41140 Glossectomy; complete or total, with or without tracheostomy, without radical neck dissection

Name of the Procedure:

Glossectomy; complete or total, with or without tracheostomy, without radical neck dissection

Summary

A glossectomy is a surgical procedure involving the removal of all or a significant portion of the tongue. This particular procedure can be performed with or without a tracheostomy, which is a separate operation to create an airway through an opening in the neck. The procedure is performed without a radical neck dissection, meaning it doesn't include the removal of lymph nodes from the neck.

Purpose

Glossectomies are primarily undertaken to treat various conditions affecting the tongue, such as:

• Oral Cancer: Especially tongue cancer.
• Severe Trauma: Damage to the tongue that cannot be repaired.
• Non-cancerous Tumors: Large benign growths affecting tongue function.

The main goals are to remove pathologic tissues, improve oral health, and maintain as much tongue function as possible.

Indications

• Presence of malignant or large benign tumors on the tongue.
• Persistent bleeding or pain from tongue lesions.

• Difficulty eating or speaking due to significant tongue pathology.

  Patient criteria include:

• Diagnosis confirmed by biopsy.
• Inability to manage condition through less invasive treatments.

Preparation

• Fasting: Patients are generally required to fast for a set period pre-surgery, typically 8-12 hours.
• Medication Adjustments: Adjustments or cessation of certain medications such as blood thinners.
• Pre-operative Tests: Blood work, imaging studies (like MRI or CT scans), and other diagnostic assessments.

Procedure Description

1. Anesthesia: Administered general anesthesia to ensure the patient is fully unconscious during the procedure.
2. Incision and Exposure: Surgical incision made in the oral cavity to access the tongue.
3. Tongue Removal: The affected tongue tissue is excised. If required, a tracheostomy is performed to secure the airway.
4. Hemostasis: Controlling bleeding.
5. Reconstruction: Reconstructive techniques may be used to aid in oral function and appearance post-removal.
6. Closure: Surgical area is closed with sutures.

Tools may include a scalpel, electrocautery devices, and suturing materials.

Duration

Approximately 3-6 hours, depending on the extent of tissue removal and complexity of the reconstruction.

Setting

Typically performed in a hospital operating room.

Personnel

The surgical team usually comprises:

• Surgeon: Often an ENT (ear, nose, throat) specialist or an oral/maxillofacial surgeon.
• Anesthesiologist: Manages anesthesia.
• Nurses and Surgical Technicians: Assist throughout the procedure.

Risks and Complications

Common risks include:

• Infection.
• Bleeding.
• Swelling.
• Pain.

Rare complications can involve:

• Airway obstruction.
• Nerve damage affecting speech or swallowing.
• Adverse reaction to anesthesia.

Benefits

• Elimination of cancerous or problematic tissues.
• Potential preservation of important tongue functions.
• Improved quality of life.

Benefits can be observed shortly after recovery once healing begins.

Recovery

Post-procedure care includes:

• Pain Management: Medication for pain control.
• Nutrition: Possible feeding tubes initially; dietary modifications.
• Speech Therapy: To assist with speech and swallowing.
• Follow-up Visits: Regular appointments to monitor healing and manage any complications.

Recovery time varies but often spans several weeks to months.

Alternatives

• Radiation Therapy: Non-surgical cancer treatment.
• Chemotherapy: Systemic treatment for cancer.
• Partial Glossectomy: Less extensive tongue removal.
• Laser Ablation: Minimally invasive option for smaller lesions.

Each alternative has its own pros and cons, often based on the specific condition being treated and the patient's overall health.

Patient Experience

Patients will be under general anesthesia and feel no pain during the procedure. Post-operative experiences can include:

• Swelling and discomfort.
• Difficulties with speaking and eating initially.
• Pain management through medications.
• Emotional support for coping with changes in oral function.