Glossectomy Research Articles

Major Glossectomy in the Dog

Major Glossectomy in the Dog

Outcomes of Combined Pharyngoplasty and Midline Glossectomy

Objective: 1) Discuss the theory of multilevel sleep surgery for obstructive sleep apnea (OSA) management. 2) Evaluate the outcomes of lateral pharyngoplasty and midline glossectomy. Method: Retrospective chart review of adult patients with polysomnographic evidence of OSA treated at a tertiary care center with multilevel surgery involving lateral pharyngoplasty and midline glossectomy between 2009 and 2010. Outcome measures included change in preoperative and postoperative AHI, RDI, and oxygen nadir. Statistical analysis performed using Wilcoxon rank test. Results: Thirty-three patients were identified that met inclusion criteria. The mean preoperative BMI was 30.4, and postoperative BMI was 29.1 ( P = .04). The mean decrease in AHI was 12.5 from 32.7 to 20.2 ( P = .027). The mean decrease in RDI was 16.4 from 37.2 to 20.7 ( P = .17). The mean improvement in oxygen nadir was 13% from 63.5 to 76.8 ( P = .09). Conclusion: Multilevel sleep surgery results in a statistically significant improvement in polysomnographic metrics, such as AHI and RDI, for obstructive sleep apnea.

Morbidity of Combined Lateral Pharyngoplasty and Midline Glossectomy for Obstructive Sleep Apnea

Objective: 1) Describe the technique of lateral pharyngoplasty and midline glossectomy. 2) Evaluate the morbidity of multilevel sleep surgery involving lateral pharyngoplasty and midline glossectomy for management of obstructive sleep apnea (OSA). Method: Retrospective chart review of adult patients with polysomnographic evidence of OSA treated at a tertiary care referral center with multilevel sleep surgery involving lateral pharyngoplasty and midline glossectomy between 2009 and 2010. Outcome measures included estimated blood loss, length of hospital stay, and complications during the perioperative and postoperative period. Results: Thirty-three patients were identified that met inclusion criteria. Estimated blood loss at time of surgery was 144 milliliters. The average hospital stay was 1.4 days with 1.03 days in an intensive care setting. Sixty-one percent of patients required postoperative oxygen and 9.1% required postoperative continuous positive airway pressure therapy. The perioperative complication rate was 3% (1/33). There were 21% (7/33)minor and 0% (0/33) major complications in the immediate postoperative period. Conclusion: Lateral pharyngoplasty and midline glossectomy are safe procedures that present a minimal risk to the patient. Postoperative complications are marked predominantly by treatable complaints, including odynophagia and minor infections requiring antibiotic therapy.

Current Concepts in Tongue Surgery for OSA

Program Description: To describe the various tongue base surgical techniques that are available for patients with OSA. Why we do them, who we do them for, and when? Tongue base obstruction has been known to be one of the levels of obstruction in OSA. Surgical treatment of the palate alone has been shown to be ineffective in patients with high Mallampati grades, Friedman Stage II & III, and tongue base collapse seen on dynamic nasopharyngoscopy. Severity of OSA is currently known to correlate with degree of tongue base and lateral pharyngeal wall collapse. Patients with severe OSA are more likely to have tongue base obstruction. Airway evaluation is vital in the management and assessment of patients with OSA. The indications for tongue base surgery is pivotal in the decision making process. All the indications based on the clinical examination would be explored and discussed. Various tongue base surgical techniques are discussed, ranging from radiofrequency of the tongue base, genioglossus advancement, hyoid suspension, laser midline glossectomy, tongue suspension, coblator channeling techniques, and robotic tongue base surgery. The surgical steps are illustrated, success rates are presented, and complications are discussed. Educational Objectives: 1) Apply the appropriate airway evaluation. 2) Choose the correct procedure. 3) Understand the technique behind each procedure.

Robotic Glossectomy for the Treatment of Obstructive Sleep Apnea/Hypopnea Syndrome

Objective: 1) Present the safety, morbidity, and efficacy of robotic midline glossectomy (RG) for the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the first series of patients undergoing this procedure without tracheotomy. 2) Compare the efficacy of robotic midline glossectomy (RG) vs coblation and radiofrequency base-of-tongue (RFBOT) MG. Method: Retrospective review of patients treated between January 2009 and December 2010 at a tertiary care center. Efficacy and morbidity of 40 RG patients was compared with a matched cohort of 40 patients who underwent traditional MG. Outcome variables included: postoperative pain, narcotic use, postoperative reduction of AHI, disposable costs, and complications. Results: Twenty patients with severe disease treated with ZPP+RG were compared with 20 patients with ZPP + Coblation. The mean AHI of patients undergoing RG decreased from 55.1 (SD 28.7) preoperative to 25.9 (SD 9.9) postoperative which was significantly greater than the AHI reduction for ( P < .05). Twenty patients with moderate disease treated with palatal stiffening + RG were compared with 20 patients with RFBOT + palatal stiffening. Pain outcomes measured on postoperative days 0-5 using the Faces Visual Analogue Scale (VAS) resulted in no statistical difference between RG and coblation whereas RG vs RFBOT showed higher pain levels for RG. Conclusion: This is the first recorded series of robotic MG performed without the need for tracheotomy. Results demonstrated an excellent safety profile with no significant complications. Although morbidity vs standard hypopharyngeal treatments is significant, robotic glossectomy allows for more aggressive tissue removal vs coblation and RFBOT thereby significantly improving efficacy.

Non-CPAP therapies in obstructive sleep apnoea

In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.

Initial Tissue Response after Partial Glossectomy by 3 Watt, 6 Watt CO2 Laser and Scalpel

Objective: To compare advantages and disadvantages of CO 2 laser and scalpel in wound healing after an oral soft tissue surgical procedure. Place and Duration of Study: Study was carried out at animal laboratory of Post Graduate Medical Insti-tute, Lahore from January 2005 to March 2005. Subjects and Methods: Study was conducted on 30 Sprague - dawley Albino rats, which were divided into 3 equal groups of 10. Partial glossectomy was done with 3 watts CO 2 laser in first group (A), with 6 watts CO 2 laser in second group (B) and with scalpel in third group (C). Wound healing was observed and compa-red grossly and histologically, 24 hours after surgery. Results: Significant differences were seen in gross wound appearance in A and B groups as compared to C group. Histological formation of zones, thickness of blood and carbonization were highly significant in A and B groups as compared to group C. Conclusion: Six watts CO 2 laser wound was much better as compared to scalpel in terms of bleeding duration of surgery, wound appearance, and initial inflammatory response. Key words: CO 2 laser, Scalpel, Wound healing, Par-tial glossectomy, inflammation, zones of laser wound.

Stepwise Combined Treatment of Cervical Lymphangioma with Macroglossia

Macroglossia caused by lymphangiomas of the tongue and those in the cervical area is a rare congenital disease that may lead to an emergent condition of airway compromise. As lymphangioma in the head and neck region is a congenital malformation of the lymphatic system that most commonly occur in children less than 2 years of age, the treatment modality chosen requires careful considerations of various developmental aspects of speech, jaw occlusion, nutritional, cosmetic, and social needs. We report a pediatric case that presented at birth with extensive cervical lymphangioma and macroglossia. Initial treatments of OK-432 sclerotherapy to the cervical lesions at ages 2 and 3 years, and subsequent keyhole wedge glossectomy at age 4 years successfully eliminated the danger of airway obstruction and the need for tracheostomy. Through the utility of this stepwise combined approach of both conservative sclerotherapy and surgery, we preserved the functionality and cosmetic appearance of this child.

Is Glossectomy Necessary for Late Nodal Metastases without Clinical Local Recurrence after Initial Brachytherapy for N0 Tongue Cancer? A Retrospective Experience in 111 Patients Who Received Salvage Therapy for Cervical Failure

To assess the efficacy of neck dissection (ND) without glossectomy (GL) for late nodal metastases without local recurrence after brachytherapy for N0 tongue cancer. Among 396 patients with N0 tongue cancer treated with brachytherapy, a retrospective analysis was performed in 111 patients who were clinically diagnosed as having nodal metastases without local recurrence and whose neck lymph nodes turned out to be pathologically positive after salvage surgery. One hundred and five patients had undergone only ND (the ND group), six patients had undergone ND with GL (the ND+GL group). The 5 year disease-free and cause-specific survival rates after salvage therapy for the 111 patients included in this study were 58.1 and 61.9%, respectively. In the ND group, there were only nine patients who had local recurrence after ND. In addition, only six patients (5.7%) had a local recurrence within 2 years in the ND group. Sixty-three patients were free of disease after ND, 31 patients had regional or distant metastases without local recurrence and two patients had progressive disease at ND. In the ND+GL group, four patients were alive without disease and two died from regional or distant metastases. None of the patients in the ND+GL group were found to have malignant tissue in the pathological findings from the excised tongue. GL should be avoided or suspended when the clinical evaluation had revealed cervical failure without apparent local recurrence in the mobile tongue cancer patients after initial brachytherapy.

Reconstruction of the tongue with rectus abdominis musculoperitoneal flap

To investigate the outcome of surgical reconstruction of the tongue after hemiglossectomy with reinnervated rectus abdominis musculoperitoneal flaps in the treatment of tongue cancer. Five patients underwent immediate reconstruction of the tongue and oral floor defects with rectus abdominis musculoperitoneal flaps after resection of squamous cell carcinoma of tongue. The rectus abdominis musculoperitoneal flap consists of the rectus muscle, posterior rectus sheath, peritoneum, the 10 th, 11th, 12th intercostal nerves and the vascular pedicle that includes the deep inferior epigastric artery and veins. During the operation a reinnervated rectus abdominis musculoperitoneal free flap, in which the intercostal nerves were anastomosed to the descending branch of hypoglossal nerve, was grafted to remaining tongue stump. All patients recovered uneventfully from surgery, with no immediate postoperative complications. All transplanted flaps survived. The peritoneum was replaced by squamous epithelium 8 weeks after surgery. The average follow-up period was 10 months. During the follow-up period the contour of the reconstructed tongues was satisfactory. The patients demonstrated good functional mobility of the reconstructed and remaining tongue. The swallowing and speech function was nearly at normal levels and the patients could ingest a solid or semisolid diet. Reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy is a suitable, cosmetically acceptable method. Long-term follow-up is needed for reaching some final conclusions.

Comparison of Speech and Swallowing Function between Anterolateral Thigh Flap, Radial Forearm Flap and Primary Closure for Tongue Reconstruction after Hemiglossectomy

Anterolateral thigh perforator (ALT) flaps have been successfully used in many places of the body other than the tongue. We conducted this study to compare the postoperative functional recovery of tongue reconstruction after hemiglossectomy with ALT flaps, radial forearm flaps, and primary closure. Eighteen patients with squamous cell carcinoma of the tongue who had undergone hemiglossectomy and were reconstructed with primary closure, radial forearm flaps or ALT flaps were included in this study. Six months later speech and swallowing function assessment for articulation, intelligibility and repetition rate for speech and bolus volume, duration of deglutition of single bolus for swallowing were conducted. We found that patients undergoing primary closure had better intelligibility and clearer articulation but similar repetition rate than the two free flap groups. Patients in the two free flap groups had faster ingestion rate than those in the primary closure group. No significant difference in both speech and swallowing function were found between the two free flap groups.

Videofluoroscopic Study of Swallowing Function in Hemiglossectomized Patients-Comparison of Primary Closure and Free Radial Forearm Flap Reconstruction

The swallowing function of patients who had undergone hemiglossectomy with either primary closure of the defect or radial forearm flap reconstruction were studied with videofluoroscopy. Patients with primary closure were unable to lift the tongue tip, had poor tongue-to-palate contact on initiating swallowing, premature spilling of the bolus into the pharynx, a large amount of barium stasis on the floor of the mouth, and prolonged oral transit time. With flap reconstruction, patients could easily lift the tongue and make good contact with the entire palate. They were able to seal the posterior pharyngeal sphincter by elevation of the reconstructed tongue, approximating it to the soft palate, so that premature spilling of the bolus rarely happened. Their swallowing pattern was nearly normal. Although the reconstructed flap is nonfunctional, it provides bulk and helps the remaining tongue to complete the swallow. Compared with primary closure of the tongue defect, free radial forearm flap reconstruction provides better swallowing function when more than 50% of the tongue is resected.

Tongue Base Reduction with Radiofrequency Tissue Ablation: Preliminary Results after Two Treatment Sessions

Over the last few years, different surgical techniques for the treatment of obstructive sleep apnea syndrome have been developed. While new methods for the treatment of velopharyngeal obstruction turned out to be safe and effective, treatment of hypopharyngeal obstruction due to tongue base hypertrophy has remained, in many aspects, an unsolved problem. Surgical techniques for partial resection of the tongue base (midline glossectomy, lingualplasty) are effective but very invasive procedures requiring temporary tracheotomy, and have high postoperative morbidity. A maxillofacial approach showed significant reduction in the Respiratory Disturbance Index (RDI), especially when bimaxillar osteotomies are performed. Along with the concerns of postoperative morbidity, these techniques require general anesthesia and hospitalization. Tongue base reduction with temperature-controlled radiofrequency tissue ablation was introduced in 1998, and has proven to be a safe and simple procedure. Significant reduction in RDI has been shown in the majority of the treated patients. This procedure does not require general anesthesia and has low postoperative morbidity. For curative results, tongue base reduction with radiofrequency requires multiple treatment sessions. The goal of the present study is to investigate the beneficial effect of increased amount of energy applied per treatment session, reducing the number of treatment sessions per patient. By delivering increased amounts of energy, a similar cure and/or responder rate with 2 treatment sessions, rather than 5 to 6 as published in earlier studies, was accomplished. Postoperative morbidity was similar to previously published results although there was a slight increase in postoperative complications. Apart from the reduced number of treatment sessions needed per patient, we also demonstrated the beneficial effect of prophylactic use of antibiotics in our study group. This more aggressive treatment scheme appears to be well tolerated by the patients and may be an effective means of reducing the overall number of treatments.

Eight Years of Follow-up - Uvulopalatopharyngoplasty Combined with Midline Glossectomy as a Treatment for Obstructive Sleep Apnoea Syndrome

In 22 patients with obstructive sleep apnoea, uvulopalatopharyngoplasty was combined with a midline glossectomy of the dorsum of the tongue. The body mass index (BMI) was normal in 13 cases and abnormal in 9. Daytime polysomnography was performed in all cases both preoperatively and 1 year postoperatively. In 16 patients another daytime polysomnography was performed after 8.4 years. The patients also answered a questionnaire 11, 33, 43 and 98 months postoperatively. The apnoea index (AI) was reduced in 82% of cases 12 months postoperatively, being reduced by 50% in 59% of cases and normalized in 32%. After 8.4 years a reduction in the AI was found in 75% and a normal AI in 25% of patients. Subjectively speaking, 95% of the patients were satisfied with the operation at the first follow-up, and the figure was 86% at the fourth follow-up; 64% did not suffer from sleep apnoea at the first follow-up as compared with 46% at the latest follow-up. There was an increase in subjective symptoms postoperatively until the third follow-up. After that the symptoms became stable. There were no immediate postoperative complications, and only minor long-term problems. The duration of postoperative care at the hospital was 2 days. No relationship was found between BMI and outcome.

SURGICAL MANAGEMENT OF THE HYPOPHARYNGEAL AIRWAY IN SLEEP DISORDERED BREATHING

The etiology of sleep disordered breathing is collapse or obstruction of the upper airway during sleep. This obstruction may be localized to one or two areas or may encompass the entire upper airway passages to include the nasal cavity, nasopharynx, oropharynx, hypopharynx, and larynx. The presurgical evaluation, which includes polysomnography, a comprehensive head and neck physical examination, fiberoptic nasopharyngoscopy, and lateral cephalometric analysis is essential in directing surgical therapy in a site specific approach. The surgical procedures available to address hypopharyngeal and base of the tongue collapse include inferior sagittal mandibular osteotomy and gengioglossus advancement, hyoid myotomy and suspension, laser midline glossectomy, lingualplasty, partial glossectomy, and maxillomandibular advancement surgery. The Riley-Powell-Stanford Surgical Protocol has proven to be an effective and safe method for controlling upper airway collapse in sleep disordered breathing.

Surgery in early cancer of the oral tongue (Tl-2). Wide excision versus hemiglossectomy

Cancer of the oral tongue is a common disease. Thirty five (35%) percent of patients seen at our hospital are in Stages I&II. The choice of surgical treatment is a wide excision of the lesion (WE) or a hemiglossectomy (HG). This study was carried out to compare the local recu-rrences and survival in patients undergoing either a WE or HG for early cancer of the tongue. One hundred and twenty six (126) patients were evaluated, 40 underwent a WE and 86 HG. The local recurrence was higher in the WE group, 25% compared with 9% in the HG group; which is statistically significant (p=0.02). This was also seen in the Tl subgroup (p=0.003). Survival were better in the HG group (p=0.005), which was also seen for the Tl subgroup (p=0.004). Our study demonstrates that there is a lower incidence of local recurrences following a hemiglossectomy for Tl-2 tumours of the oral tongue with improved survivals. Our recommendation is that hemi-glossectomy should be the optimal surgery performed for early cancer of the oral tongue.

ＱＯＬからみた気道・食道疾患治療の新戦略 咽喉頭疾患 切除かレーザーか

Department of Otorhinolaryngology, Tohoku University School of Medicine, Sendai The KTP/532 laser has the advantage of utilizing flexible fibers which can be used to treat deep lesions with an endoscope. Its wavelength is highly absorbed in hemoglobin. These properties are suitable for indications of oropharyngeal disorders. The present research studied the clinical application of the KTP/532 laser in the following cases : i) nasopharyngeal cysts, ii) laser-assisted uvulopalatoplasty, and iii) laser mid-line glossectomy.

Surgical criteria for obstructive sleep apnea syndrome based on localization of upper airway collapse during sleep: a preliminary study.

Obstructive sleep apnea syndrome (OSAS) is defined as intermittent complete or partial upper airway obstruction during sleep, causing mental and physical effects. Localization of obstructions in the upper airways in OSAS patients provides indispensable information for the selection of surgical procedures. We measured the pressure within the upper airways during sleep in 6 patients with OSAS in order to select the surgical procedure. Five patients were found to have the airway collapse in the velopharynx, and in three of them underwent uvulopalatopharyngoplasty (UPPP) with tonsillectomy was performed. The remaining one patient, having an obstruction in both the velopharynx and hypopharynx, underwent laser-assisted midline glossectomy as well as UPPP. The 4 patients receiving the operation showed improvements in the sleep apnea index and the lowest oxygen saturation postoperatively. These findings suggest that pressure measurement may be a reliable tool for localizing obstructions in OSAS patients and may be used for determined the surgical option.

Midline glossectomy and epiglottitectomy for obstructive sleep apnea syndrome: Mickelson SA, Rosenthal L., Laryngoscope 107:614, 1997

Midline glossectomy and epiglottitectomy for obstructive sleep apnea syndrome: Mickelson SA, Rosenthal L., Laryngoscope 107:614, 1997

Practice Parameters for the Treatment of Obstructive Sleep Apnea in Adults: The Efficacy of Surgical Modifications of the Upper Airway

These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provide recommendations for the practice of sleep medicine in North America regarding the role of surgical procedures in the treatment of obstructive sleep apnea in adults. Surgical procedures that are considered include: uvulopalatopharyngoplasty, laser midline glossectomy and lingualplasty, inferior sagittal mandibular osteotomy and genioglossal advancement with hyoid myotomy and suspension, maxillomandibular osteotomy and advancement, and tracheotomy. Whenever possible, conclusions are based on evidence from review of the literature. In instances where scientific data are absent, insufficient or inconclusive, recommendations are based on consensus of opinion. The Standards of Practice Committee of the American Sleep Disorders Association appointed a task force to review the topic, the surgical treatment of obstructive sleep apnea. Based on the review and consultation with specialists, the subsequent recommendations were developed by the Standards of Practice Committee and approved by the Board of Directors of the American Sleep Disorders Association. Recommendations are as follows: The presence and severity of obstructive sleep apnea must be determined before initiating surgical therapy. The desired treatment outcomes include resolution of the clinical signs and symptoms of obstructive sleep apnea and the normalization of the apnea-hypopnea index and oxyhemoglobin saturation levels. Because of the complexity of airway narrowing or collapse during sleep, any one surgical procedure may not eradicate a patient's sleep apnea. A stepwise approach to surgical management is acceptable if the patient is advised at the onset of treatment about the likelihood of the success of each procedure and that multiple operations may be necessary. After the surgical site has healed, a follow-up evaluation, including an objective measure of respiration and quality of sleep, must be performed to ensure that the abnormalities noted in the original study are corrected.