Let’s talk total glossectomy for a minute. I’ve actually worked with multiple partial glossectomies in my career and recently have had 2 total glossectomy patients.
It seems like a pretty difficult task, right? Getting someone to eat and drink again with no tongue.
Taking the tongue out of the equation of swallowing makes the entire process very difficult, but not impossible.
I was looking at an article recently, wanting to make sure that I’m doing right by my patient, but also limited to access to most articles.
Son, et al
An article looked at 133 patients from 2007-2012. There was a study of swallowing ability before and after surgery.
The study found risk factors for aspiration with tongue cancer including:
- Gender (higher incidence in males)
- Extensive tumor resection
- Higher node stage
- Extensive lymph node dissection
Patients in this study were a mean age of 53.5 with 85 men and 48 women.
Patients with tongue cancer had a higher incidence of:
- inadequate tongue control
- inadequate chewing
- delayed oral transit time
- vallecular residue
- pyriform sinus residue
- inadequate laryngeal elevation
Of the patients:
- 16 hemiglossectomy
- 82 wide resection
- 23 partial glossectomy
- 5 total glossectomy
- 70 underwent radiation
- 57 underwent chemotherapy
- 74 VFSS before surgery
- 87 VFSS after surgery
Of the patients that had VFSS before and after surgery, after surgery, there was a higher incidence of:
- lip movement abnormality
- tongue control
- oral transit time
- pharyngeal phase differences with aspiration/penetration in 8 patients before surgery and in 26 patients after surgery
- 4 patients with nasal regurgitation after surgery
- vallecular residue in 6 patients before surgery and 39 after surgery
- pyriform sinus residue in 3 patients before surgery and 16 after surgery
- inadequate laryngeal elevation in 1 patient before surgery and 12 patients after surgery
Furia, et al
I read an article recently about Videofluoroscopic Evaluation after Glossectomy (cited below). The study was small, only 15 patients, 5 with partial glossectomy, 2 with subtotal glossectomy and 8 with total glossectomy.
Those patients with partial glossectomy had difficulty with bolus formation, anterior/posterior propulsion and increased oral time particularly with thicker substances.
All patients had increased oral transit time and oral/pharyngeal/esophageal stasis.
2 patients had moderate aspiration, 2/10 had persistent asymptomatic aspiration.
Compensatory strategies that were effective for patients was a head back posture, Supraglottic Swallow, Mendelsohn Maneuver and subsequent swallows following initial swallow of the bolus. After VFSS, 8 patients had a functional swallow and 2 patients had moderate aspiraiton with residue.
I think the biggest take away with our patients with glossectomy, no matter the degree is to not give up on them. These patients deserve a chance at eating and drinking, even if only small amounts.
Don’t be that SLP that completes the VFSS or FEES with no compensatory strategies, no assistance with anterior/posterior propulsion and only 1-2 trials. There is evidence to support that these patients may not have a normal swallow, but may have a functional swallow.
Push for prosthesis for your patients. These can be functional for your patient’s speech and swallowing. There are multiple studies regarding prosthetics for your patient listed below. A flap can help to fill the floor of the mouth and give your patient a stronger chance of a functional swallow.
Furia, C. L. B., Carrara-de Angelis, E., Martins, N. M. S., Barros, A. P. B., Carneiro, B., & Kowalski, L. P. (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., Lazarus, C., Logemann, J., & Hurst, P. S. (1987). Effect of a maxillary glossectomy prosthesis on articulation and swallowing. Journal of Prosthetic Dentistry, 57(6), 715-719.
Donaldson, R. C., Skelly, M., & Paletta, F. X. (1968). Total glossectomy for cancer. The American Journal of Surgery, 116(4), 585-590.
Hirano, M., Matsuoka, H., Kuroiwa, Y., Sato, K., Tanaka, S., & Yoshida, T. (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. Report of the management of 1,554 patients. Cancer, 15(6), 1085-1099.