Indications, reconstructive techniques, and results for total glossectomy

Mazarro, A; Pablo, A. De; Puiggròs, C.; Velasco, Mercedes; Saez, Manel; Romero, J. Pamias; Bescós‐Atín, Coro

doi:10.1002/hed.24369

Cited by 22 publications

(16 citation statements)

References 32 publications

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“…The survival figures in our study concur with others. According to many published studies, the survival after total glossectomy has remained unsatisfactory and a review by Vartanian et al concluded, that for this particular patient group, a 5-year OS above 25% in most series can be considered acceptable [3,[8][9][10][11]. In univariate analysis, we found only high CCI to predict poor survival.…”

Section: Discussionmentioning

confidence: 53%

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Total or subtotal glossectomy with laryngeal preservation: a national study of 29 patients

Keski-Säntti

Bäck

Lassus

et al. 2017

Eur Arch Otorhinolaryngol

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Total glossectomy remains a controversial procedure as it often leads to notorious sequalae in swallowing and speaking functions. Disease entities indicating total glossectomy tend to have poor prognosis. We evaluated whether this type of surgery can be concidered justified based on our national series. We reviewed all total and subtotal glossectomies with laryngeal preservation performed in Finland between 2005 and 2014 in terms of overall survival (OS), disease-specific survival (DSS), locoregional control (LRC), and functional outcome as assessed by gastric tube or tracheostomy dependence and ability to produce intelligible speech. Of the 29 eligible patients, 15 had undergone total and 14 subtotal glossectomy with curative intent. In eight patients, total/subtotal glossectomy was performed as salvage procedure after the previous treatment. One-year estimates for OS, DSS, and LRC were 48, 59, and 66%, and corresponding 3-year estimates were 31, 46, and 46%, respectively. The gastrostomy and tracheostomy dependence rates at 1 year after operation were 77 and 15%, respectively. Fifty-nine percent of the patients were assessed to be able to communicate verbally. As in most other published studies, we found unsatisfactory survival figures after subtotal or total glossectomy and most patients remained dependent on gastrostomy tube. This surgery is, however, presumably the best and often only chance for cure in a selective patient population, and according to our opinion, it is indicated as a primary or salvage treatment provided that the reconstruction is planned optimally to guarantee a reasonable quality of life after surgery.

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Section: Discussionmentioning

confidence: 53%

“…As in our material, anterolateral thigh-free flap (ALT) and vertical rectus abdominis myocutaneous-free flap (VRAM) are the flaps most often used to reconstruct total glossectomy defects [2,8,9,11,[16][17][18]. To optimize functional results, several technical aspects have been proposed.…”

Section: Discussionmentioning

confidence: 99%

Total or subtotal glossectomy with laryngeal preservation: a national study of 29 patients

Keski-Säntti

Bäck

Lassus

et al. 2017

Eur Arch Otorhinolaryngol

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“…The resultant functionality of neural anastomosis has been widely questioned, especially when correlated to postoperative RT . Indeed, although the preservation from muscular atrophy is often recognized as a result of this procedure, in 2016 many still doubted its potential to restoring a contractile function .…”

Section: Discussionmentioning

confidence: 99%

“…The resultant functionality of neural anastomosis has been widely questioned, especially when correlated to postoperative RT. 14,15 Indeed, although the preservation from muscular atrophy is often recognized as a result of this procedure, in 2016 many still doubted its potential to restoring a contractile function. 14 However, evidence exists in the literature that postoperative RT has no negative effects on reinnervation, 5,16,17 and that results concerning the efficacy of nerve repair in irradiated patients are similar to those of other series of neural repair in patients who did not receive postoperative RT.…”

Section: Discussionmentioning

confidence: 99%

Dynamic tongue reconstruction with innervated gracilis musculocutaneos flap after total glossectomy

et al. 2018

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Objective Advanced tongue cancer treated with total glossectomy with laryngeal preservation (TGLP) has a high risk of severe postoperative morbidity due to the loss of swallowing and articulation ability. The purpose of our work is to highlight the potential of the innervated gracilis musculocutaneous flap (IGMF) to permit a good quality of life in patients after undergoing this kind of surgery, particularly when associated with an adequate rehabilitation course. Methods We are presenting a cohort of 15 patients with T3 or T4 tongue cancer treated with TGLP and dynamic reconstruction with IGMF between 1998 and 2016. Functional outcome data were collected employing flexible endoscopic examination of swallowing, as well as swallowing and speech tests and questionnaires. Our reconstructive procedure was compared with different techniques described in the literature. Results In 13 out of 15 patients, a positive functional outcome was recorded, defined as the achievement of an adequate swallowing and speech ability. In two patients, the lack of success was caused by the flap's necrosis and death from early pulmonary metastasis. Of 13 patients, 12 were still alive after 2 years. Ten patients regained an independent feeding by mouth for normal food, whereas three patients continued percutaneous endoscopic gastrotomy supplementation. After 40 months, all 13 patients displayed a moderately intelligible speech capability. Conclusion Although TGLP can have devastating morbid effects, an appropriate dynamic reconstruction—along with an adequate course of rehabilitation—can provide good swallowing and articulation outcomes, which permit a satisfactory long‐term quality of life. Level of Evidence 4 Laryngoscope, 129:76–81, 2019

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“…Larger surgical defect areas are usually reconstructed with flap/graft to restore normal function [ 46 ]. The effect on the intelligibility and quality of speech was more pronounced in these surgically reconstructed cases due to the reduced extensibility of the grafted tissue which may lead to decreased tongue mobility.…”

Section: Post-glossectomy Oral Cancer and Speech Difficultiesmentioning

confidence: 99%

Post-glossectomy in lingual carcinomas: a scope for sign language in rehabilitation

Santosh

Cumberbatch

Jones

2017

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The treatment option for cancers of the tongue is glossectomy, which may be partial, sub-total, or total, depending on the size of the tumour. Glossectomies result in speech deficits for these patients, and rehabilitative therapy involving communication modalities is highly recommended. Sign language is a possible therapeutic solution for post-glossectomy oral cancer patients. Patients with tongue cancers who have undergone total glossectomy as a surgical treatment can utilise sign language to replace their loss of speech production and maintain their engagement in life. This manuscript emphasises the importance of sign language in rehabilitation strategies in post-glossectomy patients.

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Indications, reconstructive techniques, and results for total glossectomy

Cited by 22 publications

References 32 publications

Total or subtotal glossectomy with laryngeal preservation: a national study of 29 patients

Total or subtotal glossectomy with laryngeal preservation: a national study of 29 patients

Dynamic tongue reconstruction with innervated gracilis musculocutaneos flap after total glossectomy

Post-glossectomy in lingual carcinomas: a scope for sign language in rehabilitation

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