Glossectomy Research Articles

Surgical Outcomes Following Combined Barbed Palato-Pharyngeal Surgery and Coblator-Assisted Midline Glossectomy for Obstructive Sleep Apnea

Surgical Outcomes Following Combined Barbed Palato-Pharyngeal Surgery and Coblator-Assisted Midline Glossectomy for Obstructive Sleep Apnea

Surgical Management of Pediatric Obstructive Sleep Apnea Beyond T&A – Tongue Base and Larynx

Pediatric patients with persistent obstructive sleep apnea (OSA) after adenotonsillectomy often have additional sites of upper airway obstruction such as the tongue base or larynx. Sleep endoscopy and cross-sectional, dynamic imaging can be used to direct the surgical management of persistent OSA. The tongue base is one of the most common sites of obstruction in children with persistent OSA, especially for patients with Trisomy 21. Lingual tonsillectomy, tongue suspension, and/or posterior midline glossectomy may be used to address lingual tonsil hypertrophy and tongue base obstruction. Epiglottopexy and/or supraglottoplasty may be used to address laryngomalacia and epiglottic prolapse resulting in OSA. Evidence shows that surgery can lead to significant improvement in postoperative polysomnographic outcomes. Important considerations following surgery of the tongue base and larynx include bleeding, edema, oropharyngeal stenosis, and dysphagia.

Airway Fire During Tracheostomy

Introduction Airway fire is a life-threatening complication in the operation table which is preventable. We report an incident of airway fire that occurred during a tracheostomy and discuss what went wrong. Case report A 48-year-old gentleman with carcinoma tongue and multinodular goiter underwent modified radical neck dissection, hemithyroidectomy, tracheostomy, hemi glossectomy, and free radial forearm flap reconstruction. During tracheal hemostasis with cautery, a flame appeared, and airway burns resulted. It was extinguished in a few seconds with wet mops, but the resultant combustion injury of the tracheobronchial tree and later bilateral pneumonia required multiple sittings of bronchoscopic toileting and intensive airway management for recovery. Discussion This report is to make anesthetists and surgeons aware of such a rare but life-threatening complication, its prevention, and early therapeutic steps which can prevent long-term complications and death.

Comparative Assessment of Total Versus Hemi Glossectomy Defects Reconstructed With Anterolateral Thigh Free Flap

Free tissue transfers for reconstruction following tongue resection has become standard practice. This study sought to evaluate volume shrinkage of the anterolateral thigh free (ALTF) reconstructing tongue defects at 6months postoperative. The aim was to estimate a shrinkage factor for ALTF reconstructing hemi and total glossectomy. This was an IRB-approved retrospective cohort study conducted at the head and neck service at the University of Florida, College of Medicine, Jacksonville (FL). This study targeted patients with tongue cancer from January 2018 to April 2022. patients with tongue squamous cell carcinoma (SCC) who were surgically treated by either hemi or total glossectomy and reconstructed with ALTF. Patients had to have a postoperative computer tomography scans at 1 and 6months post-surgery. Patients with constant body mass index during 6months postreconstruction. Additionally, the patients were to have been treated with adjuvant radiotherapy. patients with recurrent tongue cancer and those who weren't reconstructed or managed with other treatment modalities. Type of tongue resection hemi versus total glossectomy for treatment of tongue SCC. Shrinkage percentage of ALTF reconstructing tongue defects at 6months postoperatively. Age and gender. Paired t-test and student t-test with level of significance P≤.05 were used to statistically analyze ALTF volume changes at 1 and 6months postoperatively and ALTF shrinkage percentage at 6months postreconstruction, respectively. We identified 85 patients who were treated for tongue SCC during the time period of study. Out of the 85 patients, 11 patients were reconstructed with an ALTF. Eight males and 3 females with a mean age of 62.3years old. Six patients had total glossectomy and 5 had hemi glossectomy. Patients with hemi glossectomy had a significant difference in mean average flap shrinkage of 39.6%, while in those with total glossectomy had 17.7% (P=.004). According to our results, we recommend that the flap size should be larger than the defect to adjust for volume shrinkage (1.4 times and 1.2 times for cases of hemi and total glossectomy, respectively).

CT volumetric analysis permits comparison of tongue size and tongue fat in different canine brachycephalic and mesaticephalic breeds.

While macroglossia is a newly accepted component of brachycephalic obstructive airway syndrome (BOAS) in dogs, macroglossia with increased tongue fat is a well-known cause for obstructive sleep apnea (OSA) in people, and targeted reduction procedures such as midline glossectomy are used to treat people with OSA. While midline glossectomy has been described in dogs, tissue contributions to macroglossia have not been characterized. The purpose of this retrospective, descriptive, case-control study was to describe and compare volumetric dimensions of the tongue and tongue fat in brachycephalic (BC) and mesaticephalic (MC) dogs using CT images. Data collected included head and neck CT images from 17 BC and 18 control MC dogs. Multiplanar reformatted and 3D reconstructed images were created using image segmentation and specialized visualization software to calculate volumetric dimensions of the total tongue, tongue fat, and tongue muscle. Rostral and caudal topographical distributions of fat were compared. Total tongue and tongue muscle volume (P<0.0001) and tongue fat volume (P=0.01) normalized to body weight (BW) were greater in BC dogs. More fat was localized in the caudal tongue in both groups (P<0.04). In regression analysis, BC conformation and increased weight were significant predictors of increased tongue fat volume. As in people, increased tongue fat may contribute to macroglossia and sleep-disordered breathing in BC dogs. Use of CT volumetry to identify tongue fat deposits may permit targeted surgical reduction of tongue volume in BC dogs and contribute substantially to treatment of BOAS.

Comparison of quality of life and psychological distress in patients with tongue cancer undergoing a total/subtotal glossectomy or extended hemiglossectomy and free flap transfer: a prospective evaluation

The aim of this study was to assess changes in the quality of life and psychological distress of patients with tongue cancer undergoing total/subtotal glossectomy (TG) or extended hemiglossectomy (HG) and free flap transfer. Differences between the two groups were compared using the Short Form 8-Item Health Survey (SF-8) and Hospital Anxiety and Depression Scale (HADS). Of the 43 patients with tongue cancer, 24 (56%) underwent TG and 19 (44%) underwent HG. The general health and social functioning scores in the SF-8 and depression in the HADS were significantly worse in the TG group than in the HG group at 12 months after surgery, indicating that patients in the TG group may experience social isolation and psychological distress, and have difficulty in employability even 12 months after surgery. In contrast, all items of the SF-8 in the HG group were nearly equal to those in the general population. Due to the extensive psychological impact on patients with tongue cancer who are planned for an extended resection, curative surgery with free flap transfer and multidisciplinary psychiatric support are essential to improve quality of life and manage psychological distress.

Measurement of Lingual Artery Using Ultrasound Versus Computed Tomography Angiography for Midline Glossectomy in Patients With Obstructive Sleep Apnea.

To clarify the differences in assessing the course of the lingual artery between lingual artery computed tomography angiography (CTA) and ultrasound (US). Twenty-six OSA patients were included in this study and accomplished lingual artery CTA and US, respectively. The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries on 3 measurement levels based on lingual artery CTA and US were compared. The depths of the lingual arteries on 3 measurement levels by CTA were deeper than those by US (P < .01). There was no significant difference in the distances between bilateral lingual arteries on 3 measurement levels between CTA and US (P > .05). The parameters of lingual artery measured by lingual artery US were similar to or smaller than those measured by lingual artery CTA. Like lingual artery CTA, lingual artery US could be used as an effective method to ensure the safety of the operation.

Is tracheotomy necessary for transoral robotic surgery base of tongue reduction in obstructive sleep apnoea syndrome? Our experience in 20 patients.

-TORS BOT reduction is a safe surgical approach for OSAS patients with BOT collapse and failure to medical treatments. -Tracheotomy may be avoided in patients without midline glossectomy due to the low risk of postoperative major hemorrhage. -Tracheotomy is associated with a higher risk of aspiration, use of feeding tube, and lengthening of both the operative time and the hospital stay.

Presentation and surgical outcome of oral malignancy at tertiary care centre

Aim: to study etiological factors, clinical presentation and surgical outcome in oral malignancy.Materials and Methods: This study was done from April 2019 to march 2020 a total of 9 cases of oral malignancy who underwent surgery for oral malignancy were included. Patients who underwent other modality of treatment, or refused surgery were excluded from study. In our study all patient who presented with oral lesion underwent preoperative biopsy from oral cavity lesion to confirm diagnosis, Indirect laryngoscopy, CT scan Head and neck, CT Chest for metastatic workup preoperatively.Results: Out of 9 cases 7 were male and 2 were female with male to Female ratio 3.5:1. The age of the patient ranged between 30-70 years.All the 7 (77.7%) male patients had the history of chewing tobacco and 4 (44.4%) males having both tobacco and alcohol consumption habit.All 9 (100%) cases presented with growth in the oral cavity. Difficulty in chewing, trismus, difficulty in speech, palpable cervical lymph nodes were other presenting symptoms in cases.All the cases underwent preoperative biopsy. Out of 9 cases 8 (88.8%) cases were of squamous cell carcinoma in which one case of SCC of maxillary sinus. Rest of them were SCC of oral cavity, in which 3 cases were of ca tongue and 3 case of ca cheek, 1 case of gingiva. One (11.1%) of the case which was turned out as ameloblastoma of the mandible on preoperative biopsy.5 (55.5%) patients underwent commando procedure with pectoralis major myo cutaneous flap. One patient underwent maxillectomy, one underwent hemi mandibulectomy,2 patients underwent hemi glossectomy. In our study most common complication was wound infection (22.2%) followed by bleeding, wound dehiscence, pulmonary embolism. Margins were free in all resected specimen.8 (88.8%) patients were referred for post op radiotherapy. one (11.1%) patient died on post op day 3 due to acute pulmonary embolism.Conclusion: Early diagnosis and complete surgical excision is the key to good prognosis and survival, multidisciplinary team is absolutely essential to ensure a favourable outcome.

Results of coblation midline glossectomy for obstructive sleep apnea

ObjectiveThe aim of this study is to determine the effectiveness of coblation midline glossectomy for obstructive sleep apnea (OSA) when used as an isolated procedure. We also aim to compare the effect of this surgical procedure on supine and non-supine apnea. Materials and MethodsThe medical records of patients who underwent isolated tongue base surgery as a part of step-wise surgeries between January 2014 and February 2019 are retrospectively reviewed. Pre-operative and post-operative Epworth sleepiness score (ESS), body mass index (BMI), and polysomnographic data, including the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), supine AHI, and non-supine AHI of the patients were compared. ResultsThe study included 29 patients (26 male and 3 female). AHI improved significantly, decreasing from 34.9 ± 20.9 to 25.8 ± 17.6. Supine AHI decreased from 62.55 ± 28.23 to 55.18 ± 31.67 post-operatively, but this decrease was not significant. Non-supine AHI decreased significantly from 22.49 ± 24.02 to 14.08 ± 17.46. ESS and ODI also improved significantly. ConclusionCoblation midline glossectomy is an effective surgical procedure when applied solely, with a success rate of 52%. Non-supine apnea benefits to a greater degree than supine apnea from this surgical procedure.

Quilotórax bilateral após esvaziamento cervical: um raro relato de caso

Objetivo: relatar um caso de quilotórax bilateral após esvaziamento cervical devido a carcinoma de língua, complicação rara descrita 65 vezes na literatura. Detalhamento do caso: mulher, 63 anos, atendida no ambulatório de cirurgia de cabeça e pescoço com grande lesão vegetante em borda lateral esquerda da língua, a biopsia incisional diagnosticou carcinoma espinocelular, paciente então foi encaminhada para realizar glossectomia parcial à esquerda associado a esvaziamento cervical radical tipo 2 à esquerda e esvaziamento cervical supra homoióideo à direita. Evoluiu com dispneia moderada no 2º dia pós operatório, através do exame físico, radiografia de tórax e análise do líquido pós toracocentese foi diagnosticado quilotórax bilateral, uma complicação extremamente rara, uma vez que não houve lesão do ducto torácico. Considerações finais: trata-se de uma complicação rara e importante, o melhor método para minimizar as consequências e a taxa de morbidade é o diagnóstico precoce. Logo, deve-se aprimorar os registros na literatura e o manejo clínico cirúrgico e clínico a fim de obter prognóstico melhor desses pacientes.

An analysis of the demography and histology of patients presenting with oral cavity malignancy

In the modern world one of the most dreaded disease is cancer. Among all the cancers that occur, cancer within the oral cavity ranks as the eleventh most common cancer globally In view of the changing trends in oral cancer we did a study to evaluate the practices followed for oral cancer in our study.The present study was a non-randomized prospective observational study that was done on patients who visited hospital and were diagnosed by histopathology as having oral cancer. The study was done at the department of general surgery and surgical oncology at the Father Muller Medical College. Kankanady in the state of Karnataka South India. The study was done. During the study period that extended from March 2014 to February 2020 the following observations were done on a total of 202 cases.Those who met a predefined criteria and gave a written informed consent were enrolled in the study. They were explained regarding their disease, the treatment options that are available and the alternative treatments if any. Once the patients was optimized, based on the decision of the tumour board appropriate therapy was given and the complications of each was noted down. During the study period that extended from March 2014 to February 2020 the following observations were done on a total of 202 cases .In the present study between the age of 20 and 60 years we had 148 cases (73.26%), the most common decade involved was 41-50 years with 68 cases (33.66%). In the productive age group between the age of 21 years and 50 years we had 146 cases. The predominant population affected by oral cancer was male’s 164 cases (81.19%)On evaluation of the clinical presentation distribution in the study subjects all cases presented with ulcer .Lesions of the tongue were seen in 99.01% cases. In most cases wide excision and reconstruction was possible (54 cases) near glossectomy with MRND was done in 1patient hemi glossectomy with MRND was done in 16 patient partial glossectomy with MRND was done in 17 patient. All case were proved as Squamous cell carcinoma. The minimum follow up was for 13 months and at the last follow-up all cases were found to be tumour free . The mainstay of current. Exciting challenges include improving success rates of current therapy, reducing the morbidity of treatment, and to select the most appropriate treatment.

Efficacy of Modified Hyoid Bone Suspension Technique Compared to Midline Glossectomy in Management of Hypopharyngeal Obstruction in Obstructive Sleep Apnea Patients

Background: Obstructive sleep apnea (OSA) is a common and challenging health problem, especially in adults, as it is the second most common disease related to sleep. Surgical treatment plays an important role in management of OSA. However, the optimal procedure is not yet determined. Aim of the work: To compare between modified hyoid bone suspension and midline glossectomy in management of OSA due to hypopharyngeal obstruction. Patients and Methods:40 patients with OSA due to hypopharyngeal obstruction were randomly assigned to either modified hyoid bone suspension (group A; 20 patients) or midline glossectomy (group B; 20 patients). All had been assessed by full history, clinical examination and Lab investigations and underwent pre-assigned surgical intervention. Indicators of OSA such as minimal oxygen saturation, Apnea hypopnea Index [AHI] and Epworth Sleepiness Scale [ESS] had been measured preoperatively and 6 months after surgery. Results: The studied groups were comparable as patient characteristics and preoperative data. However, hyoid suspension was associated with significant decrease of AHI [16.67±6.06 vs 20.72±4.41] and ESS [9.10±2.42 vs 11.20±2.33]. Also, minimal oxygen saturation improved significantly in group A than group B. The percentage of responders increased significantly in group A (75.0% vs 40.0% respectively). Conclusion: Modified hyoid suspension is superior than the midline glossectomy, as a safer and more effective procedure for treatment of OSA due to hypopharyngeal obstruction.

Ultrasonic Measurement of Lingual Artery and Its Application for Midline Glossectomy.

To explore the application of lingual artery ultrasound (US) for midline glossectomy in patients with obstructive sleep apnea (OSA). Lingual artery US was performed in 57 OSA patients (OSA group) and 20 normal persons (control group). The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries were compared between two groups. The correlations between apnea-hypopnea index (AHI), AHI after the nasopharyngeal tube insertion (NPT-AHI), Friedman tongue position (FTP) and all the parameters of lingual arteries were analyzed. Both the depths of the lingual arteries and the distances between the bilateral lingual arteries in the OSA group were larger than those in the control group (P < .01). All the parameters of the lingual arteries in OSA patients were positively correlated with AHI, NPT-AHI and FTP (P < .05). While controlling for body mass index (BMI), all the parameters of the lingual arteries in OSA patients were still correlated with NPT-AHI positively (P ≤ .01). Pre-operative US can show the course of the lingual artery clearly for pre-operative planning. The depth and width of the lingual artery in OSA patients were different from controls. NPT-AHI has high sensitivity in predicting all the parameters of the lingual arteries. FTP is closely correlated with the depth of the lingual arteries.

Application of free anterolateral thigh tissue flap in repairation of tissue defects in total or near-total glossectomy

Objective To evaluate the functional outcomes of the flaps repaired with free anterolateral thigh tissue flap in patients who had total or near-total glossectomy. Methods From March, 2015 to May, 2018, 15 patients with tongue cancer were treated by total or near total tongue resection. The free anterolateral thigh tissue flaps were used to repair the defects of tongues after radical tumor resection. The size of 15 flaps were 6 cm×10 cm to 8 cm×15 cm. Patient data were retrospectively analyzed. Patients were requested to conduct the postoperative reviews. Results All 15 flaps survived, while 1 occurred vascular crisis which was survived after the exploration and corresponding treatment. As the results of 12 to 48 (average 30) months followed-up by clinic visits, the mouth and chewing function recovered well after 6 months, while the swallowing and pronouncing function were poor. The motion of thigh donor area was good, without numbness, pain and discomfort. Conclusion The defect being left after total or near-total tongue resection is repaired and reconstructed with anterior lateral cutaneous tissue flap, which is able to partially restore the functions and shape of the tongue. Key words: Tongue cancer; Anteriolateral thigh tissue flap; Reconstruction; Microsurgical technique

Application of 3D reconstruction for midline glossectomy in OSA patients.

To explore the application of three-dimensional (3D) reconstruction technology for midline glossectomy in patients with obstructive sleep apnea (OSA). Fifteen patients with OSA were included in this study. Each of them received computed tomography angiography (CTA) examination of lingual arteries in the resting tongue position and fully extended tongue position respectively. The two-dimensional CTA images were converted to 3D models using 3D reconstruction technology. We simulated the midline glossectomy in different tongue positions with a safe margin of 3mm. The differences in the distances between bilateral lingual arteries, the depths of the lingual arteries and the surgical resectable volumes of the tongue were compared between different tongue positions in 3D models. The depths of the lingual arteries, the distances between bilateral lingual arteries based on three measuring sections and the surgical resectable volumes of the tongue in the fully extended tongue position were significantly smaller than those in the resting tongue position (P < 0.01 or 0.05). The 3D reconstruction technology can show the course of lingual artery stereoscopically and visually, and can be more beneficial to guide surgery than two-dimensional examination. Lingual artery examination in the fully extended tongue position has higher specificity in displaying intraoperative actual situation.

Techniques for evaluation and management of tongue-base obstruction in pediatric obstructive sleep apnea.

Tongue-base obstruction (TBO) is a common cause of persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy in children. This review discusses available diagnostic modalities and surgical treatment options for the management of TBO. Recently, a systematic review that included nine studies using drug-induced sleep endoscopy (DISE) in the evaluation of children with persistent OSA after tonsillectomy and adenoidectomy identified the tongue-base as the most common site of obstruction. TBO is a common and correctable cause of persistent OSA in children. Diagnostic modalities include awake flexible laryngoscopy, plain neck films, DISE, and cine MRI. Because DISE and cine MRI are performed in a sleep-like state, they are fairly reliable in identifying the site of obstruction. As continuous positive airway pressure is often poorly tolerated in the pediatric population, there is considerable interest in surgical options for TBO. Depending on the location and the severity of the obstruction, interventions such as lingual tonsillectomy, posterior midline glossectomy, tongue suspension suture, epiglottopexy, hypoglossal nerve stimulation, tongue-lip adhesion, and hyoid suspension may play a role in management.

Prosthetic Rehabilitation with Implant-Supported Mandibular Overdenture after Partial Glossectomy and Radiation Therapy: A Case Report.

Implant-supported overdenture is a well-established treatment option for many patients who have functional problems with conventional dentures. It may be primary choice for patients with altered jaw anatomy, neuromuscular disorders, pronounced gag reflex, severe residual ridge resorption and oral tissue defects. In this article we describe a case report, where tongue cancer patients occlusion was rehabilitated with an implantretained overdenture. In 2001 patient was operated for squamous cell carcinoma on the left side of the tongue. Before preoperative radiation therapy, small residual mandibular dentition was removed because of its poor prognosis. Radiation dose on mandible was 57-66 Gy. After tumor surgery patient received conventional complete dentures. Ten years later, the patient was referred again to the Turku University Central Hospital due to constant ulceration under the mandibular denture. The residual ridge of the mandible was severely resorbed. Patient's existing lower complete denture was replaced with a milled bar-retained overdenture on four implants. Treatment turned out to be challenging due to severely restricted tongue movement and tissue defects.

Hyoid suspension versus laser midline glossectomy in the management of obstructive sleep apnea

Background The base of the tongue and the hypopharynx are the major sites of obstruction in up to 50% of patients with obstructive sleep apnea (OSA) possibly explaining the cause of failure in palatal surgery. Hyoid suspension and laser midline glossectomy can be used as a surgical treatment for tongue base and hypopharyngeal collapse. Objective The aim of this study was to compare hyoid suspension type I and laser midline glossectomy in the management of OSA as regards safety, efficiency, and postoperative morbidity and mortality. Patients and methods In this study, 30 patients were diagnosed as having OSA by means of polysomnography with retrolingual collapse using Muller maneuver. Fifteen patients were operated upon using hyoid suspension type I and the other 15 patients were operated upon using laser midline glossectomy. Results In hyoid suspension type I, the incidence of responder patients [50% or more reduction in their apnea–hypopnea index (AHI) plus reduction in the AHI below 20] was 66.67%, with reduction in the AHI by 77.2%, and the incidence of nonresponder patients was 33.33%, with reduction in the AHI by 36.17%. However, in midline laser glossectomy, the incidence of responder patients was 53.34% with reduction in the AHI by 73.87%, and the incidence of nonresponder patients was 46.67% with reduction in the AHI by 40.79%. Complications were higher in laser midline glossectomy compared with hyoid suspension type I. Conclusion Our data indicate that hyoid suspension type I may be safer and more effective with lesser morbidity compared with laser midline glossectomy.

Outcomes of Drug-Induced Sleep Endoscopy-Directed Surgery for Pediatric Obstructive Sleep Apnea.

Objectives To determine the effectiveness of pediatric drug-induced sleep endoscopy (DISE)-directed surgery for children with infant obstructive sleep apnea (OSA) or OSA after adenotonsillectomy. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods We included 56 children undergoing DISE from October 2013 to September 2015 who underwent subsequent surgery to address OSA. The primary outcome was successful response to DISE-directed surgery based on the postoperative obstructive Apnea-Hypopnea Index (oAHI). Wilcoxon matched-pairs signed-ranks tests were used to compare polysomnography variables before and after surgery, and regression was used to model response to surgery. Results We evaluated 56 patients with a mean age of 5.9 ± 5.5 years (range, 0.1-17.4) and mean body mass index of 21.2 ± 7.9 kg/m2 (percentile, 77 ± 30). The most commonly performed surgical procedures were adenoidectomy (48%, n = 27), supraglottoplasty (38%, n = 21), tonsillectomy (27%, n = 15), lingual tonsillectomy (13%, n = 7), nasal surgery (11%, n = 6), pharyngoplasty (7%, n = 4), and partial midline glossectomy (7%, n = 4). Mean oAHI improved from 14.9 ± 13.5 to 10.3 ± 16.2 events/hour, with 54% (30 of 56) of children with oAHI <5 and 16.1% (9 of 56) with oAHI <1. There was a significant improvement in oAHI ( P = .001) and saturation nadir ( P < .001) but not in time with end tidal carbon dioxide >50 mm Hg ( P = .14). Multivariable modeling, controlling for age, race, body mass index, sex, and baseline polysomnography variables, revealed that white race predicted success of DISE-directed surgery. Conclusion Fifty-four percent of children with infant OSA or persistent OSA after adenotonsillectomy had oAHI <5 events per hour after DISE-directed surgery. Only white race was predictive of oAHI <5 events per hour.