Glossectomy

A glossectomy (glah-SEK-toh-mee) is surgery to remove all or part of your tongue. It’s most often used to treat tongue cancer. In some cases, a glossectomy procedure can treat severe obstructive sleep apnea and macroglossia (an enlarged tongue). But this is rare.

Your tongue helps you speak. It helps you chew, swallow and taste food. Removing it can impact these important functions. This is why learning how to use your changed tongue is often an important part of recovery.

Types

The tumor’s size and location determine the type you need. Types include:

• Partial glossectomy: Removes a small portion of your tongue
• Hemiglossectomy: Removes half of your tongue
• Total glossectomy: Removes your entire tongue

Related, subtotal and near-total glossectomies remove most of your tongue but not all of it.

Often, surgeons can do the procedure through your mouth. But sometimes, they have to make cuts to your jaw or throat to reach the tumor.

How should I prepare for this procedure?

Your healthcare provider will help you prepare by doing tests and giving you instructions.

They’ll take a detailed medical history and do a physical exam. They’ll likely order imaging tests, like CT scans or MRI scans. Imaging shows the tumor inside your body. It helps providers know which type of tongue removal surgery you need.

Before your glossectomy, your provider will tell you when you should stop eating and drinking and whether you should pause your medicines. They’ll let you know what kind of help you’ll need at home during recovery. Be sure to follow these guidelines closely.

What happens during a glossectomy procedure?

First, you’ll get general anesthesia to put you to sleep. You won’t feel any pain.

Partial glossectomy

If you’re having a partial glossectomy, your surgeon will remove the diseased part of your tongue. Then, they’ll close the incision with dissolvable sutures (stitches). Your surgeon may place a tissue graft to fill the hole left behind.

Hemiglossectomy

For a hemiglossectomy — up to half of your tongue removed — you may need a tracheostomy. This procedure places a trach tube through a hole in your neck to help you breathe. This is important because swelling in your mouth after a hemiglossectomy may briefly block your upper airway.

After surgery, your surgeon will rebuild (reconstruct) your tongue. They’ll use tissue from somewhere else on your body. For instance, they may use tissue from your thigh or forearm. To ensure blood flow, your surgeon will connect any remaining blood vessels to the new piece of tissue.

Total glossectomy

For a total glossectomy, your surgeon removes all of your tongue. Subtotal and near-total glossectomies remove most of your tongue. Again, you may need a trach tube so that swelling doesn’t block your airway.

In some cases, your surgeon can create a new tongue. To do this, they’ll take a tissue graft from your forearm, chest or thigh. This is unique to each person. Your healthcare provider can talk to you about your options before surgery.

What are the potential benefits and risks of this procedure?

A glossectomy is the main treatment for tongue cancer. If the tumor is only in one part of your tongue, this surgery may cure it.

Like any surgery, it carries risks, like bleeding or infection. Other possible complications may be temporary or long term. They include:

• Trouble speaking and swallowing
• Changes in your ability to move or feel sensations on your tongue
• Changes in your sense of taste
• Issues with wound healing in your tongue or at the donor site (where the graft was taken)

Sometimes, the surgery doesn’t cure the cancer, and it comes back.

What happens after a glossectomy?

Following this procedure, most people need to stay in the hospital for about a week. During this time, your care team will monitor your recovery. They’ll help you:

• Breathe: If you have a trach tube, your care team will remove it once you can breathe on your own. In some cases, you may need to go home with a trach or use it long term.
• Eat: You may need to eat through a feeding tube that goes in through your nose or belly. Your team will transition you to mouth (oral) feedings as soon as it’s safe. You may need to continue tube feedings if there’s a risk of food going into your lungs (aspiration).
• Communicate: You may not be able to talk at first. If that’s the case, your care team will ask yes-or-no questions or give you a pad to write on. At some point, you’ll likely meet with a speech-language pathologist. They’ll help you speak and swallow after your glossectomy.

Your healthcare provider may recommend radiation therapy, depending on the cancer stage. Or you may need chemotherapy with radiation. This helps reduce the risk that the cancer comes back. Your provider will discuss these options with you if they apply.

What is the recovery time?

Your recovery time depends on how much of your tongue your surgeon had to remove. Some people may be able to eat and drink normally after two weeks. People who’ve a total glossectomy may lose speech or swallowing function. This is because tongue movement is what triggers your throat to swallow.

Most people continue speech therapy for several months to help with speaking and swallowing.

Recovery may take lots of time, patience and teamwork. But most people adjust and enjoy an improved quality of life after surgery.

Can you talk after a glossectomy?

It depends on how much of your tongue your surgeon had to remove. With a partial glossectomy, you may still be able to form most sounds and words, with the help of speech therapy. Those who’ve had a total glossectomy may need to use pen and paper or technology (like a tablet) to communicate.

One way healthcare providers measure communication skills is through something called speech intelligibility. Speech intelligibility refers to how well others can understand a person’s speech. This is different from sounding out words perfectly. Even if a large portion of your tongue is removed, others may still be able to understand the gist of what you’re saying.

Research shows that intelligibility is greater when less of your tongue has been removed. It helps if the reconstruction allows you to move your tongue freely. Also, preserving the tip of your tongue goes a long way in helping you make consonant sounds, so others understand what you’re saying.

Your speech-language pathologist will work with you to improve speech intelligibility after the procedure.

Can you taste after a glossectomy?

You can have good taste sensation even if most of your mobile tongue (the part that moves) is removed. One study shows that people who have at least half of their tongue base experience tastes normally. But if your surgeon had to remove over half of your tongue, foods may not taste the same.

Some people think that taste buds in charge of detecting certain tastes are clustered on certain parts of the tongue. (Taste buds that detect “sweet” are only on the front, taste buds that detect “sour” are on the sides, and so on.) So, removing any part of the tongue risks losing that taste sensation entirely.

But this is a myth. You have taste buds scattered all over your tongue. They’re also in the flap covering your breathing tube (epiglottis) and in the back of your throat.

This is why many people continue to taste and enjoy food after this procedure.

When should I call my healthcare provider?

If you’ve recently had a glossectomy, there are certain warning signs to watch for. Call your healthcare provider right away if you have:

• Fever, chills or other signs of infection
• Heavy bleeding from your mouth
• Nausea or vomiting
• Severe pain that doesn’t go away with medicine
• Swelling that gets worse after the first few days
• Trouble swallowing or the inability to eat or drink