficulties with both speech and swallowing, frequently requiring long-term nutritional support. Immediate post-operative management typically involves the placement of a nasogastric (NG) tube or a gastrostomy (G) tube to ensure sustained nutritional intake and hydration, as oral feeding is often initially unsafe or impossible.
Sensory Loss: Taste and Oral Sensation
The tongue is a primary sensory organ, and its removal results in a significant alteration or loss of both taste (gustation) and tactile sensation. Taste buds, which house the chemoreceptors for the five basic tastes—sweet, sour, salty, bitter, and umami—are distributed across the surface of the tongue, particularly within the fungiform and vallate papillae. The surgical removal of the tongue, therefore, directly eliminates a vast number of these receptors, leading to a diminished or complete loss of the sense of taste.
Beyond gustation, the tongue provides feedback on the texture, temperature, and location of food within the mouth, a function mediated by the lingual nerve and filiform papillae. The loss of this tactile sensation profoundly impacts the ability to manage a food bolus, as the patient cannot feel where the food is located or if residue remains, increasing the risk of aspiration. The extent of the sensory loss is often correlated with the depth of the resection.
Rehabilitation and Adaptation Strategies
Long-term management following a glossectomy focuses on rehabilitation to maximize functional recovery for both communication and swallowing. Speech and language pathologists (SLP) work with patients to develop compensatory articulation strategies, teaching them to use residual structures, like the palate, pharynx, and even the throat, to produce sounds. For those with severe articulation difficulties, alternative communication methods are introduced, which may include using an electrolarynx—a device that generates a mechanical voice vibration—or developing esophageal speech.
Dietary adaptation is crucial for patients experiencing chronic dysphagia, which involves modifying the consistency of foods and liquids to be safer and easier to swallow. This typically means consuming thicker liquids and softer, pureed foods, which require less oral manipulation and can be propelled more easily. For patients who cannot safely maintain adequate nutrition orally, the feeding tube may remain a long-term fixture to prevent malnutrition and dehydration.
Prosthetic devices can also be employed to help bridge the functional gap left by the missing tongue tissue. A palatal augmentation prosthesis (PAP) or obturator is a custom-made device that lowers the roof of the mouth, bringing the palate closer to the remaining tongue or the reconstructed flap. This reduced gap allows the patient to generate more effective contact pressure for both speech articulation and the propulsion of the bolus during swallowing, significantly improving intelligibility and safety.