Swallowing Without a Tongue: Let’s Talk Glossectomy

I’ve worked with a number of patients over the years who’ve had partial glossectomies—but recently, I’ve had two patients with total glossectomies.

Let that sink in for a second. Total glossectomy. As in, no tongue.

It sounds like a nearly impossible task: getting someone to eat or drink again when one of the primary driving forces of the swallow has been removed. But while it’s a challenge—it’s not impossible.

What Happens When You Take the Tongue Out of the Equation?

The tongue plays a critical role in bolus formation, propulsion, and initiation of the swallow. So yes, removing all or part of the tongue significantly disrupts normal swallowing. But that doesn’t mean oral intake is off the table (pun intended).

I’ve been digging through the research to make sure I’m giving my patients the best evidence-based care—even when access to full-text articles feels like an Olympic sport. Here are two studies I found especially helpful.

Study #1: Son et al. (2015) – Dysphagia in Tongue Cancer Patients

This study examined 133 patients treated for tongue cancer between 2007–2012, looking at swallowing ability before and after surgery.

Key findings included risk factors for post-op aspiration:

Male gender
Extensive tumor resection
Higher nodal stage
Extensive lymph node dissection

The study found significant impacts on swallowing post-surgery, including:

Inadequate tongue control and chewing
Delayed oral transit
Vallecular and pyriform sinus residue
Aspiration/penetration
Inadequate laryngeal elevation

Of the 133 patients:

16 had hemiglossectomies
82 underwent wide resections
23 had partial glossectomies
5 had total glossectomies
70 had radiation therapy
57 received chemotherapy
74 had VFSS pre-surgery
87 had VFSS post-surgery

Post-surgery VFSS showed:

Lip movement abnormalities
Worsened tongue control, chewing, and oral transit
Increased pharyngeal phase abnormalities
Aspiration/penetration rose from 8 patients pre-op to 26 post-op
Vallecular residue increased from 6 to 39 patients
Pyriform sinus residue increased from 3 to 16 patients
Inadequate laryngeal elevation jumped from 1 to 12 patients
4 patients experienced nasal regurgitation

Study #2: Furia et al. (2000) – Videofluoroscopic Evaluation After Glossectomy

This study looked at 15 patients:

5 had partial glossectomies
2 had subtotal glossectomies
8 had total glossectomies

Common findings included:

Difficulty with bolus formation and propulsion (especially with thicker textures)
Increased oral transit time
Significant stasis in the oral, pharyngeal, and esophageal phases

Notably:

2 patients showed moderate aspiration
2 of 10 had persistent, asymptomatic aspiration

Effective compensatory strategies included:

Head-back posture
Supraglottic Swallow
Mendelsohn Maneuver
Multiple swallows per bolus

After VFSS:

8 patients were able to achieve a functional swallow
2 had moderate aspiration with significant residue

The Takeaway: Don’t Give Up

Glossectomy—whether partial or total—is a game-changer for swallowing. But it’s not the end.

Your patient might not have a normal swallow, but they could still have a functional swallow. One that’s safe. One that gives them the dignity of eating and drinking again—maybe not everything, maybe not all the time, but something.

So please… don’t be that SLP who completes a VFSS or FEES with one or two bolus trials, no compensatory strategies, and calls it a day.

Push for compensations. Advocate for trials. Give your patients every chance.

Prosthetics Matter

Don’t overlook the potential power of a prosthesis.

Prosthetic devices—like a maxillary glossectomy prosthesis or flap reconstructions—can help rebuild the floor of the mouth, improve bolus control, and support both swallowing and speech. Several studies support their use (see references below). These tools can make a major difference in functionality for your patients.

Final Thoughts

Treating patients post-glossectomy requires creativity, persistence, and compassion. We can’t fix everything. But we can support something—and sometimes, that something changes lives.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation? Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care? You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes. You can get your copy here.

References:

Furia, C. L. B., et al. (2000). Video fluoroscopic evaluation after glossectomy. Archives of Otolaryngology–Head & Neck Surgery, 126(3), 378–383.

Son, Y. R., Choi, K. H., & Kim, T. G. (2015). Dysphagia in tongue cancer patients. Annals of Rehabilitation Medicine, 39(2), 210.

Davis, J. W., et al. (1987). Effect of a maxillary glossectomy prosthesis on articulation and swallowing. Journal of Prosthetic Dentistry, 57(6), 715–719.

Donaldson, R. C., et al. (1968). Total glossectomy for cancer. The American Journal of Surgery, 116(4), 585–590.

Hirano, M., et al. (1992). Dysphagia following various degrees of surgical resection for oral cancer. Annals of Otology, Rhinology & Laryngology, 101(2), 138–141.

Kothary, P. M., & DeSouza, L. J. (1973). Swallowing without tongue. Bombay Hosp J, 15, 58–60.

Frazell, E. L., & Lucas Jr, J. C. (1962). Cancer of the tongue. Management of 1,554 patients. Cancer, 15(6), 1085–1099.

Dysphagia Ramblings