Glossectomy

What is Glossectomy

Glossectomy is the surgical removal of part or all of the tongue. Skin and muscle tissue (grafts) may be taken from other parts of the body and used to replace the area of the tongue that is removed.

Glossectomy is usually done to treat tongue cancer. If cancer has spread (metastasized) to lymph nodes in the neck, lymph nodes may be removed from one or both sides of the neck. Lymph nodes are part of the body’s disease-fighting (immune) system.

This procedure varies depending on the location and severity of the cancer, and the size of the tumors. The procedure may be called:

• Partial glossectomy. This is when less than half of the tongue is removed.
• Hemiglossectomy. This is when half of the tongue is removed.
• A total glossectomy. This is when more than two-thirds of the tongue are removed.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.
• Any current or past tobacco use.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Difficulty swallowing, eating, or speaking.
• Fluid collecting in the mouth.
• Unintended weight loss.
• The graft not attaching to the tongue (graft failure).
• A hole (fistula) between the mouth and the skin of the neck.

What happens before the procedure?

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do nottake these medicines before your procedure if your health care provider instructs you not to.
• You may have a physical exam of your neck and mouth.
• You may have a dental exam. This may include fluoride treatments and removal of unhealthy teeth.
• You may have blood or urine tests.
• You may have imaging tests, such as:
  • CT scan.
  • MRI.
  • Ultrasound.
  • PET scan.
• Follow instructions from your health care provider about eating or drinking restrictions.
• You may be given antibiotic medicine to help prevent infection.
• Do notsmoke or use any tobacco products for as long as told by your health care provider. This includes cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Stop using alcohol before the procedure, if told by your health care provider.
• Plan to have someone take you home after the procedure.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• You may have a tube (tracheostomy tube) inserted through an incision in your neck and into your windpipe (trachea). The tracheostomy tube helps you breathe during and after surgery.
• Cancerous tissue in your tongue will be cut and removed (excised) using a surgical instrument or a laser. Any cancerous tissue in the surrounding area, such as the floor of your mouth, will also be excised.
• The incisionin your tongue and mouth will be closed in one of the following ways:
  • If you will have a hemiglossectomy or total glossectomy, a graft may be used to replace the area of the tongue that was removed. The graft will be removed from an area of your body (donor site) and attached to your tongue and mouth with stitches (sutures). The donor site may be closed with sutures or covered with bandages (dressings).
  • If you will have a partial glossectomy, your incision may be closed with sutures or left open to heal on its own.
• One or more of your lymph nodes may be removed from your neck. This will be done by making an incision in your neck. This incision will be closed with sutures or surgical glue.
• You may have tubes (drains) inserted in your neck to help drain excess fluids.
• A feeding tube may be inserted into your stomach to give you fluids and nutrition after the procedure. This may be done by:
  • Inserting the tube through your nose and into your stomach.
  • Making an incision in your abdomen and inserting the tube into your stomach.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will have some pain. Pain medicines will be available to help you.
• Do notdrive for 24 hours if you received a sedative.
• You may not be able to speak normally. You may be given a writing board to help you communicate at first. You will work with a speech therapist to learn how to speak.
• You may continue to have a tracheostomy tube inserted in your neck to help you breathe.
• You may have a feeding tube inserted in your nose or abdomen to give you fluids and nutrition.
• You may have one or more drains inserted in your neck.
• Your health care provider may suction fluid out of your mouth regularly. This may be needed if you have difficulty swallowing.

Glossectomy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Difficulty swallowing, eating, and speaking.
• Difficulty moving your mouth and jaw.
• Pain and soreness in your tongue and mouth.
• A small amount of blood or clear fluid coming from your incisions and from any donor sites. A donor site is the area from which skin or muscle tissue (graft) was taken to replace your tongue tissue.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do notstop taking the antibiotic even if you start to feel better.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Look for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Driving

• Do notdrive or operate heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you received a medicine to help you relax (sedative).

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider or speech therapist.

Eating and drinking

• Follow instructions from your health care provider about eating and drinking restrictions. Restrictions vary depending on the type of procedure you had.
• If you have a feeding tube, follow the instructions from your health care provider about how to use the tube and how much liquid food and water you need.
• If you are eating by mouth, rinse your mouth with water after every meal to prevent food from becoming trapped in your mouth.
• Drink enough fluid to keep your urine clear or pale yellow.

General instructions

• Do nottake baths, swim, or use a hot tub until your health care provider approves.
• Do notsmoke or use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. If you need help quitting, ask your health care provider.
• Gargle water in your mouth as told by your health care provider.
• If you have a tube inserted into your windpipe to help you breathe (tracheostomy tube), follow instructions from your health care provider about how to care for the tube.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have pain that gets worse or does not get better with medicine.
• You have more redness, swelling, or pain around an incision.
• You have more fluid or blood coming from an incision.
• An incision feels warm to the touch.
• You have pus or a bad smell coming from an incision.
• It gets more difficult for you to chew and swallow.
• You have a cough that gets worse.
• You feel nauseous.

Get help right away if:

• You have pain or swelling in any part of your legs or feet.
• You have shortness of breath.
• You have a rapid heartbeat.
• You vomit.
• You have chest pain.
• You urinate less frequently than usual, and you have a smaller amount of urine than usual.