Total glossectomy with laryngeal preservation
R. Tiwari, A. B. Karim, A. J. Greven and G. B. Snow
Department of Otolaryngology-Head and Neck Surgery, Free University Hospital, Amsterdam, The Netherlands.
OBJECTIVE: To evaluate the results of a planned combined therapy with
surgery and postoperative radiotherapy in the management of large (T3 to
T4) squamous cell carcinomas of the tongue-tongue base in properly selected
patients. PATIENTS AND METHODS: Twenty-one patients underwent this
procedure in a 4-year period. The selection criteria were directed to
identify those patients in whom laryngeal preservation was feasible and who
were motivated. Five categories of patients were included: those with (1)
large primary tumors of the tongue-tongue base; (2) recurrence after
initial radiotherapy, brachytherapy, chemotherapy, or a combination of
these modalities; (3) recurrence after initial surgery and radiotherapy;
(4) double primary tumors; and (5) second or third primary tumors arising
in the tongue or base of the tongue. Preoperative investigation included
examination under anesthetic and magnetic resonance imaging. Depending on
the proximity of the primary tumor to the mandible, a mandibular split, a
marginal resection, or a segmental resection was carried out. Soft-tissue
replacement was achieved by a myocutaneous or a muscle flap of the
pectoralis muscle with split skin. Whenever possible tissues of the
contralateral floor of the mouth were also used. Laryngeal suspension was
performed in all cases. Postoperative radiotherapy consisted of megavolt
therapy, 66 Gy in 6 weeks to the primary site and both sides of the neck.
RESULTS: Resumption of swallowing and speech was achieved in all patients.
External deformity was slight. Patients were able to return to their
families. CONCLUSIONS: Total glossectomy with laryngeal preservation in
properly selected patients provides local and regional control and
preserves quality of life.
