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PubMed1987

Total glossectomy.

Total glossectomy is a procedure based on sound oncologic principles, and its usefulness may not be fully appreciated. Given the dimensions of the tongue and the need to obtain a wide margin of resection, this procedure may be indicated in selected T3 lesions and recurrences after irradiation. The procedure offers excellent palliation of pain, and form and function may be preserved by rim mandibulectomy when indicated. New reconstructive techniques allow for speedier recovery. Aspiration need not be a complication of total glossectomy if care is taken to preserve the superior laryngeal nerve. Speech rehabilitation plays an important role in returning these patients to their normal environment. Overall 1 and 3 year disease-free survival rates have been encouraging.

Adolescent↗
PubMed1989

Oncologic and functional considerations of total glossectomy.

The efficacy of total glossectomy for advanced carcinoma of the tongue remains controversial. A retrospective chart review was undertaken to evaluate the oncologic and functional results in 17 consecutive patients who underwent this procedure. There were two patients with stage III disease, eight with stage IV disease, and seven with recurrent disease. The larynx was preserved in seven patients. One patient required a secondary laryngectomy. All patients were reconstructed immediately, 11 with a pectoralis major myocutaneous flap and 6 with free-tissue transfer. The operative mortality was 6 percent; the morbidity was 59 percent. At last follow-up, 53 percent of the patients were alive without disease, with a mean disease-free survival period of 36 months. Ninety-three percent of the patients regained swallowing and independent oral alimentation; 80 percent of those with laryngeal preservation regained intelligible speech. We have concluded that total glossectomy should be considered as a primary modality for advanced carcinoma of the tongue and not solely reserved for salvage in hopeless situations. With or without laryngectomy, excellent survival and functional results can be obtained.

Aged↗
PubMed1982

Prosthodontic rehabilitation for glossectomy patients.

Patients with oral carcinomas often have resection of the tongue, the floor of the mouth, or the bone of the mandible. Postoperatively, these patients encounter chewing, swallowing, and speech problems. Oral rehabilitation through prosthetic management can aid in alleviating these problems. Designs of the prosthesis vary according to patient needs. A "snap-on" tongue prosthesis or palatal augmentation prosthesis can be constructed. Total glossectomy patients require prosthetic intervention on a mandibular framework. Partial glossectomy patients require prosthetic augmentation on a maxillary framework. Through prosthetic management of this type, articulation and resonance are improved, food is more easily directed into the esophagus, tissues are protected and socialization is enhanced through improved appearance.

Deglutition↗
PubMed1983

Evaluation of the effects of palatal augmentation on partial glossectomy speech.

Patients who have had surgical removal of part of the tongue are left with varying degrees of speech deficiencies. Augmentation of the palate has been suggested as a means of compensation for this deficiency. This pilot study suggests a technique for evaluating prosthodontic efforts to improve speech for partial glossectomy patients. Although firm conclusions cannot be based on the observations of one patient, it appears that both the shape of the palatal surface and the contour of the cavity size anterior to the tongue are important factors to be considered in prosthodontic efforts to optimize fricative sound production for partial glossectomy patients. Further studies with patients who have a wider variety of tongue resections are indicated. The technique described is an effective one for further studies.

Evaluation Studies as Topic↗
PubMed1975

Swallowing and speech after radical total glossectomy with tongue prosthesis.

Radical total glossectomy is now accepted as a useful procedure for the management of advanced cancer of the tongue. This article records our study of speech and swallowing without the tongue. An artificial tongue prosthesis has been developed and found to greatly improve these functions after total glossectomy. The special operative factors to be considered in order to permit a smooth and rapid rehabilitation regarding speech and swallowing have been stressed.

Deglutition↗
PubMed2005

Siblings with spaced arches treated with and without partial glossectomy.

Macroglossia, or enlarged tongue, is thought to be an etiological factor in open bite, bimaxillary protrusion, and dental arch spacing, and it might cause instability after orthodontic treatment. Partial glossectomy to reduce tongue size might be a useful method of solving these problems. In this report, we describe orthodontic treatment of 2 siblings with enlarged tongues and arch-space problems. The sister, whose tongue was larger and spacing problem more severe, was treated with a partial glossectomy; her brother refused surgery and was treated with a tongue-crib appliance. Stability after orthodontic treatment was evaluated.

Adolescent↗
PubMed2004

Extended sigmoid-shaped free jejunal patch for reconstruction of the oral base and pharynx after total glossectomy with laryngectomy.

The procedure for reconstruction of the extensive defect after total glossectomy with total laryngectomy has not been standardised so far. We have devised a new method in which a free jejunal patch is extended to a sigmoid-shaped form specifically optimised for reconstruction of the defect that consists of the entire floor of the mouth and the antero-lateral walls of the pharyngoesophageal tract. After a jejunal segment of about 40 cm has been longitudinally opened in full length, the proximal quarter is folded parallel to the second quarter, which is then folded parallel to the third quarter in the opposite direction, to be laid out in a S-shaped form. Side-by-side sutures are then placed along each of the folded borders and corrective trimming is done to fit the defect. This widely extended patch replaces the whole oral base, whereas the remaining distal quarter of the patch replaces the antero-lateral walls of the hypopharynx and cervical esophagus. Because of the encouraging functional results with satisfactory restoration of oral alimentation, this procedure is considered to be ideal for the reconstruction of the defect which follows total glossectomy with total laryngectomy.

Adult↗
PubMed2004

Consonant intelligibility and tongue motility in patients with partial glossectomy.

PURPOSE: The primary determinants for good speech outcome after glossectomy are not well established. This study evaluated the effect of tongue motility, type of reconstruction, and affected muscles on speech intelligibility. METHODS: Fourteen German glossectomy patients participated in an intelligibility test, which targeted lingual consonants. Tongue motility was rated on nine 3-point scales. Surgical mapping documented type of reconstruction and affected muscles. RESULTS: Mean consonant intelligibility was 71.25% and mean tongue motility was 34%. There was a moderate correlation between tongue motility and consonant intelligibility (r = 0.619). Patients with platysma flap reconstructions (n = 6) had a tendency for more correctly identified consonants. Patients with an intact genioglossus (n = 4) had significantly better tongue motility scores. CONCLUSIONS: The findings support the hypothesis that good tongue motility is a precursor of good postglossectomy speech. Although flap reconstructions led to better consonant intelligibility in this study, this should be interpreted with caution due to the small sample size.

Adult↗
PubMed2004

The efficacy of palatal augmentation prostheses for speech and swallowing in patients undergoing glossectomy: a review of the literature.

This article provides a review of the literature to assist the clinician in determining the efficacy of palatal augmentation prosthesis regarding speech and swallowing for the patient undergoing glossectomy. A MEDLINE search was conducted. Peer-reviewed articles published from 1966 to July 2002 that addressed the question of the efficacy of this prosthesis to improve speech and swallowing after partial or total glossectomy were included. Studies reviewed had to incorporate an objective evaluation of one or both functions. Nine of 130 studies met the selection criteria (4 retrospective, 1 case control, and 4 case reports). A total of 50 subjects were studied, 42 for swallowing and 37 for speech. In 36/42 subjects, treatment was advantageous for swallowing and in 32/37 subjects, it was advantageous for speech. On the basis of the limited evidence available, the functional efficacy of the palatal augmentation prosthesis is supported.

Case-Control Studies↗
PubMed1986

Total glossectomy without laryngectomy.

When cancer of the tongue reaches a large size (T3, T4) it is almost impossible to treat it successfully with radiotherapy. The only therapeutic possibility in such cases is, therefore, total glossectomy. This may be effected without laryngectomy and with immediate reconstruction using musculo-cutaneous flaps. Such an operation allows total removal of the tumour and is followed by an acceptable though impaired functional result. Eight cases subjected to total glossectomy without laryngectomy are presented and aspects of ablative and reconstructive surgery are discussed. A report is made of postoperative complications and of functional rehabilitation: mastication is certainly impaired. However, swallowing is regained rapidly and phonation, although altered, is still comprehensible. An acceptable quality of life and good possibilities for a return to a working life result.

Adult↗
PubMed1989

Improvement of speech intelligibility by a secondary operation to mobilize the tongue after glossectomy.

To prove the hypothesis that speech after glossectomy would be improved more by increasing the mobility of the remaining tongue rather than by increasing its volume, the speech intelligibility of 4 glossectomy patients was investigated before and after a secondary operation in which a split skin graft was used to mobilize the residual tongue. In each case, the postoperative speech intelligibility scores were higher than preoperative ones (case 1:83.6 to 97.2%, case 2: 76.6 to 82.5%, case 3: 51.5 to 58.5%, case 4: 30.2 to 49.3%). Sounds produced with the rear portion of the tongue were improved in 3 cases, and plosive and affricative sounds were remarkably improved in all cases. These results were considered to be due to the increased mobility, especially the mid and rear portions of the tongue.

Adult↗
PubMed1989

Total glossectomy: reconstruction and rehabilitation.

Patients with carcinoma of the tongue including the base of the tongue who underwent total glossectomy in a period of just over ten years since January 1979 have been reviewed. Total glossectomy may be indicated as salvage surgery or as a primary procedure. The larynx may be preserved or may have to be sacrificed depending upon the site of the lesion. When the larynx is preserved the use of laryngeal suspension facilitates early rehabilitation and preserves the quality of life to a large extent. Cricopharyngeal myotomy seems unnecessary.

Aged↗
PubMed1996

Analysis of the articulation after glossectomy.

Rehabilitation of the oral cancer patient should aim to achieve not only morphological restoration but also post-operative functions. However, there are few reports describing quantitative evaluation of the latter. The authors have attempted quantitative evaluation of post-operative articulatory function after glossectomy, and report the evaluation of it by speech intelligibility, electropalatography (EPG), and acoustical analysis. Subjects were five directly sutured patients and five patients reconstructed with forearm flap, all after glossectomy. The target syllable was /ta/ from among speech intelligibility test samples. The speech intelligibility and acoustical analysis were investigated pre-operation, and 1,6 and 12 months post-operation. EPG data were collected by DP-01(RION) at 6 months post-operation. Acoustical analyses were carried out by consonant frequency characteristics and formant variance from consonant to vowel transitions. As a result, subjects reconstructed with a forearm flap showed higher restorative tendency than directly sutured subjects. Articulatory characteristics expected from acoustical analysis were more in agreement with the results of EPG than with the results of the speech intelligibility test. From the results, it was suggested that the acoustical analysis used for this research could reveal changes in articulatory movement and will be useful for quantitatively evaluating post-operative articulatory functions.

Adult↗
PubMed1997

Midline glossectomy and epiglottidectomy for obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome is caused by narrowing of the pharyngeal airway and loss of dilator tone during sleep. In patients with severe apnea surgical correction often requires attention to both the oropharynx and hypopharynx. Tongue reduction surgery has been described for persistent apnea after failure of palatal surgery. We describe our experience with midline glossectomy with epiglottidectomy in 12 patients with a mean age of 48.8 +/- 14.2 years and body mass index of 36.0 +/- 8.8 kg/m2. Response to treatment was defined as a postoperative respiratory disturbance index (RDI) below 20. Three patients (25%) responded to treatment. The mean apnea index decreased from 48.9 to 35.7, RDI decreased from 73.3 to 46.6, and lowest oxygen saturation increased from 65.9 to 77.9%. RDI in responders decreased from 69.7 to 10. Midline glossectomy with epiglottidectomy has variable results, yet is effective in selected patients with hypopharyngeal narrowing related to macroglossia.

Adult↗
PubMed2003

Analysis of the relations between the shape of the reconstructed tongue and postoperative functions after subtotal or total glossectomy.

OBJECTIVES/HYPOTHESIS: For reconstruction after subtotal or total glossectomy, both preserving the larynx and maintaining postoperative swallowing and speech functions can greatly improve quality of life; however, postoperative functional results are often unstable. Our experiences suggest that insufficient flap volume in the oral area and postoperative prolapse of the preserved larynx affect postoperative function. The objective was to investigate the relations of the shape of the reconstructed tongue to postoperative swallowing and speech functions. STUDY DESIGN: The shape of the reconstructed tongue was classified on the basis of magnetic resonance and intraoral inspection as protuberant, semi-protuberant, flat, or depressed. Speech intelligibility was evaluated, and body weight, which might affect the shape of the transferred flap, was measured before and after surgery. METHODS: Thirty patients who had undergone subtotal or total glossectomy and subsequent reconstruction were reviewed. RESULTS: We found that speech intelligibility (P <.001), food (P <.01), and deglutition (P <.003) scores were significantly lower in patients with flat or depressed tongues than in patients with semi-protuberant or protuberant tongues. Weight loss after surgery was significantly greater in patients with depressed tongues than in other patients (P <.013). Our results indicate that postoperative function is related to the shape of the reconstructed tongue. CONCLUSIONS: We suggest that 1) wider and thicker flaps, such as rectus abdominis musculocutaneous flaps, be used; 2) flaps be designed to be approximately 30% wider than the defect; 3) laryngeal suspension be used to prevent prolapse of the transferred flap; and 4) careful general management and sufficient nutrition are important in the early postoperative period.

Adult↗
PubMed1987

Speech intelligibility after partial glossectomy in children with Down's syndrome.

Twenty-three children with Down's syndrome, aged between 3.7 and 17.5 years, underwent partial glossectomy for improvement of cosmetic appearance. Improved speech was also expected. Preoperative and postoperative audiotaped samples of spoken words and connected speech on a standardized articulation test were rated by three lay and three expert listeners on a five-point intelligibility scale. Five subjects were eliminated from both tasks and another four from connected-speech testing because of inability to complete the experimental tasks. Statistical analyses of ratings for words in 18 subjects and connected speech in 14 of them revealed no significant difference in acoustic speech intelligibility preoperatively and postoperatively. The findings suggest that a wedge-excision partial glossectomy in children with Down's syndrome does not result in significant improvement in acoustic speech intelligibility; in some patients, however, there may be an aesthetic improvement during speech.

Adolescent↗
PubMed1983

Total glossectomy sans laryngectomy--are we justified?

Eighty-five cases of cancer of the tongue treated with total glossectomy are presented; 82 had a squamous carcinoma. The majority had a large primary with no disease in the neck. Thus only 6 patients required concurrent therapeutic radical neck dissection. A laryngectomy was done in 9 cases for gross extension of disease and in 1, as prophylaxis against aspiration. In 75 cases the larynx was preserved. Mortality from aspiration pneumonitis was 4%. Local recurrence rate was 42% for predominantly posterior lesions and 27% for anterior lesions. The speech, though not quite articulate, was fairly understandable. Thus, in cases of total glossectomy preservation of larynx is worthwhile and justifiable except when involved with disease, when the risk of even minor degrees of aspiration is high (elderly, frail individuals) and with associated extensive pharyngeal resection hampering the swallowing machanism.

Adult↗
PubMed1992

The combined sensate radical forearm and iliac crest free flaps for reconstruction of significant glossectomy-mandibulectomy defects.

The loss of motor and sensory function of the tongue following ablative surgery has a devastating effect on oral function. At the present time, there is no way to restore lost tongue musculature following partial glossectomy. The use of sensate cutaneous flaps has been shown to restore sensory feedback to reconstructed areas of the oral cavity. No single composite flap supplies a sensate soft-tissue component together with an osseous component of sufficient bone stock for functional mastication. In this article, the combination of the radial forearm free flap with the iliac crest osteocutaneous or osteomyocutaneous free flap is reported. The radial forearm free flap was used to resurface the resected portion of the tongue to provide maximum mobility and sensation. The lingual nerve was the recipient nerve for anastomosis to the antebrachial cutaneous nerves in all but one case. The iliac bone was used to reconstruct the mandible, with the iliac skin paddle or the internal oblique muscle used to reconstruct the neoridge. This combination of flaps was used in 10 patients. There was one flap failure due to vascular kinking from "piggybacking" the iliac crest to the distal end of the radial forearm flap. As a result, the use of two separate sets of recipient vessels is now advocated. Although a single composite free flap offers an excellent form of oromandibular reconstruction in most cases, it has been shown that oral function deteriorates when large areas of anesthesia are present in the oral cavity. We believe that this combination of two free flaps offers an opportunity for superior function in select patients with significant glossectomy and/or large mucosal defects.

Anastomosis, Surgical↗