Is Total Glossectomy for Advanced Caricinoma of the Tongue Justified?

Total glossectomy (with or without total laryngectomy) followed by postoperative radiotherapy remains the principal treatment method for advanced base of tongue carcinoma. The procedure remains controversial owing to poor cure rates and the inevitable functional deficits associated with it. However; even though total glossectomy is a major surgical procedure that impacts on speech; deglutition and quality of life; it may offer patients the best chance of cure in many centres; especially in the developing world.METHODS. We did a retrospective chart review of all patients at Groote Schuur Hospital; Cape Town; who had undergone total glossectomy; with or without total laryngectomy; for stage IV squamous cell carcinoma (SCC) of the tongue between 1998 and 2004. RESULTS. Eight patients had a total glossectomy performed during the study period. At 2; 3 and 5 years 63; 38and 25of patients respectively were alive without disease. No patient required permanent nasogastric or gastrostomy feeding; and all returned to a full oral diet. Three of 5 patients who had laryngeal preservation and could be assessed for speech had intelligible speech. All but 1 patient (88) reported pain relief following surgical excision. Perineural invasion was present in 75; and 38had positive resection margins. Five patients had recurrence; 2 cervical; 1 local; and 2 local and cervical. Conclusion. Advanced SCC of the tongue is a devastating disease causing severe pain and disorders of speech and swallowing. Total glossectomy (with or without total laryngectomy) and postoperative radiotherapy is a reasonable treatment option; particularly in the developing world setting. It has cure rates superior to primary radiotherapy; and provides motivated patients with excellent pain relief and a reasonable quality of life

The Surgical Management and Speech and Swallowing Rehabilitation of Patients with Advanced Tongue Cancer in South Africa

Advanced tongue cancer may have a devastating effect on a person's ability to speak and to swallow. Very little is known about the surgical management and speech and swallowing rehabilitation of persons with advanced tongue cancer in South Africa. The aim of this study was to obtain information regarding clinical practices in treatment and rehabilitation. Questionnaires were distributed to 450 surgeons and 150 speech-language pathologists in South Africa. The response rate was 16 for the surgeons and 33 for the speech-language pathologists. Results showed that only a small number of surgeons and speech-language pathologists in South Africa are involved in the treatment of persons with advanced tongue cancer. Surgeons prefer combined modality treatment (surgery and post-operative radiotherapy) in the primary treatment of patients with advanced tongue cancer; but the use of radiochemotherapy is growing. Total glossectomy is a very radical procedure; but it is sometimes used by surgeons to treat patients with advanced disease. Total glossectomy with laryngeal preservation is preferred to total glossolaryngectomy by surgeons; in order to preserve laryngeal voice. Patients with total glossectomy form only a small part of the caseload of speech-language pathologists. Swallowing rehabilitation includes aspects such as dietary changes; compensatory swallowing techniques and airway protection mechanisms. Speech intelligibility is targeted in speech rehabilitation; but alternative communication is sometimes recommended for patients who have undergone total glosso-laryngectomy