Hemiglossectomy

What is hemiglossectomy ?

A glossectomy is the surgical removal of all or part of the tongue. If a tumor is located on the tongue a tongue resection may be necessary. Depending on the size of the tumor, a partial resection or hemiglossectomy is performed. This means that parts or half of the tongue is resected.

Types of glossectomy surgery:

• The surgery may be performed in three types.
• Partial – part of the tongue is removed
• Hemi – one side of the tongue is removed
• Total – whole tongue is removed

Reasons for the surgery :

This surgery is used to treat tongue cancer when other treatments have not been successful. Removing the tongue is indicated if the patient has a cancer that does not respond to other forms of treatment. In most cases however only the part of the tongue is removed (partial glossectomy). Cancer of the tongue is considered very dangerous due to the fact that it can be easily spread to nearby lymph glands. Most cancer specialists recommend surgical removal of the cancerous tissue.

Possible complications :

Problems from the procedure occur but all procedures have some risk. Your doctor will review potential problems like:

• Tongue bleeding. This is an early complication of surgery. It can result in severe swelling leading to blockage of airway.
• Infection
• Airway blockage from swelling and bleeding. This complication depends on how much of the tongue is removed.
• Trouble swallowing or eating and aspiration of liquids
• Difficulty with speech or inability to speak
• Weight loss
• Failure of flap or reconstruction occurs when transplanted skin or flap does not enough blood flow
• Recurrence of cancer

Fistula formation. Incomplete healing may result in the formation of a passage between the skin and the mouth cavity within the first two weeks following surgery. This complication often occurs after feeding has resumed. Patients who have had radiotherapy are greater risk of developing a fistula.

Risk factors :

The most important risk factor for cancer of the tongue is alcohol consumption and smoking and Chronic diseases, such as diabetes or obesity. The risk is significantly higher in patients who use both alcohol and tobacco than in those who consume only one. Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications.

Diagnosis :

If an area of abnormal tissue has been found in the mouth, either by the patient or by dentist or doctor, a biopsy is the only way to confirm a diagnosis of cancer. A pathologist who is physician who specializes in the study of disease, examines the tissue sample under a microscope to check for cancer cells.

If the biopsy indicates that cancer is present a comprehensive physical examination of the patient’s head and neck is performed prior to surgery. The patient will meet with the treatment team before admission to the hospital so that they can answer questions and explain the treatment plan.

What to expect prior to procedure?

Your doctor may do the following:

• You will be asked about your medical history, including whether you smoke or drink alcohol.
• Physical exam
• Blood tests
• Biopsy of the tongue- a piece of tongue is removed and sent to a lab for testing to diagnose cancer
• Pictures of structures inside the body may be taken x-ray, CT scans, MRI scan of the brain.
• Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.

Before surgery :

• Arrange for a ride to and from the hospital. Eat a light meal the night before. Do not eat or drink anything after midnight.
• If you have diabetes ask your doctor if you need to adjust your medications.
• General anaesthesia will be used. You will be asleep during the procedure.

How to perform surgery :

It is performed under general anaesthesia. A partial glossectomy is relatively simple operation. If the hole left by the excision of the cancer is small, it is commonly repaired by sewing up the tongue immediately or by using a small graft of skin. If the glossectomy is more extensive care is taken to repair the tongue so as to maintain its mobility. A common approach is to use a piece of skin taken from the wrist together with the blood vessels that supply it. This type of graft is called radial forearm free flap. The flap is inserted into the hole in the tongue. This procedure requires a highly skilled surgeon who is able to connect very small arteries. Complete removal of the tongue called a total glossectomy is rarely performed.

You will have tracheotomy to allow you to breathe during and after surgery. This creates an opening from the outside of your neck to your windpipe. A tube is inserted through the opening to allow for air flow. It is usually temporary. If part of the tongue needs to be removed the doctor will remove this cancerous section. The remaining area of the tongue will be sewn so that there is no hole. Sometimes a small graft of skin will be used to fill the hole. This skin graft will then be sewn into place.

If the entire tongue needs to be removed, this is a more complicated surgery. The doctor will remove the diseased tongue. A piece of skin from your wrist will also be removed. This skin graft will be placed in the hole left by the tongue. Blood vessels will also be attached from any remaining tongue to the graft. This is to ensure blood flow. Occasionally a new tongue will be constructed from tissue removed from the thigh forearm, or chest. Sometimes the lymph nodes in the neck will also need to be removed.

How long the surgery will take ?

Generally the surgery will take several hours.

How much will it hurt ?

Anaesthesia will prevent pain during surgery. Pain and discomfort after procedure can be managed with medications.

Hospitalization :

Patients usually remain in the hospital for seven to 10 days after a surgery.

After surgery :

While recovering at the hospital you may receive the following care:

Supplemental oxygen for the first 1-2 days. Oxygen is administered through a face mask or through two small tubes placed in the nostrils. Fluids and medications will be given through an IV. A tube that goes from the nose to the stomach until he or she can tolerate taking food by mouth. Special boots or socks to help prevent blood clots. You will also be encouraged to get out of bed as soon as possible.

Instructions to breathe deeply and cough 10 to 20 times every hour for the first few days. This will decrease the risk of pneumonia. Nutrition through a tube when you are able to swallow you will be able to have drinks and pureed food. If a total glossectomy is done. You may need a permanent feeding tube in your stomach. Radiation treatment is often scheduled after the surgery to destroy any remaining cancer cells. As patients regain the ability to eat and swallow, they also begin speech therapy.

In addition your doctor may have you:

Work with a speech therapist to learn to speak and swallow after surgery. Begin radiotherapy to treat the cancer it had not been given before. During your stay the hospital staff will take steps to reduce your chance of infection, such as:

• Washing their hands
• Wearing gloves or masks
• Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

• Washing your hands often and reminding your healthcare providers to do the same. Reminding your healthcare providers to wear gloves or masks.
• Not allowing others to touch your incision.

What type of care should be taken after going home ?

When you return home, do the following to help ensure a smooth recovery:

• Gargle several times a day to prevent infection.
• Take antibiotics as prescribed. Take pain medication to ease discomfort. Slowly resume your normal diet you are able to swallow effectively. Continue to work with a speech therapist.

Quality of the life after surgery :

A successful surgery results in complete removal of the cancer, improved ability to swallow food, and restored speech. The quality of the patients speech is usually very good if at least one third of the tongue remains and an experienced surgeon has performed the repair.

Total glossectomy results in severe disability because the new tongue is incapable of movement. This lack of mobility creates enormous difficulty in eating and talking.

Morbidity and mortality rates:

Even the case of a successful surgery the long term outcome depends on the stage of the cancer and the involvement of lymph glands in the neck. Five year survival data reveal overall survival rates of less than 60% although the patients who do survive often endure major functional cosmetic and psychological burdens as a result of their difficulties in speaking and eating.

When to call a doctor:

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor.

Signs of infection, including fever and chills. Difficulty swallowing or choking on food or liquids swelling, excessive bleeding or discharge from mouth pain and or swelling in the feet, calves, or legs cough, shortness of breath, chest pain, or severe nausea or vomiting.

Increased pain

New or worsening symptoms

Why choose KIMS?

You will find well experienced doctors surgeons, medical team especially for this surgery. Technicians give you the accurate results of your medical tests. Nurses they will take care of everything after your surgery. You will find modern equipments in the operation theatre. And also surgeons will use latest technology to treat your disease.