Total glossectomy with laryngeal preservation

Abstract

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.