Total Glossectomy Defect Reconstruction

Abstract

Advanced tumours of oral tongue or base of the tongue have poor oncological outcome and are functionally debilitating. The procedure of total glossectomy for surgical management of such locally advanced disease of the tongue was described in 1950s by Kremer [1]. However, total glossectomy procedure with laryngeal preservation was associated with significant morbidity due to aspiration; therefore, this procedure often has been mentioned as a “morbid procedure for a morbid disease”. Due to poor functional outcomes, it was relegated as a palliative procedure, and validity of such a procedure without laryngectomy was questioned [2, 3]. Due to the procedure-related morbidity, there was a trend towards organ preservation, and a variety of modalities such as chemoradiation and neoadjuvant chemotherapy followed by chemoradiation are now recommended for management of advanced carcinomas of oral and base of the tongue. However, many patients undergoing organ preservation treatment require surgical salvage for a residual or locally recurrent disease. Also, reports suggest unacceptable compromise with oncological outcome following organ preservation protocols. Recent development in microvascular reconstructive techniques has enabled better functional outcomes in patients undergoing total glossectomy [2, 4]. Therefore, in order to improve the oncological outcome without debilitating morbidity, there is renewed interest in considering total glossectomy as primary modality for management of advanced tongue tumours. The main factors that underlined this transition were better understanding of the dynamics associated with tongue reconstruction and availability of reconstructive options (Fig. 7.1).