41155 Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck dissection (Commando type)

Name of the Procedure:

Glossectomy; Composite Procedure with Resection Floor of Mouth, Mandibular Resection, and Radical Neck Dissection (Commando type)

Summary

A glossectomy is a surgical procedure that involves the removal of part or all of the tongue. When combined with a resection of the floor of the mouth and mandibular resection (jaw bone removal), along with a radical neck dissection (removal of lymph nodes in the neck), this is referred to as a "Commando" type procedure. This extensive surgery is often necessary to treat advanced oral cancers.

Purpose

The primary aim of this procedure is to remove cancerous tissues from the tongue, floor of the mouth, and possibly the jaw bone and lymph nodes to prevent the spread of oral cancer and improve the chances of survival.

Indications

• Advanced oral cancer affecting the tongue and/or floor of the mouth.
• Presence of cancerous cells in the jaw bone.
• Cancer has spread to lymph nodes in the neck.
• Patients who are assessed as fit for major surgery.

Preparation

• Fasting for at least 8 hours prior to surgery.
• Adjustments in medications as advised by the doctor.
• Pre-surgical assessments may include imaging studies such as CT scans, MRIs, or PET scans, and blood tests.
• Meeting with a surgeon and anesthesiologist for pre-operative consultation.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is fully unconscious and pain-free.
2. Incisions and Resections: Incisions are made in the mouth and neck. The surgeon removes the affected portion of the tongue (partial or total glossectomy), resects the floor of the mouth, and removes the mandible (jaw bone) if necessary.
3. Neck Dissection: Lymph nodes in the neck are removed to eliminate potential cancer spread.
4. Reconstruction: Depending on the extent of the resection, reconstructive surgery may be performed to rebuild the removed structures using tissue grafts or flaps.
5. Closure: Incisions are closed with sutures, and drains may be placed to remove excess fluids.

Duration

The procedure typically lasts 6-10 hours, depending on the complexity and extent of the surgery.

Setting

This surgery is performed in a hospital operating room equipped for major surgical procedures.

Personnel

• Surgeons (Head and Neck, Oral, Reconstructive)
• Anesthesiologists
• Surgical nurses
• Support staff and possibly oncologists

Risks and Complications

• Infection
• Bleeding
• Difficulty speaking and swallowing
• Changes in appearance
• Nerve damage
• Nutritional challenges requiring feeding tubes
• Potential need for further surgeries

Benefits

• Removal of cancerous tissues
• Improved chances of long-term survival
• Prevention of cancer spread
• Possible improvement in quality of life post-recovery

Recovery

• Hospital stay ranging from 1-2 weeks.
• Pain management with medications.
• Nutritional support via feeding tubes initially.
• Speech and swallowing therapy.
• Instructions on wound care and activity limitations.
• Follow-up appointments for monitoring healing and checking for recurrence.

Alternatives

• Radiation therapy: Non-surgical option with its benefits and limitations.
• Chemotherapy: Used either alone or in combination with radiation.
• Less extensive surgical options may be considered if cancer is detected early.

Patient Experience

• Patients may experience significant discomfort and pain, managed with medications.
• Difficulty speaking and swallowing initially, with potential long-term challenges.
• Physical and emotional adjustments due to changes in appearance and function.
• Support from speech therapists, nutritionists, and psychologists is often beneficial.