Subtotal Glossectomy Research Articles (Page 1)

We present a case of a 43-year-old woman with advanced squamous cell carcinoma (SCC) of the tongue who underwent subtotal glossectomy, neck dissection, and pectoralis major myocutaneous flap reconstruction (which is widely used in head and neck reconstruction). Follow-up 18F-FDG PET/CT scans revealed recurrence not only at the primary site but also at the donor site of the flap, and histopathology confirmed metastatic SCC at the chest wall. This case highlights the potential for rare but serious complications following flap-based reconstruction and underscores the importance of careful imaging interpretation during follow-up.

71 Preservation of swallowing in anterior subtotal glossectomy cases: A unique surgical technique supported by cadaveric anatomic studies

The local spread of oral tongue squamous cell carcinoma (OTSCC) follows pathways of dissemination along areas of lesser resistance. In more advanced scenarios, the tumor can extend beyond the hemi-tongue of origin, by passing through the lingual septum and following the fibers of the transverse muscle. This can lead to the invasion of the contralateral extrinsic muscles, the first being the genioglossus and more laterally the hyoglossus. An anatomically guided surgical resection of the tumor can be planned to ensure both oncological safety and an acceptable functional outcome. This approach aims to preserve the hyo-styloglossus unit (HSU) whenever feasible. Between January 2019 and November 2022, six patients received extended glossectomy Type B (EG Type B), with preservation of the HSU. Preliminary oncological results and functional results in terms of swallowing (FOIS score) and quality of life (MDADI) are presented. Five out of the six patients are alive and disease-free, while one patient died due to other causes. All patients who were candidates for an EG Type B underwent a swallowing assessment prior to surgery and followed daily postoperative swallowing training. At discharge, the patients continued swallowing training in an outpatient clinic. Five out of the six patients reached a full oral diet within 1 year of follow-up. The oncological results confirm the safety of this technique. The importance of preserving the HSU, the minimal functional unit, shows very encouraging results in terms of swallowing rehabilitation.

Neurotized profunda artery perforator flap for subtotal tongue reconstruction – Prospective case series

Comparison of complications and functional outcomes following total or subtotal glossectomy with laryngeal preservation using a deep inferior epigastric artery perforator free flap versus a rectus abdominis musculocutaneous free flap

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&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 <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&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.

There exists a lacuna in the structured reporting of swallowing dysfunction and quality of life (QoL) outcome following major glossectomy. Prospective cohort study to assess the swallowing dysfunction and QoL following STG (subtotal glossectomy) or NTG (near total glossectomy) over a 6-month period using FEES and PAS scale, MDADI, and FACT-HN. Twenty-four patients were available for analysis. The pre- and post-adjuvant evaluation revealed a statistically significant improvement in the composite MDADI and FACT-HN scores. Subscale analysis of FACT-HN scores revealed maximum deficit in the head and neck cancer-specific score domain followed by functional domain and social well-being domain, with serial improvement noted in the post-adjuvant setting. This study showed serial improvement in terms of swallowing dysfunction although social and functional well-being domains related to QoL continued to reveal major deficits. Better outcomes were seen with preservation of bilateral base of tongue and mandible.

The omohyoid muscle is an essential surgical landmark in cervical dissection since it separates cervical areas and is closely related to the neurovascular bundle of the neck and brachial plexus. We present the omohyoid muscle variation, poorly described in the literature, and concisely review other already known anatomical variations. We present the case of a 30-year-old woman with an oral squamous cell carcinoma staged as cT3N0M0. She was submitted to a subtotal glossectomy via pull-through approach and bilateral neck dissection. The defect was reconstructed using an anterolateral thigh free flap. During the neck dissection, we noticed a unilateral anatomical variation of the omohyoid muscle that passed deep to the internal jugular vein, maintaining the remaining path and insertions as traditionally described. A knowledge of the variations of the omohyoid muscle is important to the head and neck surgeon, considering its relationship with various noble structures of the neck, serving as a reference in various surgical procedures. We report this case of a variation deeper to the internal jugular vein to alert to a potential hazard during neck dissection and to contribute to the literature about omohyoid variations. Cite this article as: Caneira T, Subtil J, Nabuco C, Porfírio Costa T, Saraiva J. An unusual variation of the omohyoid muscle with surgical implications and review of the literature. Essent Dent. 2023;2(3):141-145.

Favourable swallowing outcomes after subtotal glossectomy with laryngeal suspension

Abstract BackgroundDistant metastases to the skin or skeletal muscle in oral squamous cell carcinoma (OSCC) are rare. Metastases to the gluteal region increase patient suffering and decrease quality of life.Case presentationA 66‐year‐old woman with tongue OSCC (cT4aN3bM0) underwent neck dissection, subtotal glossectomy, and adjuvant postoperative chemotherapy. Six months after surgery, the patient developed multiple metastases to the gluteal region. Radiation therapy was administered to the gluteal region for her pain.ConclusionRadiotherapy for metastases of the gluteal region contributed to improving the patient's quality of life.

Reconstruction after resection of malignant tongue tumors remains one of the most difficult problems in head and neck oncology. Recent trends in tongue reconstruction have focused on optimizing speech and swallowing functions and maximizing quality of life. In the recent literature, several reconstructive strategies including regional flaps and free flaps have been described. A case series of 328 patients underwent oral tongue reconstruction between March 2011 and March 2022. Functional evaluation was performed in all patients 3 months after reconstruction (where the patients required no adjuvant radiotherapy) or after radiotherapy. Total flap necrosis was seen in 5 patients with free flap reconstruction (2 radial forearm flaps, 1 lateral arm flap, and 2 anterolateral thigh flaps), 5 patients with infrahyoid myocutaneous flap, and 1 patient reconstructed with a supraclavicular flap. Our success rate is 96.6%; partial flap necrosis was observed in 11 patients with infrahyoid myocutaneous flap and 2 patients with a supraclavicular flap. Most patients with subtotal glossectomy or smaller defects (type II-IVA defects) could communicate on the phone and had the near-normal capacity for an oral diet. The remaining patients (type IVB-V defects) had significantly lower speech scores. The majority of patients could eat liquid and semiliquid foods. Tongue cancer surgery and subsequent reconstruction posed exciting challenges for the surgeon to optimize tongue function and quality of life for patients. Attention to the principles of tongue reconstruction and choosing appropriate flap for each defect achieve better functional results.

The formation and persistence of an orocutaneous fistula as a sequela of major head and neck surgery followed by microvascular reconstructive surgery and adjuvant radiation therapy is a common and frustrating challenge to address. When reconstructive surgical options are exhausted, limited, or with high risk for failure, the fabrication of an oral appliance can provide a temporary to long-term treatment option for the patient. In this case report, an oral appliance was fabricated to decrease salivary incontinence, improve intelligibility, and deglutition in a 60-year-old patient who underwent a subtotal glossectomy with radical mandibulectomy followed by reconstruction with an osteocutaneous radial forearm free flap who developed a chronic orocutaneous fistula following completion of radiation therapy.

A lingual augmentation prosthesis (LAP) is an appliance attached to the mandible to increase swallowing by extending the denture base area. It has been proven that the swallowing function improves with the insertion of an LAP assisting the palatal augmentation prosthesis (PAP). We delivered both the PAP and LAP to a patient with subtotal glossectomy who experienced saliva drooling and masticatory dysfunction. As the dead space between the reconstructed tongue and dentures decreased in both the vertical and anterior directions, his maximum tongue pressure increased, and the status of salivation and food residue improved. LAP assisted not only for saliva drooling control but also mastication.

"CLO22-034: Subtotal Glossectomy. Functional Outcomes After Compartmental Tongue Resection and Reconstruction With Pectoralis Major Myocutaneous Flap" published on 31 Mar 2022 by National Comprehensive Cancer Network.

The incidence of oral cancer in Japan accounts for 1% of all cancers, with oral tongue cancer accounting for 60% of oral cancers based on the subsite. The most common histologic type is squamous cell carcinoma. This study aimed to evaluate the series of surgical treatments for 432 patients with oral tongue squamous cell carcinoma (OTSCC). Initial surgical treatments for the primary site included partial glossectomy, hemiglossectomy, and total or subtotal glossectomy in 348, 58, and 26 patients, respectively. Therapeutic neck dissection, elective neck dissection, and subsequent neck dissection were performed in 74, 53, and 37 patients, respectively. Patients with advanced cases had level IIb, IV, and V metastasis and outside regional lymph node metastases. The cumulative 5-year disease-specific survival rate for OTSCC was 92.8%, and the rates for each stage were 96.6%, 93.9%, 84.1%, and 79.0% in stages I, II, III, and IV, respectively. The recurrence rate, overall salvage rate for recurrent cases, and rate for the additional surgical group were 10.4%, 46.7%, and 78.6%, respectively. Patients with multiple cervical lymph node metastases, extranodal extension, metastases to multiple levels, and lower neck metastases had poor prognosis. In conclusion, careful follow-up is necessary to detect recurrence of primary tumors at a stage when surgical treatment can be performed, and cervical lymph node status is one of the most important prognostic factors in OTSCC.

The lower lip-splitting incision associated with different types of mandibulotomy, in order to obtain wide access to total or subtotal glossectomy, is described. In those cases, high rates of functional and aesthetic deficit and postoperative morbidity (more in cases of patients in which adjuvant radiotherapy has been performed) are described. We present our experience in the treatment of patients undergoing total or subtotal glossectomy and contemporary reconstruction with flaps, and without lip-splitting incision and mandibulotomy. Materials and Methods: Data about patients affected by malignant tumors requiring total or subtotal (posterior third of the tongue) resection that were treated at our department from January 2004 to December 2014 were retrospectively reviewed. Data evaluated included: T and N stage, resection margins, operation time, and post-operative complications, such as fistula and flap necrosis. Results: 41 patients were identified. In two cases microscopic infiltration of one margin was found (R1); in one case a close margin was identified. In 26 cases reconstruction was performed using free flaps, and in the remaining cases a pectoralis major flap was used. In three cases postoperative complications were observed. Discussion and conclusions: In theory, lip-splitting and mandible discontinuity could allow for increased access and tumor visualization, and could facilitate flap positioning. Nevertheless, in our experience, it is not necessary in the case of total or subtotal glossectomy.

Microvascular tongue reconstruction after total and subtotal glossectomy

Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery; however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.

The effects of palatal augmentation prosthesis after subtotal glossectomy and reconstruction: A case report

What is the best way of resection for subtotal glossectomy?