Glossectomy

(Partial Glossectomy; Total Glossectomy; Hemiglossectomy)

Pronounced: Gloss –ek-to-me

by ]]>Patricia Griffin Kellicker, BSN]]>

Definition

A glossectomy is the surgical removal of all or part of the tongue. The surgery may be:

Partial—removal of part of the tongue
Hemi—one side of the tongue is removed
Total—removal of the whole tongue

Mouth Cavity After Total Glossectomy

Reasons for Procedure

This surgery is used to treat tongue cancer]]>. It is done when other treatments have not been successful.

Cancer of the Tongue

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.

What to Expect

Prior to Procedure

Your doctor may do the following:

Blood work
Physical exam
Ask about your medical history, including whether you smoke or drink alcohol
Biopsy]]> of the tongue—a piece of tongue is removed and sent to a lab for testing to diagnose cancer
]]>X-ray]]> or CT scan of the chest—tests that take a picture of structures inside the chest
]]>CT scan of the mouth and neck]]>—a type of x-ray that uses a computer to make pictures of structures inside the body

Leading up to the surgery:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Anti-inflammatory drugs (eg, ]]>aspirin]]>)
- Blood thinners, such as ]]>clopidogrel]]> (Plavix) or ]]>warfarin]]> (Coumadin)
Arrange for a ride to and from the hospital.
Eat a light meal the night before. Do not eat or drink anything after midnight.
If you have diabetes, ask your doctor if you need to adjust your medicines.

Anesthesia

]]>General anesthesia]]> will be used. It will block any pain and keep you asleep through the surgery.

Description of the Procedure

If part of the tongue needs to be removed, the doctor will remove this cancerous section. The remaining area of the tongue will be sewn so that there is no hole. Sometimes, a small graft of skin will be used to fill the hole. This skin graft will then be sewn into place.

If the entire tongue needs to be removed, this is a more complicated surgery. The doctor will remove the diseased tongue. A piece of skin from your wrist will also be removed. This skin graft will be placed in the hole left by the tongue. Blood vessels will also be attached from any remaining tongue to the graft. This is to ensure blood flow. Sometimes the lymph nodes in the neck will also need to be removed.

How Long Will It Take?

Several hours

How Much Will It Hurt?

Anesthesia will prevent pain during the surgery. You will have pain during recovery. Ask your doctor about medicine to help with the pain.

Average Hospital Stay

7-10 days

Post-procedure Care

At the Hospital

While recovering at the hospital, you may receive the following care:

Oxygen through prongs attached to your nose for the first 1-2 days
Nutrition through a tube—Once you are able to swallow, you will be able to have drinks and pureed food. If a total glossectomy is done, you may need a permanent feeding tube in the stomach.
Fluids and medicines will be given through an IV
Special boots or sock to help prevent blood clots—You will also be encouraged to get out of bed as soon as possible.
Instructions to breathe deeply and cough 10-20 times every hour (for the first few days)—This will decrease the risk of ]]>pneumonia]]>.

In addition, your doctor may have you:

Work with a speech therapist to learn to speak and swallow after surgery
Begin ]]>radiation therapy]]> to treat the cancer if it had not been given before

At Home

When you return home, do the following to help ensure a smooth recovery:

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.

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occurs:

Signs of infection, including fever and chills
Difficulty swallowing or choking on food or liquids
Swelling, excessive bleeding, or discharge from mouth
Pain and/or swelling in the feet, calves, or legs
Problems with urination
Cough, shortness of breath, chest pain, or severe nausea or vomiting
Increased pain
Any other worrisome symptom

In case of emergency, CALL 911.

RESOURCES:

National Cancer Institute
http://www.nci.nih.gov/

Oral Cancer Foundation
http://www.oralcancerfoundation.org/

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca/

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

References:

Fujimoto, Yet al. Swallowing Function Following Extensive Resection of Oral or Oropharyngeal Cancer With Laryngeal Suspension and Cricopharyngeal Myotomy. Laryngoscope. 117(8):1343-1348, August 2007.

Glossectomy. Surgery Encyclopedia website. Available at: http://www.surgeryencyclopedia.com/Fi-La/Glossectomy.html. Accessed November 18, 2008.

Kimata Y, Uchiyama K, Ebihara S, et al. Postoperative complications and functional results after total glossectomy with microvascular reconstruction. Plast Reconstr Surg. 2000 Oct;106(5):1028-35.

Mehta, Samir M.S.et al. Complications of the Pectoralis Major Myocutaneous Flap in the Oral Cavity: A Prospective Evaluation of 220 Cases. Plastic & Reconstructive Surgery: July 1996 - Volume 98 - Issue 1 - pp 31-37

Oral cancer. National Cancer Institute website. Available at: http://www.nci.nih.gov/cancertopics/types/oral. Accessed November 18, 2008.

Oral tongue cancer. Mayo Clinic website. Available at: http://www.mayoclinic.org/oral-tongue-cancer/treatment.html. Accessed November 19, 2008.

Surgery. Oral Cancer Foundation website. Available at: http://www.oralcancerfoundation.org/facts/surgery.htm. Accessed November 18, 2008.

What you need to know about oral cancer, treatment. National Cancer Institute website. Available at: http://www.nci.nih.gov/cancertopics/wyntk/oral/page9. Updated September 2004. Accessed November 18, 2008.

Last reviewed November 2009 by ]]>Elie Edmond Rebiez, MD, FACS]]>

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.