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A glossectomy is the surgical removal of all or part of the tongue. The procedure is performed to treat cancer of the tongue if other treatment options have failed. Since mouth cancer can spread to the nearby lymph glands, a glossectomy to remove cancerous tissue can be life-saving.
Most glossectomies remove only part of the tongue. A total glossectomy, in which the entire tongue is removed, is very rare. In either case, the surgery is performed under general anesthesia.
If only a small part of the tongue is removed, the hole can usually simply be sewn up. If larger parts of the tongue are removed, a skin graft is necessary. The goal of a skin graft, as part of a glossectomy, is to preserve the mobility of the tongue as much as possible. A common procedure in such cases is a radial forearm free flap, in which skin from the wrist, along with the blood vessels supplying it, is grafted onto the tongue.
After a glossectomy, the patient is not able to breathe or eat on his or her own. The patient must remain in the hospital for seven to ten days, receiving oxygen through a face mask, or small tubes in the nostrils, for the first 24 to 48 hours. The patient must also be fed through a tube for the first few days after surgery.
A glossectomy patient will usually undergo radiation treatment after surgery to ensure that the cancer does not recur. Speech therapy is also usually required as part of the aftercare. If at least a third of the original tongue remains after surgery, and if the surgery is successful, the patient has a very good chance of regaining the ability to eat and speak as before the surgery.
Like all surgeries, there are risks involved with glossectomy. Bleeding of the tongue can occur early in the procedure, potentially blocking the patient's airway. A fistula, or an abnormal passageway, may form between the skin and the mouth cavity. If a radial forearm free flap is performed, the graft may be unsuccessful. Finally, especially in cases in which over two-thirds of the tongue are removed, the patient may suffer a lack of mobility in the new tongue, leading to difficulty eating, swallowing, and speaking.
The prognosis for oral cancer is not good, with only 50% of patients surviving after five years. A glossectomy does not drastically improve the prognosis. An alternative to the surgery is the insertion of radioactive wires into the cancerous tissue, but the procedure requires specialized doctors and facilities, and is not performed as often.