41153 Glossectomy; composite procedure with resection floor of mouth, with suprahyoid neck dissection

Name of the Procedure:

Glossectomy with Composite Resection Floor of Mouth and Suprahyoid Neck Dissection

Summary

A glossectomy is a surgical procedure that involves partial or total removal of the tongue. When combined with composite resection of the floor of the mouth and a suprahyoid neck dissection, additional tissues and nearby lymph nodes are also removed to ensure comprehensive treatment, typically for cancerous tumors.

Purpose

The procedure primarily addresses oral cancers that affect the tongue, floor of the mouth, and nearby tissues. The goal is to remove cancerous tissues thoroughly to prevent the spread of cancer and increase the chances of a cure or long-term remission.

Indications

• Diagnosed oral cancer affecting the tongue and floor of the mouth.
• Presence of tumors in the tongue that are malignant.
• Spread of cancer to nearby lymph nodes in the neck.
• Patients who have not responded to other treatments like radiation or chemotherapy.

Preparation

• Patients will need to fast for at least 8 hours before the surgery.
• Instructions include stopping specific medications that might interfere with blood clotting.
• Pre-operative assessments may include imaging studies like CT scans or MRIs, blood tests, and a thorough physical examination.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and comfortable throughout the surgery.
2. Incision: The surgeon makes an incision in the oral cavity to access the tongue and floor of the mouth.
3. Resection: The affected part of the tongue and the floor of the mouth are surgically removed. The extent of the resection depends on the size and location of the tumor.
4. Neck Dissection: A suprahyoid neck dissection involves removing lymph nodes and possibly other tissues in the neck to prevent the spread of cancer.

5. Closure: The surgical site is closed with sutures, and any necessary reconstruction is done to maintain the function and appearance of the mouth and neck.

   Tools used include scalpels, surgical scissors, and specialized instruments for tissue removal and handling.

Duration

The procedure typically takes 4 to 6 hours, depending on the complexity and extent of the resection.

Setting

Usually performed in a hospital operating room due to the complexity and need for specialized surgical and anesthetic support.

Personnel

• Head and Neck Surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a reconstructive surgeon

Risks and Complications

• Infection at the surgery site
• Bleeding
• Difficulty speaking or swallowing
• Altered appearance of the mouth and neck
• Numbness or weakness in the tongue and nearby areas
• Risk of cancer recurrence

Benefits

• Complete removal of cancerous tissue
• Prevention of cancer spread
• Potential for long-term remission or cure
• Improved overall prognosis

Recovery

• Hospital stay ranging from several days to a week.
• Post-operative care includes pain management, nutritional support, and speech therapy.
• Avoid strenuous activities for a few weeks.
• Follow-up appointments for monitoring healing and any further treatment.

Alternatives

• Radiation therapy: Non-surgical option but may not be as effective for certain cancers.
• Chemotherapy: Often used in conjunction with surgery but not typically as a standalone treatment.
• Less invasive surgeries: May not be suitable for extensive or deeply embedded tumors.
• Palliative care: For advanced stages where the focus is on quality of life rather than curative treatment.

Patient Experience

Patients may experience significant discomfort initially, managed through prescribed pain medications. Difficulty in speaking and swallowing is common, and rehabilitation therapies are often required. Emotional and psychological support is also recommended to help patients adjust to changes in function and appearance.