glossectomy

Glossectomy is the surgical removal of all or part of the tongue. It is most often performed for squamous cell carcinoma of the tongue but may be indicated for severe trauma, infection, or benign lesions that threaten function. Surgery may be partial or total, with the extent of resection including hemiglossectomy (removal of one lateral half, typically the anterior two-thirds of the tongue), subtotal glossectomy (removal of most of the tongue), or total glossectomy (removal of all tongue tissue). In some cases extended resections involve adjacent structures such as the floor of the mouth, base of tongue, or mandible, and may be combined with neck dissection for cancer control. Techniques include transoral approaches or open surgery; laser and transoral robotic surgery can be used in select cases.

Preoperative planning relies on imaging to define tumor extent and margins, dental assessment, and evaluation of swallowing and speech function. The goal is to achieve oncologic clearance while preserving as much tongue tissue as possible to maintain function.

Reconstruction is often performed to restore form and function. Options include regional or free tissue transfer, such as radial forearm or anterolateral thigh free flaps, pectoralis major flaps, or local mucosal or fasciocutaneous flaps. Postoperative rehabilitation with speech and swallow therapy is critical. Nutritional support may be required during recovery.

Complications include bleeding, infection, airway compromise, fistula, wound breakdown, dysphagia, dysarthria, altered taste, and risk of aspiration. Long-term prognosis depends on tumor stage, margin status, nodal involvement, and response to adjuvant therapy.