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A glossectomy is a surgical procedure to remove part or all of the tongue, often performed to treat malignant or potentially malignant lesions in the oral cavity. The extent of tongue removal is classified based on the area and proportion removed: partial, hemiglossectomy, subtotal, or total glossectomy. While glossectomy is primarily used to treat tongue cancers, this procedure may also address conditions involving the tongue, including macroglossia, obstructive sleep apnea, and obstructing benign tumors. Several surgical approaches exist, each tailored to tumor size, location, and cancer staging, and are chosen based on the level of visibility and access needed for effective resection. Surgical planning considers tumor depth and potential spread to surrounding tissues or lymph nodes. In cases where significant portions of the tongue are removed, reconstructive surgery may be necessary to restore functionality and appearance. Glossectomy aims to balance adequate resection while balancing surgical risks and recovery impacts. Glossectomy complications include general surgical risks, specific challenges, including speech and swallowing impairments, altered sensation, and potential salivary fistulas, and long-term issues, eg, functional deficits and dependence on tube feeding. This activity for healthcare professionals is designed to enhance the learner's competence in performing various glossectomy techniques, recognizing indications and contraindications, and implementing an appropriate interprofessional approach when managing postoperative care and complications associated with this procedure. Objectives: Identify the indications for a glossectomy. Compare the techniques for performing a glossectomy. Implement the appropriate management for complications of glossectomy. Apply interprofessional team strategies to improve care coordination and outcomes for patients undergoing glossectomy. Access free multiple choice questions on this topic.

Glossectomy refers to a group of surgical procedures that involve the resection of a portion or the entirety of the tongue. Although there are various ways to classify glossectomy, it is commonly categorized based on laterality (left, right, or midline) and the amount of tongue removed. The classifications include: Partial glossectomy: removal of less than half of the tongue Hemiglossectomy: removal of half of the tongue Subtotal glossectomy: removal of more than half but less than the entire tongue Total glossectomy: complete excision of the tongue Glossectomy is primarily performed to treat malignant and premalignant tongue lesions. However, this procedure may also be indicated for macroglossia, obstructive sleep apnea, and obstructing benign tumors.[1][2] Various glossectomy surgical approaches can be applied to all of these glossectomy indications.[3][4]

The risks for glossectomy include those pertinent to most surgical head and neck procedures, including pain, bleeding, infection, sequelae of healing, damage to nearby structures, and the need for possible future procedures. Risks of general anesthesia, including cardiopulmonary events, stroke, and death, though remote, must also be considered and discussed with the patient. Furthermore, discussing procedure-specific speech and swallowing function risks is essential in counseling patients. Dysarthria and Dysphagia Dysarthria and difficulties with speech or swallowing to varying degrees are almost guaranteed with every glossectomy. The long-term functional outcomes may also vary.[34] Dysarthria and dysphagia are secondary to the loss of intrinsic and extrinsic muscles that shape and position the tongue. Even with shallow partial glossectomy, patients may experience some degree of dysarthria secondary to postoperative changes to their tongue. In general, oral (ie, anterior two-thirds of the tongue) resections lead to more dysarthria than dysphagia, while tongue base (posterior one-third) resections lead to much more pronounced dysphagia and less dysarthria. Total and subtotal glossectomy frequently leads to extreme difficulties with both, regardless of reconstruction, and can lead to oral crippling and gastrostomy dependence.[35] Flaps used to reconstruct the tongue do not have volitional movement; therefore, postoperative tongue function is influenced by residual tongue musculature and the bulk of the reconstructive flap.[36] Rehabilitation and speech therapy are essential in optimizing functional outcomes after postglossectomy.[37] Changes in speech and swallowing may also be secondary to the sequelae of healing. In cases of primary closure, tongue tethering can occur, limiting freedom of movement. Even in cases of secondary intention, tongue tethering can occur from unanticipated annealing of open surfaces to one another. Altered Tongue Sensation and Taste

Changes in speech and swallowing may also be secondary to the sequelae of healing. In cases of primary closure, tongue tethering can occur, limiting freedom of movement. Even in cases of secondary intention, tongue tethering can occur from unanticipated annealing of open surfaces to one another. Altered Tongue Sensation and Taste An altered sensation of the tongue is another inevitable complication. Patients may experience neuropathic or phantom sensations from the soft tissue resection. Sensory changes can also be secondary to lingual nerve trauma during glossectomy or neck dissection. In cases with more significant tongue resection, sensory changes are more secondary to loss of sensory input and the sacrifice of the lingual nerve. In reconstructive cases with regional flaps or free tissue transfer, the reconstructive substrate is commonly nonsensate, and if the tissue used contains muscle, the muscle cannot be used in any meaningful way to restore motor function. Some institutions perform reinnervated free flap reconstructions, which provide sensation but no taste.[38] In cases where the tongue base is resected and reconstructed, the altered sensation combined with the loss of functional tongue muscle can result in aspiration, making the patient dependent on tube feeds.[39] Patients commonly ask about altered taste. A myth regarding the tongue having a taste-specific topography is prevalent. All 5 taste senses are represented throughout the tongue. Higher acuity taste is facilitated by olfaction via retrograde airflow to the nasal cavity, which should be unaffected by glossectomy. Salivary Fistula

Patients commonly ask about altered taste. A myth regarding the tongue having a taste-specific topography is prevalent. All 5 taste senses are represented throughout the tongue. Higher acuity taste is facilitated by olfaction via retrograde airflow to the nasal cavity, which should be unaffected by glossectomy. Salivary Fistula Salivary fistula is another complication in which the oral cavity is continuous with the deep neck space. This complication tends to occur between the floor of the mouth and the submandibular triangle. The loss of the submandibular gland and the vascularized fascia creates a direct communication between the oral cavity and the neck through the floor of the mouth. It can also happen at the site of the sagittal-split osteotomy. In the setting of primary surgery, these wounds tend to heal or can be assisted with some local tissue rearrangement. However, salvage surgery after radiation is prevalent and leaves the operative bed with altered vascularity and impaired healing.[40] Vascularized tissue transfers have become the standard and significantly decrease the risk of fistula, even in the setting of prior radiation. Additional Surgical Complications Another risk with surgery is positive margins and recurrences in patients with malignancies. Positive margins can make wound closure impossible, as the reconstruction might not heal the cancer on the inset margins. In that scenario, the risk of salivary fistula and chronic, nonhealing wounds is almost certain. Persistent cancer should always be on the differential in a chronic, nonhealing wound. Patients undergoing lip-split mandibulotomy face increased risks specific to the osteotomy, including osteoradionecrosis of the mandible, malocclusion, and hardware complications. Osteoradionecrosis is a radiation injury resulting in devitalized bone. If the patient develops osteoradionecrosis, they may require secondary resection and reconstruction.

Patients undergoing lip-split mandibulotomy face increased risks specific to the osteotomy, including osteoradionecrosis of the mandible, malocclusion, and hardware complications. Osteoradionecrosis is a radiation injury resulting in devitalized bone. If the patient develops osteoradionecrosis, they may require secondary resection and reconstruction. Even if surgery results in a microscopically-negative margin resection and the wound heals, surveillance could still be complicated. In cases of transoral glossectomy without reconstruction, scar tissue from primary and secondary closure may make it difficult to survey for local recurrences, which may result in future procedures coupled with anxiety for the patient and uncertainty for the oncologists surveilling the patient. In cases with trismus from prior radiation where surgery worsens their trismus, surveillance will be difficult. In such cases, the clinical impression may rely on the sum of imaging, fiberoptic endoscopy, and clinical history.

Effective glossectomy management demands skills, strategy, and responsibilities from a range of healthcare professionals working in a coordinated, patient-centered approach. Physicians, advanced practitioners, nurses, pharmacists, and other health professionals collaborate to optimize patient outcomes and safety through each phase of care. Preoperative assessment by otolaryngologists is complemented by imaging, fiberoptic exams, and consultations with cardiology, pulmonology, and anesthesia to evaluate and manage comorbidities, as well as the involvement of an interprofessional tumor board to guide treatment planning. Intraoperatively, streamlined communication among surgeons, anesthesiologists, pathologists, and nurses is essential for achieving margin-negative resections and preparing for reconstruction. Postoperative care comprises multiple healthcare team members, including nurses who monitor wound and flap viability, pharmacists who aid in adequate pain control, and dietitians who guide nutrition in conjunction with speech-language pathologists who provide speech and swallowing rehabilitation. This interprofessional strategy ensures seamless care transitions, maximizes functional recovery and supports early reintegration into patients' daily lives.