Glossectomy 101: What to know about this common tongue surgery

A glossectomy is surgery to remove part or all of the tongue. It’s the primary recommended treatment for oral tongue cancer and can also be used to treat benign tongue conditions.

To learn more about glossectomies, we spoke with head and neck surgeon Karen Choi, M.D., and clinician scientist Carly Barbon, Ph.D. They answered questions about glossectomies, including the different types, and what to expect during the procedure and recovery.

What are the different types of glossectomy?

First, it may be helpful to explain the anatomy of the tongue, says Choi. The tongue is divided into two parts: the oral tongue and the base of the tongue.

Oral tongue: This is the part of the tongue you see when you open your mouth and look at your tongue in the mirror. The oral tongue is a part of the oral cavity.

Base of tongue: This part of the tongue cannot be seen through your mouth. Doctors use a scope, or camera, to see it during exams. The base of the tongue is part of the oropharynx. Circumvallate papillae are small bumps that form a V-shape toward the back of the oral tongue. They contain hundreds of taste buds and separate the base of the tongue from the oral tongue.

There are distinct differences between cancers of the oral tongue and cancers of the base of the tongue, and their treatments will differ.

Glossectomy types

These are the types of glossectomies used to treat oral tongue cancer:

• Partial glossectomy: surgical removal of less than half of the tongue
• Hemiglossectomy: surgical removal of half of the tongue
  
• Subtotal glossectomy: surgical removal of more than half but less than the whole tongue (including part of the base of the tongue)
• Total glossectomy: surgical removal of the whole tongue (including the base of the tongue)

The cancer’s location and size determine which part and how much of the tongue needs to be removed.

Why would you need a glossectomy?

Glossectomy is the most common surgery to treat oral tongue cancer. This includes squamous cell carcinoma – the most common type of cancer on the oral tongue – as well as rarer cancers, like minor salivary gland cancer and sarcomas that develop in the tongue.

Glossectomies are also used to treat non-cancerous conditions, such as benign salivary gland tumors, painful granulomas and severe dysplasia.

What happens during a glossectomy?

A glossectomy is a major surgery. It is done under general anesthesia, so you will be asleep throughout the procedure.

The length of surgery depends on the extent of the disease and how much of your tongue needs to be removed. Your surgeon may also need to do a neck dissection to remove lymph nodes in your neck.

Small glossectomies

Benign tumors or small cancerous tumors may only require removing a small part of your tongue. These often can be closed using sutures. In some cases, we may need to do a skin graft or artificial graft to reconstruct part of your tongue.

These types of surgeries can take anywhere from one hour to three hours. Most glossectomies can be outpatient procedures. This means you do not have to stay in the hospital overnight. Some patients may stay in the hospital overnight, so we can make sure they’re able to eat and drink.

Large glossectomies

For larger cancers that require a large part of the tongue to be removed, surgery can take eight to 12 hours.

Plastic surgeons will help reconstruct the tongue, often with a free flap. A free flap is when surgeons take tissue like muscle, skin and fat from another part of your body – usually the arm or leg – and use that tissue to reconstruct your tongue. The free flap will connect to the blood vessels in the neck to provide blood flow to the flap. It’s common to have swelling in the back of the throat after this surgery, so you will get a tracheostomy. This is a temporary breathing tube in the neck that bypasses swelling in the upper throat, so that your airway is not blocked and you can breathe during the recovery period. The tracheostomy typically gets removed before you leave the hospital, once the swelling has gone down.

You will need a temporary feeding tube to provide nutrition while you are healing. This helps prevent infection in the mouth as the sutures are healing.

You’ll also have surgical drains in your neck as well as the part of the body from which the free flap was taken. Most patients will stay in the hospital for about a week after surgery to recover.  

How long is the recovery after a glossectomy?

Recovery time after a glossectomy will vary from person to person and largely depends on the extent of the surgery.

“For partial glossectomies that can be reconstructed with a primary closure, patients can often start gentle oral rehabilitation about one to two weeks after surgery if they’re healing well,” says Choi. “If you’ve had a free flap reconstruction and a feeding tube, your feeding tube won’t be removed until your first swallow study. You generally won’t start any kind of oral rehabilitation until your first swallow study, which could be anywhere from one to six weeks after surgery.”

Some patients will also undergo radiation therapy after surgery to destroy any remaining cancer cells and help reduce the risk of recurrence. This can impact healing and recovery time.

Your doctor and care team will talk to you about what to expect during recovery.

Can you talk after a glossectomy?

Yes, it is possible to talk after having a glossectomy.

“Your speech will never be the same as it was before surgery, but you will still be able to communicate,” says Barbon, who works with patients on swallowing and speech recovery after glossectomies.

If you’ve had a small partial glossectomy, people may notice slight distortions in how you articulate words. You can still speak and communicate even if half of the tongue or more is removed. It just requires more intensive rehabilitation.  

This may include exercises to teach you how to manipulate your jaw, tongue or other parts of your oral cavity to get you back to a speech pattern people can understand.

It can also be helpful to keep a pen and notepad handy to write out specific words if someone is having a hard time understanding what you’re saying. There are a lot of new technologies that can assist you with this.

Can you eat after a glossectomy?

How easily you’re able to eat after a glossectomy depends on how much of your tongue was removed.

“If you’ve had a total glossectomy, it will be difficult to chew solid foods,” says Barbon. “Most of these patients will be on a liquid or pureed diet, so the fluids and liquids can move through the mouth and throat by gravity.”

How does a glossectomy affect swallowing?

There are three sequential phases of swallowing, and they’re most impacted when patients have half or more of their tongue removed.

Oral phase: Once food passes your lips, it’s manipulated by chewing and mixing that food with your saliva before the food is moved to the back of your throat using your tongue. This oral process can be difficult if you’ve lost more than half of your tongue. You may need to add moisture to your food or eat softer foods.

Pharyngeal phase: This is about a one-second process where the food moves down your throat. Patients who lose a lot of muscle and soft tissue during a glossectomy sometimes can’t feel the food that’s coming into their throat. This can lead to swallowing difficulties or food getting stuck in their airway.  

Esophageal phase: This is when food is moved from the esophagus into the stomach.

How long will I need a feeding tube?

If you’ve had a small partial glossectomy, you may not need a feeding tube at all.

If you’ve gotten reconstructive surgery with a flap, you will need a temporary feeding tube to make sure no food gets into the oral cavity while it’s healing.

“Patients who have smaller glossectomies with a flap usually only need a feeding tube for one to two weeks,” says Barbon. “Patients with larger glossectomies and thicker flaps may need a feeding tube for two to six months, depending on their progress during rehabilitation.”   

Will my taste be affected?

Your taste will be impacted after a glossectomy, depending on how much of your tongue was removed.

“If you have radiation after surgery, you may have swelling and less lubrication in the mouth,” says Barbon. “The good news is that most patients, even those who get a total glossectomy, can still taste if they are left with some residual tongue.”

What tongue exercises help after a glossectomy?

“I like to get a swallow study done on every patient after surgery,” says Barbon. “Then I have them tell me what their priorities are for rehabilitation: Is it speech, swallowing or both?”

Then Barbon will do exercises with the patient to address each. These may include:

• Lingual range of motion and lingual control
• Bolus manipulation strategies, which involve using the tongue to move food around more efficiently
• Swallowing saliva and other muscle-strengthening exercises
• Tongue strengthening and endurance

Each patient is unique, so your care team will tailor rehabilitation to fit your needs.

What’s life like after a glossectomy?

Rehabilitation after a glossectomy is very important because it helps guide your recovery.

Your care team will also talk to you about oral hygiene and pain management, so that you can heal properly.   

Side effects that don’t get talked about as much include intimacy and changes to your appearance.

“Everyone wants to be able to enjoy a meal in public, speak in large group settings or even intimately kiss their partner,” says Barbon. “Sometimes, treatment can affect the nerves in your face and neck, giving you a crooked smile or a smile that looks different than what you’re used to.”

If you are struggling with lingering side effects after a glossectomy, Barbon recommends speaking to a social work counselor to help you work through feelings about body image and appearance. Every UT MD Anderson patient has access to a social work counselor. You can call Social Work at 713-792-6195.

Collaborative approach to improve patient outcomes

At UT MD Anderson, you’ll have a team of specialists to help you before, during and after your glossectomy.

“The head and neck surgeons will often send glossectomy patients for a consult with speech pathologists,” says Barbon. “We talk to patients about how their speech and swallowing may change, how long they can expect to stay at the hospital, if they’ll need a feeding tube and foods we recommend during recovery.”

Barbon, Choi and plastic surgeons have been pushing to start oral rehabilitation sooner for UT MD Anderson patients.

They believe that the earlier patients can safely begin rehabilitation, the better their swallowing and speech will be after surgery. This is something Barbon has been actively researching.

“Speech pathologists are a big part of the multidisciplinary team when it comes to rehabilitation, even with partial glossectomies,” says Barbon. “This research is really important to help ensure patients continue to have a good quality of life after treatment.”       

Request an appointment at UT MD Anderson online or call 1-877-632-6789.