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Reconstruction after total or subtotal glossectomy.

Y P Krespi, G A Sisson

    American Journal of Surgery
    |October 1, 1983
    PubMed
    Summary
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    This study explored preserving voice after extensive tongue cancer surgery. Epiglottopexy successfully prevented aspiration in patients undergoing glossectomy without laryngectomy, enabling safe swallowing.

    Area of Science:

    • Oncology
    • Surgical Reconstruction
    • Otolaryngology

    Background:

    • Malignant tongue lesions often necessitate total or subtotal glossectomy, posing significant reconstructive challenges.
    • While myocutaneous flaps have improved oral cavity reconstruction, persistent aspiration frequently requires laryngectomy after extensive glossectomy.
    • Preserving voice and swallowing function after glossectomy remains a critical clinical concern.

    Purpose of the Study:

    • To evaluate a surgical technique (epiglottopexy) aimed at preserving voice and preventing aspiration in patients undergoing glossectomy without laryngectomy.
    • To compare outcomes between patients undergoing glossectomy with epiglottopexy and those requiring laryngectomy and reconstruction.

    Main Methods:

    • Group I: 10 patients (4 total, 6 subtotal glossectomy) underwent epiglottopexy to secure the epiglottis to the posterior pharyngeal wall, aiming to preserve voice.

    Related Experiment Videos

  • Group II: 6 patients underwent total glossectomy and laryngectomy, with single-stage reconstruction using a pectoralis myocutaneous flap.
  • Outcomes assessed included voice preservation, aspiration prevention, swallowing function, and overall morbidity.

    • Main Results:

    • Epiglottopexy effectively blocked the glottic entrance, allowing swallowing without aspiration in Group I patients.
    • Patients in both groups were rehabilitated with acceptable morbidity, resuming oral diets within 3 weeks.
    • Successful reconstruction in Group I was attributed to the flap's muscle bulk and the airway protection provided by epiglottopexy.

    Conclusions:

    • Epiglottopexy is a viable surgical adjunct to glossectomy for preventing aspiration and potentially preserving voice.
    • This technique offers an alternative to laryngectomy in select patients with extensive tongue resections.
    • Further research should explore long-term functional outcomes and patient-reported quality of life.