By dentist Dr. Richard Mitchell
A glossectomy is the medical term for the surgical removal of part of the tongue. This is sometimes done to reduce the size of the tongue for someone who suffers from breathing problems while sleeping, such as snoring or obstructive sleep apnea. More commonly, though, tongue surgery is the treatment for a cancer of the tongue. It's done under a full general anesthetic.
BUT the medical terms can be misleading!
A PARTIAL glossectomy is any tongue surgery that removes less than half of the tongue.
A TOTAL glossectomy is the medical term for tongue surgery that removes more than HALF the tongue, say 55% or 60%. It does NOT necessarily mean complete removal of ALL of the tongue.
LET ME SAY THAT AGAIN;
A TOTAL glossectomy DOES NOT NECESSARILY MEAN COMPLETE REMOVAL of the tongue - it means MORE THAN HALF.
Why would tongue surgery be used? Why not treat it with chemotherapy or radiotherapy?
There are several ways to treat cancer, and it's important to understand that there is no ONE way that is best for every person, for all cancers. That's a cookie-cutter approach that treats everyone the same and gets poor results for most.
So when is tongue surgery best?
Surgery is almost always suggested because it is quick and may remove the tumor completely in one go. If there is any evidence of any spread to the lymph nodes or other surrounding tissues, then you may need further surgery to the lymph nodes in your neck to remove the cancer cells there.
This additional surgery may also be suggested if your main tumor is bigger than 4mm across, even though there is no evidence of spread.
It is sometimes possible to treat an early cancer with radiotherapy alone, but this takes much longer than a surgical procedure. Most commonly, radiotherapy is used after surgery to kill any remaining cancer cells.
But let's back-track a bit.
First, it has to be confirmed that you DO have a cancer of the tongue.The only way to be absolutely sure about this is to remove a little bit of the affected tissue, and look at it under a microscope. This is called a biopsy. If the tumor is really small, the entire tumor can be removed in one go at the biopsy stage. This leaves a relatively small wound which can heal up quickly. Tongue movement is usually not affected.
If the biopsy is positive, the next important thing is to "stage the cancer". This means that the medical specialists have to work out what stage the tumor is at.
How big is it? How deep is it? Have any cancer cells spread to the lymph nodes or other tissues? Only once they know this, can they start to plan any treatment.
And that is a very important point to remember.
The experts have to explain everything to you and do their best to make sure you understand the situation. They will recommend certain treatments, but it is up to you to decide what you agree to. Not explaining your treatment options to you could amount to Dental malpractice.
But first, you'll need some more tests to find out the exact extent of the tumor, and if it has spread anywhere. This helps your doctor to decide on the treatment you need. The most common place for mouth cancer to spread is to the lymph nodes in the neck. If any cancer cells have broken away from the main tumor, they can be carried in tissue fluid to these lymph nodes. You can read more about staging a cancer at my page about Stage 3 cancer.
While you are waiting for results, you may be worried or concerned. It may help to talk to a close friend or relative about how you feel. You might want to contact a cancer support group to talk to someone who has been through a similar experience.
As we said at the top of the page, partial tongue surgery involves taking away less than 50% of your tongue. Total tongue surgery does NOT mean complete removal of your tongue - it simply means taking more than 50%. For example, it could be 55%.
If you are told that you need to have a glossectomy due to a tumor, it's perfectly normal to be shocked and frightened at first. But remember that this type of tongue surgery is only recommended if it is absolutely necessary to remove your cancer. It might be possible to use radiotherapy or chemotherapy, or a combination, but these are nowhere near as reliable as surgery to cure the cancer.
You should talk with your doctor before having any surgery, and ask about the side effects of the type of glossectomy you have been recommended. It is likely that there will be some changes to how you talk, and of course drinking and eating will be affected in some ways too.
If you need a total glossectomy, (more than 50% of your tongue) your surgeon will surgically reconstruct your tongue. Speech and swallowing will be more difficult after the operation. However, with time, it is possible to adapt to the new situation.
Remember, the success rate of glossectomy in curing tongue cancer is very high.