The Impact of Advanced Age on Functional Recovery Following Glossectomy

Glossectomy for oral cancer can lead to significant concerns regarding speech and swallowing function. This study aims to assess the impact of age on post-glossectomy functional recovery and quality of life.

We conducted a retrospective analysis of patients who underwent glossectomy for primary oral cavity cancer involving the oral tongue from 2016 to 2024. Patients were stratified into three cohorts: < 60, 60-70, and > 70 years. Functional outcomes were assessed using speech-language pathology evaluations at 1 month, 6 months, 1 year, and 2 years postoperatively. Patient-reported quality of life was assessed using FACE-Q scores.

206 patients were included, with 92 patients under 60, 61 patients aged 60-70, and 53 patients over 70. Primary closure was performed in 80 patients (39%), and free flap reconstruction in 109 (53%). One month postoperatively, patients over 70 demonstrated significantly higher rates of moderate to severe reductions in labial ROM and strength (p < 0.05). At 1 and 2 years, most functional differences had resolved, but deficits in labial ROM and strength persisted at 2 years (p = 0.048). FACE-Q scores, gastrostomy tube and tracheostomy dependence, length of stay, readmission, reoperation, and revision rates did not differ across cohorts. When adjusting for comorbidities, glossectomy type and age were significant predictors of long-term functional outcomes.

Older patients undergoing glossectomy may experience initial delays in functional recovery, but long-term clinically meaningful functional outcomes are comparable across age groups. However, older patients may experience decreased patient-reported satisfaction in key domains, emphasizing the need for careful patient selection and shared decision-making when considering glossectomy in older adults.