Classification of GLOSSECTOMIES: Proposal for tongue cancer resections

Abstract

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.

Anatomically‐based transoral surgical approach to early‐stage oral tongue squamous cell carcinoma

“…The lack of standardized surgical procedures for oral cavity cancer has been recently overcome by the classification of glossectomies proposed by Ansarin et al This represents the first attempt to systemize a complex surgery and will allow better evaluation and comparison of outcomes in the future. Nonetheless, the so‐called type II glossectomy (transoral partial resection extended to the intrinsic muscles) remains vague from a technical point of view.…”

Tongue sonography: An introduction

“…This mode is particularly useful for spatially demonstrating the locality of lesions along the tongue surface due to the limited field of view of the “hockey stick” transducers. These high‐resolution transducers are essential to demonstrate the anatomical layers of the tongue as lesion staging relies on demonstrating lesion margins, size and vascularity 16,17 …”

“…Assessment of the vascularity of tongue lesions may also assist in diagnosis and surgical planning 16 . The main lingual artery is easily identified on ultrasound as a branching vessel arising from the external carotid artery at the level of the hyoid bone 17…”

Reply to “From compartmental to anatomically‐based circumferential resection—Is the reversal of trend justified?”

“…First of all, the technique is meant for early-stage (cT1-2 cN0) oral tongue squamous cell carcinomas (OTSCC) that do not infiltrate the tongue extrinsic muscles and/or the T-N tract. As such, it standardizes the so called glossectomy type II according to the recent classification of glossectomies by Ansarin et al 2 We would like to highlight once more the importance of this classification, which provides a common ground for oral surgeons in terms of both extent of resection and, later on, comparability of outcomes.…”

“…• Transoral resection of early-stage OTSCC can be classified as either glossectomy type I (simple mucosectomy) or glossectomy type II, which includes removal of intrinsic muscles. 2 • Transoral glossectomy type II is performed in a standardized and reproducible manner, based on anatomical and pathological considerations. • Transoral resection is not an alternative to compartmental tongue surgery (glossectomies type III, IV, and V).…”