The Functional & Quality of Life Outcomes of Total Glossectomy with Laryngeal Preservation

Abstract

Background: The tongue is an essential organ for human interaction, communication and survival. To date, there is a paucity of objective functional, patient reported, or quality of life outcomes of patients undergoing a total glossectomy with preservation of the larynx (TGLP). Objective: To examine prospectively collected objective, self-reported functional and quality of life (QOL) data in patients undergoing TGLP and free flap reconstruction. Methods: Sixteen TGLP patients were identified in the prospective head and neck cancer and functional outcomes database between January of 2009 and December 2017. Data collection included patient age, sex, performance status, TNM staging, diagnosis and adjuvant treatment. Swallowing and speech functions were measured and prospectively recorded pre-and postoperatively. Patient reported outcomes were measured with the Speech Handicap Index (SHI) and the M.D. Anderson Dysphagia Inventory (MDADI). Results: All patients had a significant reduction in their objective swallowing (P = 0.035), sentence (P = 0.001) and word intelligibility (P < .001) scores. There was no significant reduction in SHI or total MDADI scores. All patients maintained their QOL in the post-treatment time frame. There was no relationship between free-flap type and outcome. Conclusion: Total glossectomy with laryngeal sparing and free flap reconstruction results in significant reduction in objective functional measurements, but patients report stable functional and quality of life outcomes after treatment.

Delayed in diagnosis of upper aerodigestive tract cancers: A comprehensive review of medical malpractice cases

“…Glossectomy impacts speech, mastication, swallowing, and may cause aspiration in some cases. [29][30][31] Similarly, laryngectomy greatly impacts breathing, communication, and swallowing function. [32][33][34] The experience and perception of these postoperative changes may serve as a further impetus for litigation.…”

“…Although glossectomy and laryngectomy are oncologically sound surgical procedures, they are associated with significant functional morbidity. Glossectomy impacts speech, mastication, swallowing, and may cause aspiration in some cases 29–31 . Similarly, laryngectomy greatly impacts breathing, communication, and swallowing function 32–34 .…”

Advances in oral tongue reconstruction: a reconstructive paradigm and review of functional outcomes

“…Prior literature has supported larynx preserving total glossectomy as acceptable to patients in terms of quality of life despite increased gastrostomy tube dependence and poorer speech intelligibility. Pyne et al presented their series of 16 patients undergoing total glossectomy with laryngeal preservation and found no change in patient-reported outcomes on Speech Handicap Index or MDADI [23].…”

Radical resection of advanced tongue cancer and one-stage total tongue reconstruction

“…For surgical resection of advanced head and neck malignant tumors, patients usually need to undergo radical tumor resection or even extended ultra-radical resection to ensure su cient safe margins (10). With the development of functional surgery in oral and maxillofacial surgery, the principle of surgical treatment of malignant tumors of the tongue has changed from the original concept of radical cure to a new level that pays equal Page 6/11 attention to both radical cure and function preservation and reconstruction (11). The defect caused by extensive surgical resection and the reconstruction of the tongue have brought great challenges to the surgeon.…”