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Results for “Glossectomy”

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At least 19 recordsLinked to original sources

PubMed2000

Video fluoroscopic evaluation after glossectomy.

BACKGROUND: The swallowing deficits that result from oral or oropharyngeal resections vary considerably depending on the site, extension of the resection, and type of reconstruction. Most patients will experience some degree of dysphagia despite the reconstructive effort. Furthermore, a glossectomy is frequently associated with voice and speech difficulties. OBJECTIVES: To characterize swallowing in patients who underwent a glossectomy and to define the limits and the compensatory movements using video fluoroscopic analysis. DESIGN AND SETTING: Video fluoroscopic evaluation of 15 patients who underwent glossectomies at the Centro de Tratamento e Pesquisa Hospital do Cancer A. C. Camargo, S*ao Paulo, Brazil. PATIENTS: We examined 15 patients: 5 who underwent a partial glossectomy, 2 who underwent a subtotal glossectomy, and 8 who underwent a total glossectomy with laryngeal preservation and reconstruction with myocutaneous flaps (9 pectoralis major flaps and 1 latissimus dorsi flap). The 15 patients were enrolled in a program that included voice, speech, and swallowing rehabilitation. RESULTS: All patients who underwent a partial glossectomy had difficulties with formation and anteroposterior propulsion of the bolus in the oral cavity and an increase in oral transit time, which was more evident with materials of thicker consistencies. All patients who underwent a total or subtotal glossectomy with laryngeal preservation had an increase in oral transit time and stasis of food in the oral cavity, the pharynx, and the superior esophageal sphincter. Of the 15 patients, 2 had moderate and asymptomatic aspiration. These 2 patients had swallowing compensations, such as increased buccal, mandibular, pharyngeal, and laryngeal activity and voluntary protection of the larynx during swallowing. CONCLUSIONS: This study demonstrates the effectiveness of swallowing in patients who were enrolled in voice, speech, and swallowing rehabilitation after undergoing a partial or total glossectomy. An increase in oral transit time was detected in all patients. Only 2 of the 10 patients who underwent a total glossectomy had persistent asymptomatic aspiration.

Adult↗

PubMed2005

Ultrasonic glossectomy--simple and bloodless.

BACKGROUND: The aim of the study was the evaluation of the feasibility of glossectomy using an ultrasonic-activated surgical instrument. METHODS: This was a prospective study of 13 consecutive patients who underwent glossectomy (12 partial and one total) for carcinoma of tongue with the use of ultrasonic scissors. RESULTS: All 13 patients had glossectomy, with median blood loss of 0 mL. The glossectomies were done with an ultrasonic dissector alone. None of the glossectomies required diathermy, ligature, plication, or other methods for hemostasis. The lingual artery and veins of all 13 patients were controlled by use of the ultrasonic scissors alone. No operative complications occurred, including bleeding or wound healing problems. CONCLUSIONS: The excellent combination of coagulation and the cutting effect of ultrasonic scissors has made glossectomy a simple and bloodless procedure. It is a recommended surgical technique in our surgical armamentarium.

Adult↗

PubMed2002

Speech after partial glossectomy: a comparison between reconstruction and nonreconstruction patients.

PURPOSE: This study was undertaken to compare the articulation intelligibility of patients after hemiglossectomy or minor glossectomy within the hemitongue with or without reconstruction. MATERIALS AND METHODS: The articulation intelligibility of 19 patients who underwent hemiglossetomy or minor glossectomy within the hemitongue was investigated at least 6 months after surgery with an articulation intelligibility test with 40 sensitive Chinese sounds. Patients were divided into group 1 (those undergoing reconstructive surgery after glossectomy) and group 2 (those not undergoing reconstructive surgery after glossectomy). Defects of the tongue (in group 1) were reconstructed immediately with free radial forearm flaps or pedicled flaps after glossectomy and closed primarily without reconstruction in group 2. The articulation intelligibility scores were compared between the 2 groups. RESULTS: The mean articulation intelligibility score for group 1 was 77.0% (blade portion glossal sounds), 76.3% (mid portion glossal sounds), and 84.7% (rear portion glossal sounds), and those of group 2 were 94.6%, 92.1%, and 95.3%, respectively. The intelligibility of articulation of group 2 was significantly higher than that of group 1 in blade portion glossal sounds (P <.05), mid portion glossal sounds (P <.05), and rear portion glossal sounds (P <.01). CONCLUSION: The articulation intelligibility was better in patients not receiving grafts than in those receiving grafts. Reconstruction with flaps, which may interfere with the flexibility and mobility of the tongue, may contribute to articulatory impairment. If speech is the outcome of interest, reconstruction may be unnecessary with hemiglossectomy or other partial (minor) glossectomy within the hemitongue.

Adult↗

PubMed1978

[Technique of glossectomy (author's transl)].

Glossectomy is performed in order to reduce the size of the tongue. There are four types:--median anterior glossectomy, the most classical being median lozenge glossectomy;--central glossectomy which does not touch the peripheral border of the tongue;--glossectomy combining these two methods;--marginal glossectomy which may be segmental or extended to involve the whole of the perimeter of the tongue.

Glossectomy↗

PubMed1996

Major glossectomy: end results of 106 cases.

Advanced cancers of the oral cavity continue to be a therapeutic challenge. Despite significant improvements in radiotherapeutic techniques and adjuvant chemotherapy, patients usually die after a short period. Recent progress in reconstructive techniques has made major glossectomy (subtotal, near total, total or extended total) a reasonable palliative and potentially curative approach. It is the purpose of this study to report a series of 106 patients treated from 1985 to 1994 regarding surgical complications and prognosis. All but 1 patient undergoing major glossectomy had squamous cell carcinoma. Primary tumour sites were oral tongue (50 cases), base of the tongue (18 cases), floor of the mouth (28 cases) and other parts of the mouth (10 cases). Tumour stages were: 25 T3, 57 T4, 24 Tx, 34 N0, 20 N1, 32 N2a-N3, 20 Nx. The types of glossectomy were as follows: 24 subtotal, 31 near total and 51 total. A total laryngectomy was performed in only 6 cases. A neck dissection was performed in all but 3 patients: 12 unilateral radical neck dissection (RND), 1 unilateral supra, omohyoid (SOH), 39 simultaneous bilateral RND, 8 simultaneous bilateral SOH, and 43 RND associated to contralateral SOH. A pectoralis major myocutaneous flap was used to repair the operative defect in 96 cases. Complications were seen in 52 cases (49%). The most common complications were wound infection (17 cases), flap necrosis (15 cases) and fistula (15 cases). Significant transient aspiration was seen in 8 patients. At the study closing date, 30 patients were alive without disease, 5 had recurrent disease, 47 died of cancer, 14 died of causes not related to cancer or treatment and 10 were lost to follow-up. The 5-year actuarial survival rates were, respectively, 45%, 18% and 18% for T3, T4 and Tx. Other significant variables were pN stage (P = 0.0672) and year of admission (0.0318). In conclusion a major glossectomy without laryngectomy whenever possible is a safe procedure for a selected group of patients with advanced tongue and floor of the mouth cancer. The actuarial survival rates presented suggests that, in a very select group of patients, major glossectomy is a surgical procedure to be considered.

Aged↗

PubMedDate not supplied

Acoustic analysis of vowels following glossectomy.

This study examined the acoustic characteristics of vowels produced by speakers with partial glossectomy. Acoustic variables investigated included first formant (F1) frequency, second formant (F2) frequency, F1 range, F2 range and vowel space area. Data from the speakers with partial glossectomy were compared with age- and gender-matched controls. Results indicated no significant group difference in the mean F1 values and ranges. The speakers with partial glossectomy exhibited significantly lower mean F2 values for the vowel /i/, and restricted F2 ranges, when compared with the control speakers. These data suggest a limited range of lingual movement along the anterior-posterior dimension for vowel production. The significantly smaller vowel space areas for the speakers with glossectomy supported the hypothesis of vowel formant centralization. Two acoustic measures, vowel space area and F2 range, had a positive correlation with vowel intelligibility scores. F2 range could serve as a sensitive correlate of vowel intelligibility for speakers with partial glossectomy.

Adult↗

PubMed2005

Experimental study on the morphological and functional recovery following partial glossectomy in rabbits: a comparison between CO2 laser and electrocautery.

OBJECTIVE: The aim of the present study was to evaluate and compare the morphological and functional recovery following partial glossectomy in rabbits with the CO(2) laser and electrocautery. METHODS: Partial glossectomy with the CO(2) laser or electrocautery in rabbits was performed to investigate changes in the body weight and tongue width after surgery. The study models were classified into three groups. In group 1, the excised edges of the wound were left unsutured after partial glossectomy with the CO(2) laser. In group 2, the wound was closed after CO(2) laser surgery. In group 3, as a control group, the wound was closed after partial glossectomy with electrocautery. The specimens of the tongues obtained from the rabbit were microscopically assessed. RESULTS: No significant differences were found in the percent change in the body weight among the three groups. There was a significant difference in the tongue width between groups 1 and 3 at each time point: 2 weeks (p < 0.05), 4 weeks (p < 0.01), and 8 weeks (p < 0.001) postoperatively. Furthermore, there was a significant difference in the tongue width between groups 2 and 3 at 8 weeks (p < 0.02) postoperatively. Histologically, the scar tissue of the wound was extensive in the control group, although it was localized in the laser group. CONCLUSION: Postoperative dysfunction was reduced when excised edges were left unsutured after partial glossectomy with the CO(2) laser.

Animals↗

PubMed2000

Postoperative complications and functional results after total glossectomy with microvascular reconstruction.

Microsurgical reconstruction after total glossectomy can greatly improve quality of life; however, postoperative functional results are often unstable, and the effectiveness of total glossectomy remains questionable. To determine the problems of reconstruction after total glossectomy with laryngeal preservation and to examine the functional results of swallowing and speech, 30 patients who had undergone total glossectomy and reconstruction with free flaps were reviewed for this study. The patients ranged in age from 20 to 73 years, and 23 of the 30 had undergone reconstruction with a rectus abdominis musculocutaneous flap. Wider and thicker flaps were designed and transferred and were sutured to suspend the larynx. To maintain physiologic swallowing function after surgery, the extent of laryngeal suspension and cricopharyngeal myotomy was limited. Of the 30 patients, 21 (70 percent) could be decannulated with laryngeal preservation; 20 of these 21 could tolerate a normal/soft/pureed diet, and 1 was limited to a fluid diet. Speech was intelligible in 16 of the 19 patients evaluated. In 9 of the 30 patients, laryngeal function could not be preserved. In four of these nine patients, additional resection combined with total glossectomy caused severe aspiration and recurrent pneumonia. Two patients with preoperative cerebral dysfunction were also poor candidates for laryngeal preservation. Additionally, the transferred flap's lack of bulk in the oral cavity and the advanced age (73 years) of one patient and the poor motivation of another may have contributed to postoperative aspiration. Aspiration occurred in one patient because of local recurrence of a tumor. The presence of preoperative cerebral dysfunction (p = 0.025), resection of the epiglottis (p = 0.005), and postoperative orocutaneous fistulas (p = 0.04) were significantly associated with the failure of laryngeal preservation. However, because of the difficulty of enrolling a sufficient number of patients in the study and the inherent limitations of retrospective studies, multivariate analysis in this study showed that no factors, such as patient age, flap volume, and the type of neck dissection, were significant predictors of laryngeal preservation. Although prospective studies are necessary, the function of individual patients must be assessed so that the study experiences discussed here can be applied to subsequent patients.

Adult↗

PubMedDate not supplied

The questionable value of total glossectomy.

In a personal series of 104 patients with squamous cell carcinoma of the tongue, 14 patients were treated with total glossectomy and laryngectomy, and 2 were treated with total glossectomy alone. The high rate of local recurrence that occurred when partial glossectomy followed curative radiotherapy suggests that in selected patients total glossectomy is of value. Patients with more extensive tumors requiring total laryngectomy are rarely cured and the procedure entails serious rehabilitation problems.

Adult↗

PubMed1983

Total glossectomy.

Forty-five patients had a "total" glossectomy for initial advanced tongue carcinoma or for recurrent carcinoma. Forty percent of the patients (18) had a total laryngectomy at the time of glossectomy. Forty-nine percent of the patients (22) had either a lateral or anterior mandibulectomy at the time of glossectomy. Seventy-one percent of the patients (15 of 21) who had an intact larynx and 12.5 percent who had laryngectomy (3 of 24) had some degree of useful speech. Thirty-one percent of the patients (14 of 45) had no problems in deglutition whereas 53 percent of the patients (24) needed a nasogastric tube, 4 patients inserted the feeding tube themselves, 2 had a cervical esophagostomy, and 1 had a special prosthesis for feeding purposes. Thirty-seven percent of the patients (10 of 27) had considerable aspiration problems. Twenty-two percent (6 patients) needed a laryngectomy, and 7.5 percent (2 patients) needed a cervical esophagostomy to prevent further problems. Seven and one-half percent of the patients (2) succumbed to serious pulmonary infection. In this study, total glossectomy had a salvage rate of 65 percent at 6 months postoperatively, 27.5 percent at 1 year, 25 percent at 2 years, 25 percent at 3 years, 20 percent at 5 years, and 10 percent at 10 years.

Adult↗

PubMed1985

Speech considerations in prosthodontic rehabilitation of the glossectomy patient.

A knowledge of normal articulation is needed before the prosthodontist can assess the compensatory articulation used by glossectomy patients. The amount and portion of tongue resected is directly correlated with speech intelligibility. The loss of the tip of the tongue is more critical to intelligibility than a hemiglossectomy. Partial glossectomy speakers can often use the residual tongue stump to perform adaptive movements that approximate normal movements and should be treated as an articulation problem. The compensatory articulation used by the total glossectomy patient was reviewed. The prosthodontic management of patients with partial tongue resection often includes lowering the palatal vault, while the management of the total glossectomy patient usually requires a mandibular tongue prosthesis. These prostheses can be refined with the use of multiview videofluoroscopy, videotaping, and spectrographic analysis.

Dentures↗

PubMed2000

Articulatory function in patients who have undergone glossectomy with use of an artificial graft membrane.

OBJECTIVE: The purpose of this study was to investigate, by assessing speech intelligibility, the long-term usefulness of an artificial bilayer membrane as a mucosal substitute after glossectomy. STUDY DESIGN: Artificial membranes were grafted in 8 patients with intraoral defects after glossectomy. Five patients served as a control group and received only standard closure by suture after glossectomy. Speech intelligibility was evaluated by means of a standardized Japanese speech intelligibility test 6 months or more after the operation. RESULTS: The postoperative courses of all 13 patients were uneventful. Intelligibility scores of those who received grafts were better than those of the control group in the overall score, the glossal sounds score, and the rear portion sounds score. CONCLUSION: The artificial membrane was useful for the glossectomy as a long-term mucosal substitute, as well as for the short-term.

Adult↗

PubMed1999

The difference between delayed extubation and tracheostomy in post-operative sleep apnea after glossectomy or laryngectomy.

BACKGROUND: Patients with cancer of the tongue or larynx require glossectomies or laryngectomies and subsequent reconstruction. These procedures remove part of the patient's upper airway. In cancer of the tongue, the removed part of the airway is substituted by a flap of their skin. Post-operatively, it is possible that the patients have problems respiring comfortably. In addition to this, long surgical procedures may simply interfere with their circadian rhythm. To elucidate the possible change in their post-operative respiration, we monitored the patient's respiratory pattern with an apnea monitor. METHODS: We attached an apnea monitor to the patients and recorded their respiratory pattern and arterial oxygen saturation. The patients were monitored for a total of five days: three days prior to the operation, one day before the operation, the day of operation, two days after, and on the fourth day after the operation. The period of monitoring was from 8:00 p.m. to 6:00 a.m. the next morning. RESULTS: Sixteen patients completed this study. The patients whose tube was extubated after glossectomy showed frequent apnea, low mean oxygen saturation and low comfort score as compared to the patients with tracheostomy after laryngectomy. Because two failed cases of free skin flap were among the former, it is possible that the frequent apnea is a factor of failed free skin graft after glossectomy and laryngectomy. CONCLUSION: Further studies are required to improve the patient's respiration during their sleep after tracheal extubation in glossectomy.

Aged↗

PubMed1997

Survival, function, and quality of life after total glossectomy.

Advanced tongue cancer is associated with poor survival despite aggressive therapy. In an attempt at cure, many patients undergo total glossectomy, which significantly affects function and quality of life (QOL). This study was designed to determine the survival rate and QOL of patients who had undergone total glossectomy. A total of 54 patients underwent total glossectomy, with or without total laryngectomy, for advanced tongue cancer from 1970 to 1996. Patient outcomes were assessed for the following: 1. disease-free survival, 2. function, utilizing the Performance Status Scale (PSS), and 3. QOL, using two general cancer questionnaires (FACT-G and EORTC QLQ-C30) and a series of questions specific for head and neck cancer patients. Corrected actuarial survival was 51% and 41% at 3 and 5 years, respectively. Functional assessment using the PSS demonstrated significant deficits in speech and deglutition. QOL questionnaires revealed problems with eating, speaking, socializing, and shoulder function. However, the overall responses demonstrated that these patients have adjusted to their deficits and have a good QOL. It was concluded that total glossectomy, with or without total laryngectomy, can result in meaningful survival and an adequate QOL can be achieved in selected patients.

Activities of Daily Living↗

PubMed2005

Cortical adaptation following partial glossectomy with primary closure: implications for reconstruction of the oral tongue.

OBJECTIVES: The considerable variability in functional outcomes for speech and swallowing with different reconstruction techniques following partial glossectomy may reflect the ability of patients to adapt to altered tongue structure. The purpose of this study was to determine mechanisms of cortical adaptation in swallowing to partial glossectomy reconstructed with primary closure. METHODS: Four patients treated with partial glossectomy and primary closure underwent functional magnetic resonance imaging at a mean of 6 months after operation, and the data were compared to those from 8 healthy controls. RESULTS: Statistically significant increases in activity occurred predominately in the parietal cortices and the cerebellum. The volume of the resection was most highly correlated with activity in the premotor and parietal cortices and cerebellum. CONCLUSIONS: The adaptive changes in the cortex following partial glossectomy with primary closure reflect adaptation to the biomechanics of tongue movement during swallowing, and not altered sensation in the tongue.

Adaptation, Physiological↗

PubMed2004

The pattern of tongue pressure against the palate during articulating glossal sounds in normal subjects and glossectomy patients.

The purpose of the present study was to measure tongue pressure with the aim of characterizing the pattern of linguopalatal contact during articulating glossal sounds in normal subjects and glossectomy patients. Tongue pressures against the palate were evaluated in 13 normal subjects and 5 glossectomy patients by using three parameters: the duration from the onset of linguopalatal contact to the time of maximum pressure, the maximum pressure, and anterior posterior ratio of the maximum pressure. Three glossal sounds, [ti], [t [symbol: see text] i], and [[symbol: see text] i], which have tendency of mishearing in glossectomy patients, were selected for test sounds. A unique characteristic was demonstrated in normal subjects. The score of the maximum pressure showed an apparent order among the three sounds, while the durations revealed the opposite order. Anterior posterior ratio of the maximum pressure also showed some relationship among three sounds. In glossectomy patients, these characters were not found. The loss of tongue volume or deterioration of tongue mobility causes these results.

Adult↗

PubMedDate not supplied

[Total glossectomy with larynx preservation and reconstruction with rectus abdominis free flap].

OBJECTIVE: Our objective was to show the complexity and series of events needed to perform the reconstruction with rectus abdominis free flap to achieve an adequate rehabilitation for patients submitted to total glossectomy with larynx preservation due to advanced tongue carcinoma. METHODS: Two patients with stage IV carcinoma of the tongue were treated with surgery--one as primary treatment, the other for recurrence. Patients underwent total glossectomy, bilateral radical neck dissection, gastrostomy, tracheostomy, and reconstruction with rectus abdominis free flap. RESULTS: Both patients had an uneventful postoperative evolution and were discharged from the hospital without tracheostomy on the 7th and 8th days, respectively. The patient who received primary treatment is currently receiving adjuvant radiotherapy. CONCLUSIONS: Patients requiring total glossectomy, either with or without laryngectomy, must undergo a careful and individualized selection of the reconstructive procedure by a highly specialized surgical team. The rectus abdominis flap represents one of the best options for reconstruction in patients treated with total glossectomy. Its main disadvantage is seen in overweight patients, in whom the flap volume taken may be excessive for the oral cavity. Most of these patients are fed by a gastrostomy tube, which may be removed only when aspiration is absent. The type of gastrostomy can even be evaluated before surgery.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

[Total/near-total glossectomy for advanced carcinoma of the tongue].

Poor survival rates and the limited palliation afforded by radiotherapy alone, together with progress made in reconstructive surgery in restoring mucosal continuity after large resections, make total glossectomy reasonably indicated for treatment of advanced carcinoma of the tongue. The Authors reviewed 19 cases (17 males, 2 females, mean age 58.4 years) of total and near total glossectomy without laryngectomy treated at National Cancer Institute "Regina Elena" of Rome from 1990 to 1993 in order to evaluate oncological and functional results. All patients were reconstructed immediately, 16 with a pectoralis major flap, 2 with a nasolabial flap and 1 with a radial forearm free flap and were available for follow-up from 6 to 45 months (mean 29 months). There was no operative mortality and no patient needed total laryngectomy for aspiration. The rate of local recurrencies was 52.6%, most of them (75%) in patients who had undergone total/near total glossectomy for recurrence. Survival rate was 61.5% after 1 year and 20% after 2 years. 94% of patients resumed swallowing and independent oral alimentation (48% of them without any dysphagia); 84%; of the patients were decannulated and 48% produced easily intellegible speech. Data from our experience let us conclude that, in the light of the acceptable functional results obtained with reconstructive flaps, total glossectomy should be considered as the primary treatment modality in advanced carcinoma of the tongue (including T2 > 3 cm exceeding midline), and should not be reserved only for salvaging hopeless situations.

Adult↗