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Glossectomy: What to Expect

The tongue is a very large muscle that is extremely important for successful speech and swallowing. When cancer affects certain portions of the tongue or mouth – surgical removal of those areas is often required.

A glossectomy is a surgical procedure that involves removal of the tongue. Depending on the degree of your cancer, surgery may be one of the following:

• Partial: removal of a small part of the tongue
• Hemi: removal of one side of the tongue
• Total: removal of the entire tongue

Common procedures associated with a glossectomy:
Free Flap: If a large portion of the tongue is to be removed, the surgeon will obtain tissue from another location to replace the cancerous tissue. Common donor sites are the forearm or the thigh. The surgeon will use this tissue to replace what they remove from your tongue.
Neck dissection: This is a procedure that is completed if the cancer has spread to the lymph nodes in your neck. You have approximately 50-60 lymph nodes in your head and neck. A neck dissection is done to remove cancerous lymph nodes and often non-cancerous lymph nodes. This is to ensure that the cancer does not spread any further.

Breathing immediately after surgery: Due to swelling from surgery, you will have a tracheostomy tube placed during surgery. This is to ensure that you have an adequate airway and do not have any issues breathing. This is generally not permanent and only necessary for a few days. Once your swelling goes down, the capping process can begin and the tracheostomy tube can eventually be removed. At first you will not be able to talk. Do not let this scare you, it is not permanent. As your swelling goes down a speech therapist will teach you how to properly occlude your trache for voicing.

Swallowing immediately after surgery: You will not be able to swallow anything by mouth directly after your surgery. A nasogastric (NG) tube placed in the nose, or a percutaneous endoscopic gastrostomy (PEG) tube placed in the stomach, will be used for nutrition while you heal.

• An NG tube is a thin, flexible tube inserted through your nose and down into your stomach. This tube is placed to give you nutrition while you are unable to eat or drink by mouth. Your tube will be removed by your surgeon when it is no longer needed.
• A PEG is a surgical procedure in which a tube is passed into the stomach through the abdominal wall. This allows for you to attain nutrition safely if the surgeon believes your swallowing difficulties will be long-term.

Some patients are able to start liquid trials during their hospital stay. However, this is all dependent on the type of glossectomy, reconstruction, healing, and the overall health of your tissue. Do not eat or drink anything until your doctor or speech therapist instructs you to. Whether you can begin trials by mouth will be determined by your surgeon and speech therapist while you are in the hospital.

Following the glossectomy procedure you will need to expect changes to occur with your speech and swallowing.

• Speech: Your tongue is responsible for touching very specific places in your mouth at a high rate of speed to create clear speech. This can be very difficult following a surgery where tongue tissue is removed. Your tongue will be less mobile and not as strong as it was prior to surgery. Your speech sounds will be less clear. Your speech may sound mumbled, and it may be difficult for you to be understood by others.

• Swallowing: You will also experience some degree of dysphagia (difficulty swallowing). Your tongue is an extremely important part of swallowing. It helps move food around in your mouth and push food down your throat. Without it, you may experience aspiration (liquid or food going into your airway) or difficulty with foods sticking in your throat. Most people are able to learn a new way of swallowing and consume liquids and foods by mouth. Depending on the degree of dysphagia, a permanent feeding tube may be required to ensure you have a safe way to attain nutrition. It is very important that you get enough nutrition daily so that your body is able to continuing healing from the surgery.

Patients often require therapy depending on the degree of the glossectomy. A speech-language pathologist will work with you to improve your swallowing, speech, and overall communication following this procedure.

You will be followed closely by your doctor. Be sure to tell them about any continued difficulty you are having with eating or speaking.

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