Glossectomy; complete or total, with or without tracheostomy, with unilateral radical neck dissection
CPT4 code
Name of the Procedure:
Glossectomy; complete or total, with or without tracheostomy, with unilateral radical neck dissection
Summary
A glossectomy is a surgical procedure where part or all of the tongue is removed. This version of the procedure is more extensive, involving a radical neck dissection on one side of the neck to remove lymph nodes and surrounding tissues. A tracheostomy (a temporary breathing tube) might also be placed to help with breathing post-surgery.
Purpose
The procedure is primarily conducted to treat cancer of the tongue and nearby tissues. The removal of the tongue and neck tissues aims to eradicate cancerous cells, prevent the spread of cancer, and improve survival rates.
Indications
- Diagnosed with tongue cancer or squamous cell carcinoma
- Presence of large or invasive tumors on the tongue
- Cancer spread to nearby lymph nodes
- Ineffectiveness of other treatments like radiation or chemotherapy
Preparation
- Fasting for 8-12 hours prior to surgery
- Pre-operative physical examination and imaging studies (e.g., MRI, CT scans)
- Blood tests and assessments of overall health
- Consultation with an oncologist, surgeon, and anesthesiologist
- Instructions for any medication adjustments, especially blood thinners
Procedure Description
- Anesthesia: Patient is given general anesthesia for entire procedure.
- Glossectomy: Surgical removal of part or all of the tongue using specialized surgical instruments.
- Radical Neck Dissection: Removal of lymph nodes and possibly other tissues on one side of the neck to ensure no cancer remains.
- Tracheostomy: Insertion of a breathing tube through the neck if necessary for post-operative breathing support.
- Reconstruction: Possible reconstruction of the tongue or mouth using tissue grafts to aid in recovery and function.
Duration
The procedure typically lasts 4-8 hours depending on the extent of tissue removal and reconstruction required.
Setting
Performed in a hospital operating room due to the complexity and need for specialized equipment.
Personnel
- Head and neck or oncologic surgeon(s)
- Anesthesiologist
- Surgical nurses
- Operating room technicians
- Specialized reconstruction team, if needed
Risks and Complications
- Infection at the surgical site
- Difficulty swallowing or speaking post-surgery
- Bleeding or blood clots
- Negative reactions to anesthesia
- Partial or complete loss of taste
- Need for long-term nutritional support or feeding tubes
- Potential permanent tracheostomy
Benefits
- Removal of cancerous tissue can increase survival rates
- Reduces the risk of cancer spreading to other parts of the body
- Improves chances for local control of the cancer
- Post-recovery can see significant improvement in quality of life
Recovery
- Hospital stay for monitoring, usually 1-2 weeks
- Pain management with prescribed medication
- Nutrition through feeding tubes or specialized diets until swallowing capacity improves
- Speech and swallowing therapy sessions
- Regular follow-up appointments for cancer monitoring and recovery assessment
Alternatives
- Radiation therapy alone
- Combination of chemotherapy and radiation
- Partial glossectomy for less extensive cases
- Palliative care for advanced cancer not responsive to surgery
Patient Experience
Patients may experience pain and discomfort post-surgery, managed through medication. They often face challenges with speaking and swallowing, requiring therapy and practice. Long-term side effects might include changes in taste and permanent alterations in speech.