Partial Glossectomy Research Articles

Management of Obstructive Sleep Apnea in the Infant: A Systematic Review and Meta-analysis.

To evaluate the improvement in respiratory parameters of infants with obstructive sleep apnea (OSA) treated with medical or surgical intervention. A comprehensive review was completed using the PubMed, Web of Science, Embase, and Cochrane libraries including articles published from 1975 to 2024. Interventions studied included adenotonsillectomy, mandibular distraction osteogenesis (MDO), tongue/lip adhesion, partial glossectomy, floor-of-mouth release, supraglottoplasty, oral appliances, tracheostomy, and positioning. Continuous positive airway pressure (CPAP) served as a control. Outcomes studied included pre- and postintervention obstructive apnea-hypopnea index. Studies included randomized controlled trials and case-control trials. A total of 2161 records were identified, and 59 studies were included in the analysis. Data was extracted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and pooled using a random-effects model. The primary study outcome established prior to data collection was a change in the apnea-hypopnea index. A meta-analysis of MDO performed in infants for OSA demonstrated an overall pooled mean difference (pre-apnea-hypopnea index minus post-apnea hypopnea index) of 30.1 (95% confidence interval: 22.9, 37.4; 10 studies, 373 patients). No other data was pooled for analysis due to study heterogeneity. All CPAP studies showed apnea resolution. Tailored therapies including supraglottoplasty and tongue-lip adhesion reduced but did not resolve apneic events. Current investigations of the evaluation and treatment of infant OSA are limited by heterogeneity in reporting and study. Mandibular distraction and CPAP are promising.

Secondary Healing Following Trauma-Induced Partial Glossectomy: Case Report of an Arabian Horse

The tongue serves as an organ of food prehension, mastication, grooming, deglutition, taste, and vocalization, and is suspected to play a role in upper airway stability. A seven-year-old riding horse, weighing 350 kg and employed for load-carrying purposes, was brought to Atatürk University Faculty of Veterinary Medicine Hospital due to a transversal injury in the rostral part of the tongue caused by trauma from the bridle's rope. During the general examination, it was observed that the tongue protruded outside the mouth, there was a presence of necrotic odor, paralysis in the apex lingualis region, and bloodstains on the mouth corner and front limbs. After the removal of the tongue tissue, debridement of the necrotic areas in the remaining caudal portion was performed, and it was left for secondary wound healing. Postoperatively, intramuscular injections of 200,000 IU benzylpenicillin procaine were administered every 24 hours for 7 days, along with flunixin meglumine given for 3 days. Additionally, a 0.12% chlorhexidine gluconate solution was used as an oral antiseptic three times daily for a duration of 7 days. Daily phone calls were made to the patient owner to inquire about the overall condition of the patient. Upon the follow-up appointment on the seventh day, improvement in the healing of the tongue was observed.

Immunomodulatory extracellular matrix hydrogel induces tissue regeneration in a model of partial glossectomy

While oropharyngeal cancer treatment regimens, including surgical resection, irradiation, and chemotherapy, are effective at removing tumors, they lead to muscle atrophy, denervation, and fibrosis, contributing to the pathogenesis of oropharyngeal dysphagia – difficulty swallowing. Current standard of care of rehabilitative tongue strengthening and swallowing exercises is ineffective. Here, we evaluate an alternative approach utilizing an acellular and injectable biomaterial to preserve muscle content and reduce fibrosis of the tongue after injury. Skeletal muscle extracellular matrix (SKM) hydrogel is fabricated from decellularized porcine skeletal muscle tissue. A partial glossectomy injury in the rat is used to induce tongue fibrosis, and SKM hydrogels along with saline controls are injected into the site of scarring two weeks after injury. Tissues are harvested at 3 and 7 days post-injection for gene expression and immunohistochemical analyses, and at 4 weeks post-injection to evaluate histomorphological properties. SKM hydrogel reduces scar formation and improves muscle regeneration at the site of injury compared to saline. SKM additionally modulates the immune response towards an anti-inflammatory phenotype. This study demonstrates the immunomodulatory and tissue-regenerative capacity of an acellular and minimally invasive ECM hydrogel in a rodent model of tongue injury.

Prognostic Factors for Locoregional Control in Early-Stage Oral Tongue Squamous Cell Carcinoma Treated with Partial Glossectomy and Elective Neck Dissection

Prognostic Factors for Locoregional Control in Early-Stage Oral Tongue Squamous Cell Carcinoma Treated with Partial Glossectomy and Elective Neck Dissection

Partial Glossectomy and Reconstruction for Excision of a Tumor of the Tongue in a Dog

Partial Glossectomy and Reconstruction for Excision of a Tumor of the Tongue in a Dog

Risk factors for late postoperative bleeding after partial glossectomy for tongue cancer

Background Partial glossectomy is the most common procedure for early-stage tongue cancer. Although late postoperative bleeding occasionally occurs, the associated risk factors have not been adequately identified. Aims/objectives We aimed to investigate the rate and risk factors for late postoperative bleeding after transoral partial glossectomy with or without neck dissection for tongue cancer at our institution. Material and methods We analysed 211 patients who had undergone transoral partial glossectomy between January 2016 and January 2023. The potential risk factors associated with late postoperative bleeding were investigated using univariate and multivariate logistic regression analyses. Results Of the 211 patients, 40 (19%) showed late postoperative bleeding, with 19 (9%) classified as grade IIIa (Clavien-Dindo classification). Regarding all grades, late postoperative bleeding was significantly higher in patients aged <70 years and in those with polyglycolic acid (PGA) sheets (p = .046 and .030, respectively). For grade ≥ IIIa, late postoperative bleeding was significantly higher in patients with a history of anticoagulant/platelet administration, a mucosal defect covered with fibrin glue and a PGA sheet (p = .045 and .026, respectively). Conclusions and significance The findings of this study suggest that primary closure decreases the frequency of late postoperative bleeding.

Evaluation of the results of tongue reconstruction using local flaps following partial glossectomy.

Tongue reconstruction results following partial glossectomy using primary closure and local tissue rearrangement were evaluated in this study. 7 patients diagnosed with tongue carcinoma were included. Tongue defects were reconstructed using local transposition, advancement and rotation of the remaining tongue tissue and closure of the defect. The patients were evaluated 6 months and 1 year following the surgery. None of the patients had permanent speech impairments or major swallowing problems following the surgery despite 33% to 50% reduction in tongue length. Unnecessary utilization of microvascular flaps for partial tongue reconstruction should be avoided in partial glossectomy patients in which reduction in tongue length is below 50%.

Bilateral vocal cord paralysis and airway obstruction during postoperative period after partial glossectomy

Bilateral vocal cord paralysis is a rare complication of endotracheal intubation, causing serious problems. We report a case of bilateral vocal cord paralysis and airway obstruction in the postoperative period after partial glossectomy. A 61-year-old male patient with diabetes mellitus underwent partial glossectomy under general anesthesia. The anesthesia during surgery was uneventful. After extubation, the patient appeared to have airway obstruction and complained of dyspnea. Flexible fiberoptic laryngoscopy was performed immediately, and the patient was diagnosed with bilateral vocal cord paralysis. Therefore, reintubation was performed. The patient was extubated the following day and discharged with incomplete recovery of vocal cord paralysis. The study findings indicate that inappropriate endotracheal tube location and cuff pressure can cause bilateral vocal cord paralysis. The involvement of head position and tongue traction during glossectomy was suggested in this case. Anesthesiologists should be able to consider and manage bilateral vocal cord paralysis in patients with airway obstruction in the postoperative period.

Assessment of Oncosurgical and Functional Outcomes in Patients undergoing Glossectomy for Advanced Carcinoma Tongue: A Cross-sectional Study at a Tertiary Cancer Care Centre in Northern India

Introduction: Tongue carcinoma presents a global oncological challenge due to its aggressive nature and late-stage diagnosis. Glossectomy, a key surgical procedure for advanced cases, significantly affects both cancer control and essential functions such as speech and swallowing. Aim: To analyse the impact of different glossectomy types on oncological and functional outcomes in patients with advanced carcinoma of the tongue. Materials and Methods: A cross-sectional study was conducted in the Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Uttarakhand, India over a one-year period from September 1, 2022, to August 31, 2023. The study included 47 patients with squamous cell carcinoma of the oral and posterior tongue who underwent glossectomy. Oncological outcomes (mortality and hospital stay) and functional outcomes (swallowing, speech, dysphagia, and Quality of Life (QoL)) were assessed. The questionnaires used were the EORTC Core Quality of Life questionnaire (EORTC QLQ-C30), EORTC questionnaire for the assessment of QoL in head and neck cancer patients (EORTC QLQ-H&amp;N35), M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI). Follow-up was conducted at the 6th week to assess changes in the functional aspects compared to the baseline scores. Data were entered into Microsoft Excel, and the analysis was performed using Statistical Packages for Social Sciences (SPSS) software version 25.0. The data were analysed using the Wilcoxon Signed Rank test. A p-value of &lt;0.05 was considered statistically significant. Results: The study comprised 37 (78.72%) males and 10 (21.28%) females, with a mean age of 47.77±12.6 years. Preoperative staging indicated that 22 (46.81%) patients had T2N0 stage, 16 (34.04%) patients had T3, and 9 (19.15%) patients had T4a disease. Among the patients, 14 (29.79%) underwent partial glossectomy, 27 (57.45%) underwent hemiglossectomy, and 3 (6.38%) underwent subtotal glossectomy, and 3 (6.38%) underwent total glossectomy. The mean duration of hospital stay was 10.09±2.87 days. There were no instances of mortality or tumour recurrence at the 6th week. Regarding the functional outcomes, compared to baseline, at the 6th week, there was a significant decrease in EORTC QLQ-H&amp;N35 median scores from 6.94 to 1.73 (p=0.005), but no significant change in the mean EORTC QLQ-C30 (90±8.22 versus (vs) 89.72±8.52, p=0.368), mean MDADI (4.51±1.2 vs 4.43±1.19, p=0.585), and mean SHI (15.81±25.76 vs 13.43±26.19, p=0.052). Conclusion: It can be inferred that glossectomy for advanced carcinoma of the tongue leads to a significant improvement in symptoms; however, the overall Quality of Life (QoL) and functions of the tongue such as swallowing and speech remain comparable to pre-surgery levels.

Assessment of Functional Outcomes and Quality of Life in Patients with Tongue Cancer after Partial Glossectomy

Introduction: Tongue cancer and its therapy affect significantly patients’ quality of life (QoL) and functionality

Macroglossia associated with dentofacial deformity treated by orthognathic surgery and simultaneous partial glossectomy: Case report

Macroglossia is the abnormally large tongue volume, which, among other causes, may result from increased growth, leading to a size bigger than the oral cavity allows for functional balance. This alteration may be associated with dento-musculoskeletal deformities and instability of orthodontic-surgical treatment, besides favoring the appearance of chewing, speech, and breathing disorders. Surgical tongue reduction is an uncommon procedure indicated for functional or aesthetic correction. This case report involves a patient with relative macroglossia and dentofacial deformity with Angle Class III malocclusion who was also diagnosed with obstructive sleep apnea syndrome. In a single surgical procedure, orthognathic surgery was performed to correct dentofacial deformity using maxillary advancement and expansion, along with advancement genioplasty with basilar horizontal osteotomy and partial glossectomy using the Egyedi-Obwegeser technique. The techniques used were satisfactory for correcting the alterations and restoring function and aesthetics.

Abstract 14918: Apical Cardiomyopathy in a Transplanted Heart

Case description: A 67 year old female presented for annual review to the transplant clinic 4 years post orthotopic heart transplant for nonischemic dilated cardiomyopathy. She was asymptomatic. Her medical history included hypothyroidism, hypertension, osteoporosis, restless leg syndrome and calcineurin inhibitor related complications - CKD 3b, impaired glucose tolerance and a left partial glossectomy with neck dissection for stage 3 SCC of the left lateral tongue. Medications included aspirin, atorvastatin, prednisolone, tacrolimus, septrin and ropinirole. Family history was significant for heart failure in her father. She was a nonsmoker and did not consume alcohol. Physical examination was unremarkable. Diagnostic tests are shown below. Discussion: Apical hypertrophic cardiomyopathy (ApHCM) has rarely been described in post cardiac transplant populations. Characterized by increased left ventricular apical wall thickness, it results in a ‘spade-like’ appearance on imaging and is associated with marked T wave inversion on ECG. ApHCM is associated with progression to heart failure, apical aneurysm, ventricular arrhythmias and increased mortality rates. Patients may be asymptomatic at diagnosis. Regarding screening, criteria exist for the selection of donor hearts pre transplant with caution exercised if LVH &gt;13mm. Causes of non HCM hypertrophy in this population include calcineurin inhibitors, hypertension, obesity and graft versus host disease. Data for treatment for ApHCM is lacking however it follows the path of classical HCM, involving the use of beta and calcium channel blockers to reduce demand ischemia and management of sequelae.

A Case of Syphilis Suspected Preoperatively as a Case of Tongue Cancer

Syphilis is a sexually transmitted disease caused by Treponema pallidum (TP). We report a case of syphilis that was initially suspected as tongue cancer. An 86-year-old man consulted a neighborhood clinic with an approximately one-month history of pain in the right tongue. The result of scraping cytology of the tongue performed at the clinic was classified as class V, squamous cell carcinoma, and the patient was referred to our hospital. Physical examination revealed a mass on the right side of the tongue and a firm cervical mass. Biopsy revealed no evidence of malignancy; however, the imaging findings led to the suspicion of tongue cancer and lymph node metastasis. The results of blood examination revealed that the patient had syphilis, but since the patient showed few other symptoms, we decided to treat the infection after the planned surgery. We performed right partial glossectomy and neck dissection; however, the postoperative histopathology revealed no evidence of malignancy but nonspecific inflammatory changes with TP spirochetes. The incidence of syphilis has increased dramatically around the world, including Japan, during the last 20 years, and it no longer remains a rare disease. Therefore, syphilis should be included in the differential diagnosis of oral or cervical masses.

Depth of resection predicts loss of tongue tip sensation after partial glossectomy in oral tongue cancer: A pilot study

Objective(s)To characterize the change in sensory function following partial glossectomy for oral tongue cancer (OTC) and to identify predictors of loss of tongue-tip sensation (LoTTS). Materials and methodsPatients with at least three months follow-up after partial glossectomy for primary OTC were included. All patients underwent a qualitative tongue sensation assessment and an objective tongue sensory exam of the native tongue tip. Additional details regarding the oncologic resection, surgical reconstruction, and pathological stage were collected. Multiple linear and logistic regressions were used for statistical analysis. ResultsSixty-four patients were enrolled, including 34 (53%) men with a median age of 65 at enrollment. Ten (15%) patients reported LoTTS. Increased depth of resection (DOR) was an independent predictor of LoTTS on multivariate analysis, with an increased risk at a threshold of 1.3 cm. LoTTS was also associated with worse subjective quality of life and perceptive speech performance in our qualitative tongue assessment. ConclusionsIn this pilot study, we found that DOR is a critical prognostic factor in predicting post treatment function. Patients with an increased DOR, particularly above 1.3 cm, are at greatest risk of LoTTS and associated morbidity. These findings may be used to predict post-operative sensory deficits, manage patients’ expectations, and optimize the reconstructive approach. Future studies are needed to validate and replicate our results.

Measuring tongue strength in adults after partial glossectomy: a review

The purpose of this study is to present a scoping review of the measurements of tongue strength available, particularly in adult patients, following partial glossectomy. The subsequent impact on functionality and quality of life were also explored. &#x0D; Materials and methodsThis study used a scoping review and the study selection comprised two stages of screening: the review of the title and abstract followed by a full-text review. During the first stage of screening, the title and abstracts of all retrieved references were reviewed against the predetermined inclusion criteria. In the second stage of screening, all studies were reviewed at full-text level, utilising the Full-Text Screening Relevance measure. A total of 20 articles were reviewed as they met the inclusion criteria&#x0D; Results The study found that subjective and quality-of-life measures may still be useful in measuring tongue strength in developing contexts as they closely approximate objective measures and are reliable as an interim measure. However, there is still a need for the development of other objective measures, should funding be available.

A prediction of late cervical lymph node metastasis by ultrasound images of tongue cancer using deep learning method

ObjectiveOccult cervical lymph node metastasis is an important prognostic factor in squamous cell carcinoma of the tongue and is related to factors such as depth of invasion and angiogenesis. The objective of this study was to evaluate the performance of deep learning for predicting occult cervical metastasis from brightness mode (B-mode) ultrasound images of early-stage tongue cancer. Methods50 patients with early-stage tongue cancer who underwent ultrasound guided partial glossectomy at the Department of Oral Surgery at Saitama Cancer Center between 2015 and 2019 were divided into two groups: those with metastasis (n = 22) and those without metastasis (n = 28). B-mode ultrasound images of each patient's tongue cancer were cropped to a 128 × 128-pixel square, and images were assigned to training or testing data in an 8:2 ratio. The training iteration generation (number of epochs) was set to 120 using Neural Network Console software (Sony Corporation), and the resulting learning model was produced. Testing data were input into the learning model to evaluate its performance in predicting metastasis. ResultsPrediction of occult cervical lymph node metastasis by deep learning using B-mode ultrasound images had 79.8 % accuracy, 78.4 % sensitivity, 80.8 % specificity, 74.4 % positive predictive value, and 84.0 % negative predictive value. ConclusionThese findings suggest that deep learning using ultrasound images is useful for predicting postoperative cervical lymph node metastasis from tongue cancer.

A study of incidence and propensity of locoregional lymph nodes in clinically N0 cases of carcinoma of tongue

Background: Oral cavity cancer is the sixth most common cancer worldwide with a high prevalence in South Asia. Among the populations where tobacco chewing is not endemic, tongue is the most frequent subsite for intraoral cancer. Methods: The prospective observational study was done at our tertiary care centre on 50 patients. CECT neck was done in all the clinically N0 (zero) cases to know the extent of tumour and neck metastasis. Wide local excision with elective neck dissection (END) was done for all clinically N0 cases with 1 year follow-up. Results: Clinical examination had high false negatives, sensitivity of CT scan imaging=18/20×100=90%, positive predictive value of CT scan imaging=18/26×100=69.23% and diagnostic accuracy=40 (18+22)/50=80%. Significant association was found between neck lymph node metastasis and tumor thickness. No significant association was found between grade of tumor and metastasis. Conclusions: CECT neck help to delineate the extent of END in carcinoma of tongue. In early-stage squamous cell carcinomas of the tongue (T1 and T2), a tumour thickness &gt;5 mm should be taken as an indicator for prophylactic neck dissection as it is significantly associated with subclinical metastasis. Hemiglossectomy should be preferred over partial glossectomy to achieve better locoregional clearance and in turn to reduce rate of local recurrence. Hemiglossectomy with prophylactic END followed by appropriate chemoradiotherapy reduces locoregional recurrences and improved overall survival rate in early stage I and II of oral tongue squamous cell carcinoma (OTSCC).

INCIPIENT ORAL SQUAMOUS CELL CARCINOMA MIMICKING TRAUMATIC ULCER

Squamous cell carcinoma (SCC) is the main histological type of oral cancer and is usually diagnosed at a late stage. The most common clinical feature is an infiltrating and chronic ulcer with hardened edges. However, it can present other manifestations, mimicking different conditions. Case report: Two Caucasians patients, smokers, 53 and 59 years old, were referred, complaining of tongue sores. Upon clinical examination, superficial ulcers were observed on the posterior lateral border of the tongue. The main diagnostic hypothesis was traumatic ulcers. However, as no improvement was observed after polishing of the cusps (case 1) and extraction (case 2), incisional biopsies were performed and revealed squamous cell carcinoma. Partial glossectomy, neck dissection, and radiotherapy were performed. The two cases exemplify the importance of a correct diagnosis, especially for oral lesions that mimic non-neoplastic processes. Squamous cell carcinoma (SCC) is the main histological type of oral cancer and is usually diagnosed at a late stage. The most common clinical feature is an infiltrating and chronic ulcer with hardened edges. However, it can present other manifestations, mimicking different conditions. Case report: Two Caucasians patients, smokers, 53 and 59 years old, were referred, complaining of tongue sores. Upon clinical examination, superficial ulcers were observed on the posterior lateral border of the tongue. The main diagnostic hypothesis was traumatic ulcers. However, as no improvement was observed after polishing of the cusps (case 1) and extraction (case 2), incisional biopsies were performed and revealed squamous cell carcinoma. Partial glossectomy, neck dissection, and radiotherapy were performed. The two cases exemplify the importance of a correct diagnosis, especially for oral lesions that mimic non-neoplastic processes.

THE ROLE OF DENTISTRY IN THE EARLY DIAGNOSIS AND FOLLOW-UP OF POTENTIALLY MALIGNANT DISORDERS: A CASE REPORT

In 2017, a 66-year-old male patient, smoker and alcohol-addicted for the last 52 years, presented a white plaque with a diagnosis of epithelial hyperplasia with papillomatosis and mild epithelial dysplasia. The patient did not continue with follow-up care. Later, in May 2021, he returned for further exams, presenting an extensive, hard, ulcerated exophytic erythroleukoplakia, with undefined limits on the edge of the tongue. New biopsies were performed, and the anatomopathological examination showed moderately epithelial dysplasia in the soft palate region. The left tongue was diagnosed with moderately differentiated conventional squamous cell carcinoma staging cT3acN1cM0 tongue squamous cell carcinoma. Treatment consisted of left partial glossectomy, together with radiotherapy (20 fractions x 250cGy/field). These findings are important because they imply that many patients with oral premalignant lesions are not diagnosed in a timely manner. thereby failing to receive the benefits of early detection. In 2017, a 66-year-old male patient, smoker and alcohol-addicted for the last 52 years, presented a white plaque with a diagnosis of epithelial hyperplasia with papillomatosis and mild epithelial dysplasia. The patient did not continue with follow-up care. Later, in May 2021, he returned for further exams, presenting an extensive, hard, ulcerated exophytic erythroleukoplakia, with undefined limits on the edge of the tongue. New biopsies were performed, and the anatomopathological examination showed moderately epithelial dysplasia in the soft palate region. The left tongue was diagnosed with moderately differentiated conventional squamous cell carcinoma staging cT3acN1cM0 tongue squamous cell carcinoma. Treatment consisted of left partial glossectomy, together with radiotherapy (20 fractions x 250cGy/field). These findings are important because they imply that many patients with oral premalignant lesions are not diagnosed in a timely manner. thereby failing to receive the benefits of early detection.

Functional MRI during tongue strength tasks before and after partial glossectomy: Insights into the cortical activation of tongue motor function.

Because the tongue is a midline structure, studies on the neural correlates of lateralized tongue function are challenging and remain limited. Patients with tongue cancer who undergo unilateral partial glossectomy may be a unique cohort to study tongue-associated cortical activation, particularly regarding brain hemispheric lateralization. This longitudinal functional magnetic resonance imaging (fMRI) study investigated cortical activation changes for three tongue tasks before and after left-sided partial glossectomy in patients with squamous cell carcinoma of the tongue. Seven patients with squamous cell carcinoma involving the left tongue who underwent fMRI before and 6months after unilateral partial glossectomy were studied. Post-surgical changes in laterality index (LI) values for tongue-associated precentral and postcentral gyri fMRI activation were calculated for the dry swallow, tongue press, and saliva sucking tasks. Group analysis fMRI activation maps were generated for each of the three tasks. There were significant differences in changes in LI values post-surgery between the tongue press (p < 0.005; median: +0.24), saliva sucking (-0.10), and dry swallow tasks (-0.16). Decreased contralateral activation (change in LI ≥+0.20) was observed post-surgery during tongue press in six of seven patients, but only in two patients during saliva sucking and one patient during dry swallow (p < 0.05). There was also increased activation in the supplementary motor area following surgery. Post-surgical fMRI changes following left-sided partial glossectomy may suggest task-specific sensitivities to cortical activation changes following unilateral tongue deficits that may reflect the impacts of surgery and adaptive responses to tongue impairment.