Classification of GLOSSECTOMIES: Proposal for tongue cancer resections.

BACKGROUND: Surgery of tongue tumors includes different procedures ranging from mucosal resection to complex combined resection. Numerous terms have been used to describe such procedures, but there is no consensus between the terminology and the extent of resection. METHODS AND RESULTS: We searched the medical literature and found a lack of published information. We undertook to describe a new classification of surgical procedures for tongue tumor resection. We based it upon the surgical anatomy of the tongue and the spread of the cancer. We posited that there were five major types of glossectomy embracing all the methods of tongue cancer resection. This classification was reviewed and endorsed by an international team of experts. CONCLUSION: We propose a more precise classification than that currently in practice, thereby bringing clarity and consistency to the terminology, facilitating shared communication between surgeons, comparison between published research, and ultimately improving surgical practice and patient care.

A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes.

In the surgical management of oral cancer the resection and reconstruction of the mobile tongue and soft palate are most important if function is to be maintained. The present trend towards primary laryngeal surgery for early disease has emphasized the importance of primary surgery if good functional outcomes can be achieved. This study compares the functional and health-related quality of life outcomes for primary surgery and reconstruction of the anterior tongue and soft palate. From a cohort of 566 patients treated from 1992 to 2002, 118 fitted the criteria for anterior tongue and 44 for soft palate resection. University of Washington Quality of Life scores were available in around three quarters of patients. In terms of speech and swallowing a 3/4 or total anterior glossectomy had a worse outcome than a 1/4 or 1/2. In patients having a 3/4 or total resection of the soft palate however, the results showed a similar outcome to those with 1/4 or 1/2 resection. The functional results of 3/4 and total soft palate reconstruction were superior to 3/4 and total anterior tongue resections and were similar to the whole cohort. This finding extends the role of functional surgery in the oropharynx for which primary radiotherapy is often preferred to preserve function.

Consonant intelligibility and tongue motility in patients with partial glossectomy.

PURPOSE: The primary determinants for good speech outcome after glossectomy are not well established. This study evaluated the effect of tongue motility, type of reconstruction, and affected muscles on speech intelligibility. METHODS: Fourteen German glossectomy patients participated in an intelligibility test, which targeted lingual consonants. Tongue motility was rated on nine 3-point scales. Surgical mapping documented type of reconstruction and affected muscles. RESULTS: Mean consonant intelligibility was 71.25% and mean tongue motility was 34%. There was a moderate correlation between tongue motility and consonant intelligibility (r = 0.619). Patients with platysma flap reconstructions (n = 6) had a tendency for more correctly identified consonants. Patients with an intact genioglossus (n = 4) had significantly better tongue motility scores. CONCLUSIONS: The findings support the hypothesis that good tongue motility is a precursor of good postglossectomy speech. Although flap reconstructions led to better consonant intelligibility in this study, this should be interpreted with caution due to the small sample size.

A systematic approach to functional reconstruction of the oral cavity following partial and total glossectomy.

Mobility, sensation, volume, and to a lesser extent, the shape of the tongue following partial glossectomy are critical elements to the successful rehabilitation of the patient with oral cancer. Our approach to tongue reconstruction is based on the extent and functional status of the residual tongue and whether there is an associated mandibulectomy. Despite the devastating effects of ablative surgery and radiation, the application of available reconstructive techniques can help to improve the quality of life of these patients. Herein, we present a revised classification scheme for tongue defects along with a discussion of the optimal method for reconstruction based on available techniques.