Glossectomy; composite procedure with resection floor of mouth and mandibular resection, without radical neck dissection
CPT4 code
Name of the Procedure:
Glossectomy; Composite Procedure with Resection Floor of Mouth and Mandibular Resection, Without Radical Neck Dissection
Summary
A glossectomy is a surgical procedure to remove part or all of the tongue. The composite procedure involves additional resection of the floor of the mouth and part of the mandible (lower jawbone) but does not include radical neck dissection, which is the removal of lymph nodes from the neck.
Purpose
The procedure is primarily used to address oral cancers affecting the tongue, floor of the mouth, and surrounding areas, aiming to remove malignant tissues. The goal is to achieve complete cancer removal while preserving as much function as possible and minimizing disfigurement.
Indications
- Presence of malignant tumors in the tongue, floor of the mouth, or mandible.
- Diagnosed oral cancer that has not spread extensively to the neck lymph nodes.
- Severe oral pain or difficulty swallowing due to the size or location of the tumor.
Preparation
- Patients may be advised to fast for 8-12 hours before the surgery.
- A thorough pre-operative assessment, including blood tests, imaging studies (such as MRI or CT scans), and biopsy results, will be conducted.
- Medication adjustments might be necessary, especially if the patient is on blood thinners.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A surgical incision is made in the mouth to access the tongue, floor of the mouth, and mandible.
- Resection: The affected portion of the tongue is removed along with sections of the floor of the mouth and part of the mandible as necessary.
- Reconstruction: If needed, reconstructive techniques, such as grafts or flaps of tissue from other parts of the body, are used to repair the surgical site.
Closure: The incision is closed with sutures.
Tools and Equipment: Surgical scalpels, electrocautery devices, tissue and bone graft tools.
Duration
The procedure may take between 4 to 6 hours depending on the extent of resection and reconstruction required.
Setting
The surgery is performed in a hospital operating room.
Personnel
- A head and neck surgeon
- An assistant surgeon
- An anesthesiologist
- Operating room nurses and surgical technicians
Risks and Complications
- Common risks: Infection, bleeding, and swelling.
- Rare risks: Nerve damage, speech and swallowing difficulties, incomplete removal of cancer, and adverse reactions to anesthesia.
- Management includes antibiotics for infection, and careful post-operative monitoring.
Benefits
The main benefit is the removal of cancerous tissue, which increases the chances of disease control and potentially curing the patient. Functional and aesthetic reconstruction aims to improve quality of life post-surgery.
Recovery
- Hospital Stay: Several days post-surgery for monitoring.
- Pain Management: Pain relievers and medications to manage discomfort.
- Nutrition: Initially, patients might require a feeding tube or a liquid diet.
- Follow-Up: Regular appointments for wound care and to monitor recovery.
- Speech and Swallowing Therapy: Rehabilitation to help regain speech and swallowing functions.
Alternatives
- Radiation therapy: Suitable for early-stage cancers or as an adjunct treatment.
- Chemotherapy: Often used when cancer has spread or as part of a combined treatment approach.
- Less invasive surgical procedures: For smaller or less invasive tumors.
Each alternative comes with its own pros and cons, such as varying effectiveness, side effects, and recovery times.
Patient Experience
During the Procedure: Patients are under general anesthesia and will not feel pain during the surgery.
After the Procedure:
- Discomfort and pain managed with medications.
- Possible sensation changes due to nerve involvement.
- Gradual return to normal functions through rehabilitation and therapy.
- Psychological support may be necessary to help cope with changes in appearance and function.