A glossectomy is a surgical procedure involving the removal of a portion or, in some cases, the entirety of the tongue. It is primarily undertaken to address various conditions affecting the tongue, aiming to eliminate diseased tissue, often to treat tumors. The extent of the procedure is tailored to individual needs, depending on the nature and size of the affected area.
Understanding Glossectomy Types
Glossectomy procedures are categorized based on the amount of tongue tissue removed. A partial glossectomy involves removing a small section of the tongue, often for smaller or early-stage lesions. This approach aims to preserve as much natural function as possible.
A hemiglossectomy refers to the removal of one half of the tongue, commonly performed for larger tumors affecting one side. When more than half but not the entire tongue is removed, the procedure is termed a subtotal glossectomy. The most extensive form is a total glossectomy, which involves the complete removal of the tongue. This surgery is reserved for advanced conditions affecting most of the tongue.
Medical Reasons for the Procedure
The primary medical reason for performing a glossectomy is the treatment of oral cancer originating in the tongue. When cancerous cells are detected, surgical removal is often the primary course of action to eliminate the disease. The goal of this surgery is to remove the tumor along with a margin of healthy tissue to ensure all cancerous cells are excised.
Beyond cancer, a glossectomy may also be indicated for other conditions. These include large, benign (non-cancerous) tumors or growths that interfere with normal tongue function. The procedure can also address macroglossia, an enlarged tongue, or alleviate severe obstructive sleep apnea when other treatments have not been successful.
The Surgical Process
A glossectomy is performed under general anesthesia. Prior to surgery, imaging tests such as MRI or CT scans, along with a biopsy, help the surgical team plan the extent of tissue removal. The approach depends on the tumor’s location and size; smaller lesions may be removed transorally (through the mouth). For larger or harder-to-reach tumors, incisions might be made in the neck or jaw, sometimes requiring a mandibulotomy (temporary jawbone cut) for better access.
During the procedure, the surgeon removes the affected portion of the tongue, along with a margin of healthy tissue to reduce cancer recurrence. If cancer is suspected to have spread, lymph nodes in the neck may also be removed via a neck dissection.
After tissue removal, reconstruction is often necessary to restore tongue structure and function. For small defects, the remaining tongue tissue may be stitched directly. Larger resections might require tissue grafts, known as flaps, taken from other parts of the patient’s body, such as the forearm, thigh, or chest. These flaps, including skin, muscle, and blood vessels, are connected to the remaining tissues to rebuild the tongue. In some extensive cases, a tracheostomy (an opening in the windpipe) might be temporarily or permanently created to assist with breathing, especially if significant swelling is anticipated.
Post-Operative Care and Rehabilitation
Following a glossectomy, patients typically remain in the hospital for approximately a week, though the duration can vary based on the extent of the surgery and individual recovery. Pain management is a priority, with medication administered to control discomfort in the mouth and neck. Initial challenges often include swelling, which can affect breathing and swallowing, and a temporary inability to eat by mouth. A feeding tube, either through the nose (nasogastric tube) or directly into the stomach (gastrostomy tube), is commonly used to provide nutrition until oral intake is safe. Good oral hygiene, including regular rinsing, is important to prevent infection during the healing process.
Rehabilitation is a significant part of the recovery, focusing on adapting to changes in speech and swallowing. Speech-language pathologists play a central role, working with patients to improve speech clarity and regain the ability to communicate effectively. Swallowing therapy, also known as dysphagia management, helps patients relearn how to safely consume food and liquids, often starting with clear liquids and gradually progressing to soft or regular diets. Long-term dietary adjustments are often necessary, and a dietitian advises on suitable nutritional approaches. Multidisciplinary support from various specialists helps patients adapt to these changes, improving their quality of life after surgery.