Sample records for glossectomy

  1. Rehabilitation of swallowing and communication following glossectomy.

    LaBlance, G R; Kraus, K; Steckol, K F


    Patients who have had surgical removal of part or all of the tongue are left with varying degrees of swallowing and speech deficiencies. The extent of resection, mobility of the residual tongue segment, and adequacy of the remaining structures determine the amount and type of deficiency. While communicative impairment and dysphagia commonly are seen in a rehabilitation setting, the problems of the glossectomy patient often are unique. This article reviews the anatomy and physiology of the oral and pharyngeal musculature, discusses the speech and swallowing of the glossectomy patient, and presents nursing considerations for successful rehabilitation.

  2. Technical Considerations in Rehabilitation of an Edentulous Total Glossectomy Patient

    Pravin Bhirangi


    Full Text Available The technician by virtue of his profession plays an important role in fabricating silicone tongue prosthesis for a total glossectomy patient. The technician, with his skills and specialized knowledge in handling material, plays a valuable role as a member of the oncology team. A patient with total glossectomy can be rehabilitated by silicone tongue prosthesis as an aid to improve his speech and swallowing. This paper describes the technical steps involved in fabricating a silicone tongue prosthesis for an edentulous total glossectomy patient.

  3. Harmonic scalpel for a bloodless partial glossectomy: a case report.

    Irfan, M; Aliyu, Y A; Baharudin, A; Shahid, H


    Tongue surgery is almost always complicated by intraoperative bleeding. Its rich blood supply especially from the lingual vessels makes the operative field bloody. Electrocautery has been widely used to replace cold scissors in order to achieve better hemostasis. The use of ultrasonic harmonic scalpel for glossectomy is still new in this country. We report a case of partial glossectomy using the harmonic scalpel in a patient who had a squamous cell carcinoma of the lateral border of the tongue.

  4. Simultaneous Glossectomy with Orthognathic Surgery for Mandibular Prognathism.

    Jung, Young-Wook; On, Sung-Woon; Chung, Kyu-Rhim; Song, Seung-Il


    Macroglossia can create dental and skeletal instability after orthodontic treatment or orthognathic surgery for mandibular prognathism. In relevant literature, partial glossectomy is suggested for a good post-treatment prognosis. Most of the published partial glossectomy cases are two-staged surgery, because of concern about postoperative airway obstruction. As orthognathic surgical techniques and fixation method develop, however, concerns about postoperative airway obstruction have lessened. In this case, mandibular setback surgery and partial glossectomy were performed simultaneously, leading to stable recovery without any postoperative respiratory problems. After surgical technique to preserve the tongue tip, we achieved good outcomes without postoperative side effects of lingual hypoesthesia, pronunciation disorder and dyskinesia. We report this case with a literature review.

  5. Function of the sensate free forearm flap after partial glossectomy.

    Biglioli, Federico; Liviero, Fabio; Frigerio, Alice; Rezzonico, Angela; Brusati, Roberto


    To compare functional recovery of sensitive free forearm flaps with non-sensitive free forearm flaps, following reconstruction for partial glossectomy. Sixteen patients underwent partial glossectomy for oncological reasons, of whom: nine patients underwent repair with non-sensitive free forearm flaps (group A) and seven with sensitive free flaps (group B). All patients underwent the following tests: (1) tactile sensitivity evaluation, localization of stimulus, sharp/blunt definition, discrimination between two points (static and dynamic), thermal sensitivity to heat/cold; (2) speech evaluation by means of the modified Fanzago test; (3) subjective evaluation concerning the degree of satisfaction of the following functions: swallowing, feeding and talking. The sensitivity and logopaedic evaluation tests and the subjective evaluation charts highlight an overall better functional recovery of the sensitive repair than the non-sensitive ones. In patients who have undergone partial glossectomy repair with free forearm neurofasciocutaneous flaps allow good recovery of oral functions and, therefore, a good quality of life.

  6. A psychosocial perspective on the glossectomy experience.

    Pettygrove, W B


    This analysis of the glossectomy experience based on Goffman's concepts of the preservation of self and of stigma management suggests several helpful responses for speech-language pathologists and other clinicians. Attention to psychosocial dimensions of recovery. In the face of life-threatening illness and necessarily radical treatment, the patient and others may trivialize or overlook psychosocial needs. The importance of specific social behaviors--talking on a telephone or eating in a restaurant--can only be understood in terms of the patient's own self-definition. The psychological impact is more than frustration at lost or inadequate functioning. It may be profound grief, a response to threats to aspects of self-definition most valued by the patient. Help in the presentation and preservation of self. While helping to improve speech intelligibility by reinforcing different compensatory mechanisms, clinicians can assist with other compensations in social performance. More attention to nonverbal cues, including dress and physical appearance, may be helpful. Increased use of written communication can facilitate social interactions and reinforce the sense of linguistic competence until intelligibility and fluency are regained. From the perspective of Goffman's analyses, the individual who selectively manipulates social cues to counteract a stigma need not feel "fake." The intent of more conscious manipulations is not to invent a new self or to fool others but to preserve the integrity of the self. More information about stereotypes may help the glossectomee cope with others' inappropriate reactions and evaluate the relative importance of stigmas in different social interactions (e.g., stereotypes expressed by one's employer or family members deserve more attention than those expressed by strangers).(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Ultrasound in dysphagia rehabilitation: a novel approach following partial glossectomy.

    Blyth, Katrina M; McCabe, Patricia; Madill, Catherine; Ballard, Kirrie J


    While the presence of dysphagia following partial glossectomy has been widely reported, there is insufficient quality evidence to guide clinical decision making about the treatment of this disorder. This study investigated a novel dysphagia rehabilitation approach using ultrasound tongue imaging for patient training. Initially, a pilot study was conducted to investigate the feasibility of ultrasound visual feedback during swallow tasks. The protocol was then replicated using a single-case experimental designed study to investigate therapeutic effect. Swallow, speech, and oromotor functions were measured across multiple baselines using an A-B-A intervention study design. During intervention, both participants were able to interpret ultrasound tongue images during swallow tasks. Following intervention, positive therapeutic effect was achieved with reduced frequency of aspiration and self-initiated swallow strategies. Generalization of intervention was evidenced by reduced bolus transit duration on videofluoroscopy and improved functional oral intake scores. Speech and oromotor functions remained stable throughout the study demonstrating experimental control. This study establishes that ultrasound visual feedback is feasible in dysphagia rehabilitation following partial glossectomy. In addition, the predicted therapeutic effect specifically to swallow but not speech or oromotor functions were demonstrated. Implications for Rehabilitation Partial glossectomy results in altered tongue shape, movement, and function which negatively impact on speech and swallowing There is limited research evidence to support previously used speech pathology interventions (in particular, tongue range of movement exercises) to rehabilitate dysphagia following tongue cancer surgery The tongue, and hence oral phase of swallowing, can be viewed by placing an ultrasound probe under the chin Ultrasound scanning of the tongue is not invasive, can be repeated without dosage side effect. It's also

  8. Speech after partial glossectomy: a comparison between reconstruction and nonreconstruction patients.

    Chuanjun, Chen; Zhiyuan, Zhang; Shaopu, Gao; Xinquan, Jiang; Zhihong, Zhang


    This study was undertaken to compare the articulation intelligibility of patients after hemiglossectomy or minor glossectomy within the hemitongue with or without reconstruction. The articulation intelligibility of 19 patients who underwent hemiglossetomy or minor glossectomy within the hemitongue was investigated at least 6 months after surgery with an articulation intelligibility test with 40 sensitive Chinese sounds. Patients were divided into group 1 (those undergoing reconstructive surgery after glossectomy) and group 2 (those not undergoing reconstructive surgery after glossectomy). Defects of the tongue (in group 1) were reconstructed immediately with free radial forearm flaps or pedicled flaps after glossectomy and closed primarily without reconstruction in group 2. The articulation intelligibility scores were compared between the 2 groups. The mean articulation intelligibility score for group 1 was 77.0% (blade portion glossal sounds), 76.3% (mid portion glossal sounds), and 84.7% (rear portion glossal sounds), and those of group 2 were 94.6%, 92.1%, and 95.3%, respectively. The intelligibility of articulation of group 2 was significantly higher than that of group 1 in blade portion glossal sounds (P speech is the outcome of interest, reconstruction may be unnecessary with hemiglossectomy or other partial (minor) glossectomy within the hemitongue. Copyright 2002 American Association of Oral and Maxillofacial Surgeons

  9. A Novel Funnel-Shaped Flap for Reconstruction Surgery after Total Laryngopharyngectomy with Total Glossectomy

    Koreyuki Kurosawa, MD


    Full Text Available Summary:. Reconstruction following total laryngopharyngectomy with total glossectomy (TLPTG is challenging. To reconstruct this extended range of mucosal defect, it is necessary to overcome the remarkable discrepancy of apertures of oral and esophageal sides. We report a case of reconstruction surgery for total laryngopharyngectomy with total glossectomy with a funnel-shaped rectus abdominis musclocutaneous flap. The patient recovered without major complications and could keep a relatively good swallowing function. We believe this simple method should contribute to cases with complicated ablation.

  10. Tongue Motion Patterns in Post-Glossectomy and Typical Speakers: A Principal Components Analysis

    Stone, Maureen; Langguth, Julie M.; Woo, Jonghye; Chen, Hegang; Prince, Jerry L.


    Purpose: In this study, the authors examined changes in tongue motion caused by glossectomy surgery. A speech task that involved subtle changes in tongue-tip positioning (the motion from /i/ to /s/) was measured. The hypothesis was that patients would have limited motion on the tumor (resected) side and would compensate with greater motion on the…

  11. Laser midline glossectomy and lingual tonsillectomy as treatments for sleep apnea syndrome.

    Yonekura, Arata; Kawakatsu, Kenji; Suzuki, Kenji; Nishimura, Tadao


    Preservation treatments for sleep respiratory disorders, such as the use of a dental device and the technique of nasal continuous positive air pressure, cause discomfort to the patient and are not radical treatments. Therefore, we performed operative therapy instead. Laser midline glossectomy was performed to treat constriction at the root of the tongue in 16 patients diagnosed with sleep apnea syndrome. We also tried lingual tonsil excision using the Harmonic Scalpel in three patients with stenosis at the base of the tongue.

  12. Williams-Beuren Syndrome treated with orthognathic surgery and combined partial glossectomy: case report

    Ilaria Zollino


    Full Text Available Background: Williams syndrome, also known as Williams-Beuren syndrome (WBS, is a multi-systems, congenital and rare disorder involving the cardiovascular system, connective tissue, and the central nervous system. It is a genetic disorder caused by a hemizygous microdeletion of chromosome 7q11.23. Here we report a case of WBS treated with bimaxillary osteotomies and glossectomy. Case report: Orthognatic surgery was undertaken one year after the first diagnosis and the beginning of the orthodontic treatment. The maxilla was advanced at a Le Fort I of about 4 mm and was fixed with two angled plates, one on each side, applied laterally to the pyriform aperture. The lateral part of the maxilla was stabilized with wires. In addition, bilateral mandibular sagittal osteotomies were carried out together with a midline osteotomy. A partial glossectomy was performed. Intermaxillary adaptation was supported by applying soft elastics according to the concept of semi-rigid bone fixation. Two months post-surgery the occlusion was Angle class I with a well defined overbite and overjet. The healing was uneventful. Functional limitations or nerve disturbances did not occur. The miniplates remained in situ. In the case reported the “keyhole” partial glossectomy was performed in combination with the orthognatic surgery. No complication was recorded in the postoperative period and the patient had a successful outcome.

  13. The role of the epiglottis in the swallow process after a partial or total glossectomy due to a neoplasm.

    Halczy-Kowalik, Ludmiła; Sulikowski, Mieczysław; Wysocki, Rościsław; Posio, Violetta; Kowalczyk, Robert; Rzewuska, Anna


    Repeatable epiglottic movement patterns were recorded during a videofluoroscopic swallow evaluation of 95 patients who had undergone a total or partial glossectomy due to a neoplasm. Because no epiglottic function assessment was performed preoperatively, for the purpose of this study it was assumed that epiglottic mobility was "normal" during this time and that all abnormalities found afterward resulted from the growth of the neoplasm and the glossectomy. It was noted that in the early postoperative period, absence of epiglottic movement was accompanied by aspiration and made swallowing incompetent in a majority of cases (9 of 10). A correlation of movement between the epiglottis and the extent of oral tissue excision was found. Epiglottic mobility was evaluated as "normal" in 72% of the patients, i.e., in 67 of 91 (74%) patients after a partial or nearly total glossectomy and in 1 of 4 people who underwent a total glossectomy. In the subgroup (16%) of patients who underwent a total or nearly total glossectomy and then had videofluoroscopic examinations, 60% of the cases had normal epiglottic movements and 40% had an immobile epiglottis. Compensatory mechanisms implemented by the patients on their own initiative, such as additional swallows and prolonged apnea during deglutition, enabled them to avoid aspiration. However, upward head movement and downward chin tilting during deglutition as compensatory mechanisms used by patients with no epiglottic movement did not reduce the aspiration risk in the early postoperative period and were found to accompany incompetent swallowing attempts.

  14. Analysis of speech and tongue motion in normal and post-glossectomy speaker using cine MRI.

    Ha, Jinhee; Sung, Iel-Yong; Son, Jang-Ho; Stone, Maureen; Ord, Robert; Cho, Yeong-Cheol


    Since the tongue is the oral structure responsible for mastication, pronunciation, and swallowing functions, patients who undergo glossectomy can be affected in various aspects of these functions. The vowel /i/ uses the tongue shape, whereas /u/ uses tongue and lip shapes. The purpose of this study is to investigate the morphological changes of the tongue and the adaptation of pronunciation using cine MRI for speech of patients who undergo glossectomy. Twenty-three controls (11 males and 12 females) and 13 patients (eight males and five females) volunteered to participate in the experiment. The patients underwent glossectomy surgery for T1 or T2 lateral lingual tumors. The speech tasks "a souk" and "a geese" were spoken by all subjects providing data for the vowels /u/ and /i/. Cine MRI and speech acoustics were recorded and measured to compare the changes in the tongue with vowel acoustics after surgery. 2D measurements were made of the interlip distance, tongue-palate distance, tongue position (anterior-posterior and superior-inferior), tongue height on the left and right sides, and pharynx size. Vowel formants Fl, F2, and F3 were measured. The patients had significantly lower F2/Fl ratios (F=5.911, p=0.018), and lower F3/F1 ratios that approached significance. This was seen primarily in the /u/ data. Patients had flatter tongue shapes than controls with a greater effect seen in /u/ than /i/. The patients showed complex adaptation motion in order to preserve the acoustic integrity of the vowels, and the tongue modified cavity size relationships to maintain the value of the formant frequencies.

  15. Analysis of speech and tongue motion in normal and post-glossectomy speaker using cine MRI

    Ha, Jinhee; Sung, Iel-yong; Son, Jang-ho; Stone, Maureen; Ord, Robert; Cho, Yeong-cheol


    ABSTRACT Objective Since the tongue is the oral structure responsible for mastication, pronunciation, and swallowing functions, patients who undergo glossectomy can be affected in various aspects of these functions. The vowel /i/ uses the tongue shape, whereas /u/ uses tongue and lip shapes. The purpose of this study is to investigate the morphological changes of the tongue and the adaptation of pronunciation using cine MRI for speech of patients who undergo glossectomy. Material and Methods Twenty-three controls (11 males and 12 females) and 13 patients (eight males and five females) volunteered to participate in the experiment. The patients underwent glossectomy surgery for T1 or T2 lateral lingual tumors. The speech tasks “a souk” and “a geese” were spoken by all subjects providing data for the vowels /u/ and /i/. Cine MRI and speech acoustics were recorded and measured to compare the changes in the tongue with vowel acoustics after surgery. 2D measurements were made of the interlip distance, tongue-palate distance, tongue position (anterior-posterior and superior-inferior), tongue height on the left and right sides, and pharynx size. Vowel formants Fl, F2, and F3 were measured. Results The patients had significantly lower F2/Fl ratios (F=5.911, p=0.018), and lower F3/F1 ratios that approached significance. This was seen primarily in the /u/ data. Patients had flatter tongue shapes than controls with a greater effect seen in /u/ than /i/. Conclusion The patients showed complex adaptation motion in order to preserve the acoustic integrity of the vowels, and the tongue modified cavity size relationships to maintain the value of the formant frequencies. PMID:27812617

  16. Rehabilitation and nutritional support for sarcopenic dysphagia and tongue atrophy after glossectomy: A case report.

    Hashida, Nao; Shamoto, Hiroshi; Maeda, Keisuke; Wakabayashi, Hidetaka; Suzuki, Motoyuki; Fujii, Takashi


    Swallowing dysfunction is related to long-term weight loss and reduced body mass index in patients with head and neck cancer. We describe a 76-y-old woman who had severe sarcopenic dysphagia and atrophy of the reconstructed tongue for 17 mo after subtotal glossectomy due to tongue cancer and lost 14 kg during that period. Upon admission, the patient received diagnoses of malnutrition in the context of social or environmental circumstances with insufficient energy intake, loss of muscle mass, localized fluid accumulation, weight loss, and sarcopenia due to reduced skeletal muscle mass (skeletal muscle index dysphagia rehabilitation to improve sarcopenia, atrophy of the reconstructed tongue, and dysphagia. After 20 mo of treatment, she was considered to be no longer malnourished (11 kg weight gain) and without sarcopenia (skeletal muscle index 4.01 cm(2)/m(2)), and the volume of the reconstructed tongue was increased. Sarcopenia and atrophy of the reconstructed tongue may cause dysphagia after glossectomy due to tongue cancer. Additionally, nutritional support and rehabilitation could improve such dysphagia. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Radiotherapy deteriorates postoperative functional outcome after partial glossectomy with free flap reconstruction.

    Shin, Yoo Seob; Koh, Yoon Woo; Kim, Se-Heon; Jeong, Jun Hui; Ahn, Sanghyeon; Hong, Hyun Jun; Choi, Eun Chang


    Most patients with tongue cancer require surgical resection of the tongue to varying degrees. As a result, quality of life, which is strongly related to speech, chewing, and swallowing, can deteriorate severely from extensive surgical treatment of tongue cancer. In addition to surgery, adjuvant therapy may affect the severity of functional impairment. Therefore, the influence of postoperative radiotherapy on functional outcome after partial glossectomy with free flap reconstruction was evaluated in patients with early oral tongue cancer. Functional outcome was measured and charts of 31 patients with oral tongue cancer who were surgically treated at Yonsei Head and Neck Cancer Clinic from 2003 through 2008 were reviewed. Only patients who underwent partial glossectomy and reconstruction with radial forearm free flap and did not develop recurrence were included. Speech integrity was evaluated with diadochokinetic testing by a professional speech therapist. Tongue mobility was checked by measurements of upward distance, protrusion distance, and lateral deviation distance. Swallowing capacity was evaluated with the M.D. Anderson Dysphagia Inventory. Diadochokinetic rates of the surgery-only and postoperative radiotherapy groups were 27.8 and 23.9, respectively, which was statistically different. Swallowing capacity was significantly superior in the surgery-only group. Tongue mobility was not statistically different between the 2 groups. Functional outcome of speech and swallowing is negatively influenced by postoperative radiotherapy. Copyright © 2012. Published by Elsevier Inc.

  18. Speech and Swallowing Data in Individual Patients Who Underwent Glossectomy after Prosthetic Rehabilitation

    Viviane de Carvalho


    Full Text Available Maintaining oral function in patients undergoing glossectomy boosts interventions such as prosthetic rehabilitation. However, current literature still fails in the presentation of results of prosthetic rehabilitation in relation to speech or swallowing. The objective of this research is to evaluate the effectiveness of prosthetic rehabilitation on voice, speech, and swallowing in patients undergoing glossectomy by performing a systematic literature review and meta-analysis of individual cases. Studies were identified by relevant electronic database and included all dates available. The criteria used were sample with any n; resection due to malignant tumors, restricted to tongue and/or floor of mouth; type of prosthetic rehabilitation; and description of the oral functions outcomes with prosthesis. For the meta-analysis of individual data, associations between the variables of interest and the type of prosthesis were evaluated. Thirty-three of 471 articles met the selection criteria. Results on speech and/or voice and swallowing were reported in 27 and 28 articles, respectively. There were improvement of speech intelligibility and swallowing in 96 patients and in 73 patients, respectively, with prosthesis. Based on the available evidences, this article showed that prosthetic rehabilitation was able to improve oral functions and can be a strategy used with surgical reconstruction in selected cases.

  19. Functional MRI of tongue motor tasks in patients with tongue cancer: observations before and after partial glossectomy

    Haupage, Samantha; Branski, Ryan C.; Kraus, Dennis [Memorial Sloan-Kettering Cancer Center, Head and Neck Surgery, New York, NY (United States); Peck, Kyung K. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Memorial Sloan-Kettering Cancer Center, Medical Physics, New York, NY (United States); Memorial Sloan-Kettering Cancer Center, Department of Medical Physics and Radiology, New York, NY (United States); Hsu, Meier [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Holodny, Andrei [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States)


    The current study seeks to provide preliminary data regarding this central, adaptive response during tongue motor tasks utilizing functional magnetic resonance imaging (fMRI) before and after glossectomy. Six patients, with confirmed histological diagnoses of oral tongue cancer, underwent fMRI before and 6 months after partial glossectomy. These data were compared to nine healthy controls. All subjects performed three tongue motor tasks during fMRI: tongue tapping (TT), dry swallow (Dry), and wet swallow (Wet). Following surgery, increased activation was subjectively observed in the superior parietal lobule, supplementary motor area, and anterior cingulate. Region of interest (ROI) analysis of the precentral gyrus confirmed increased cortical activity following surgery. In addition, comparisons between pre-surgical scans and controls suggested the dry swallow task was sensitive to elicit tongue-related activation in the precentral gyrus (p {<=} 0.05). The adaptive changes in the cortex following partial glossectomy reflect recruitment of the parietal, frontal, and cingulate cortex during tongue motor tasks. In addition, post-operative activation patterns more closely approximated control levels than the pre-operative scans. Furthermore, the dry swallow task appears most specific to elicit tongue-related cortical activity. (orig.)

  20. Functional outcome after partial glossectomy with reconstruction using radial forearm free flap.

    Joo, Young-Hoon; Hwang, Se-Hwan; Park, Jun-Ook; Cho, Kwang-Jae; Kim, Min-Sik


    The purpose of this study was to investigate the relationship between the radial forearm free flap (RFFF) volume changes and speech and swallowing outcomes. The study included 18 subjects with squamous cell carcinoma of the oral tongue. Average percentage changes in flap volume between 3 and 12 months was 19.2%. Postoperative free flap volume changes were significantly and negatively correlated with the word and sentence intelligibility (Y=-0.338X+43.641, r(2)=0.383, p=0.006 and Y=-0.246X+34.322, r(2)=0.321, p=0.014, respectively). A significant positive correlation was also found between word and sentence intelligibility and floor of mouth resected, postoperative irradiation. Postoperative flap volume changes between 3 and 12 months were correlated with reduced posterior bolus movement by tongue (p=0.002), reduced tongue base to posterior pharyngeal wall contact (p=0.002), reduced laryngeal elevation (p=0.005), increased aspiration (p=0.005), delayed oral (p=0.010) and pharyngeal transit time (p=0.011). Floor of mouth resected, tongue base resected, and postoperative irradiation also influenced the swallowing outcomes. This study shows that postoperative flap volume changes are significantly related to speech and swallowing outcomes in patients undergoing partial glossectomy reconstructed with RFFF. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Coronal View Ultrasound Imaging of Movement in Different Segments of the Tongue during Paced Recital: Findings from Four Normal Speakers and a Speaker with Partial Glossectomy

    Bressmann, Tim; Flowers, Heather; Wong, Willy; Irish, Jonathan C.


    The goal of this study was to quantitatively describe aspects of coronal tongue movement in different anatomical regions of the tongue. Four normal speakers and a speaker with partial glossectomy read four repetitions of a metronome-paced poem. Their tongue movement was recorded in four coronal planes using two-dimensional B-mode ultrasound…

  2. [Articulatory function in patients receiving glossectomy followed by reconstruction with a recto-abdominal myocutaneous free flap].

    Ikema, Y; Tsukuda, M; Mochimatsu, I; Kawai, S; Enomoto, H; Zhou, L X; Yoshida, T; Hirose, H


    Postoperative articulatory functions of patients with tongue cancer have been improved by reconstructive surgery with a radial forearm or recto-abdominal myocutaneous free flap. We examined the postoperative articulatory functions of 10 patients who received reconstruction with a recto-abdominal myocutaneous free flap after glossectomy. The functions were investigated by standardized tests, i. e. a quentionnaires, the 100 Japanese monosyllable speech intelligibility test and a single-word intelligibility test. A confusion matrix was obtained from the results of the monosyllable test. On the basis of resection sites, the present cases were divided into two types: an anterior type and a lateral type. The results are summarized as follows. There was no significant difference in the results of the quentionnareis between the two types. The mean score of the 100 Japanese monosyllable speech intelligibility test in cases of the anterior type was 48% and in those of the lateral type it was 62%. The mean score of the single-word intellibibility test in cases of the anterior type was 75% and in those of the lateral type it was 83%. In cases of the anterior type, dental and alveolar sounds were often confused with fricatives, whereas in the lateral type, velars sounds were often confused with affricates or flaps. These results suggest that our classification based on resection site was useful for investigating postoperative articulatory functions after partial glossectomy.

  3. Fonoterapia em glossectomia total: estudo de caso Speech therapy in total glossectomy: case study

    Camila Alves Vieira


    Full Text Available A cirurgia curativa do câncer de língua ocasiona sequelas que prejudicam o bom funcionamento das funções estomatognáticas. O objetivo do trabalho é descrever, por meio de estudo de caso, os achados da avaliação e a evolução da reabilitação fonoaudiológica das funções de deglutição e fala de um indivíduo de 58 anos, gênero masculino, submetido à glossectomia total em junho de 2009. Após a avaliação diagnosticou-se disfagia orofaríngea mecânica severa e alteração na articulação da fala. Na reabilitação fonoaudiológica foram utilizadas, como formas de atuação, as terapias direta e indireta. Na terapia indireta trabalhou-se controle motor oral, sensibilidade, mobilidade, motricidade, tônus e postura das estruturas adjacentes da língua resseccionada. Na terapia direta empregou-se a manobra de postura de cabeça para trás para auxiliar na ejeção de alimentos para a faringe. O paciente passou a alimentar-se exclusivamente por via oral, com a restrição de sólidos, após dez meses em tratamento. No que se refere à fala, foram utilizados exercícios de sobrearticulação, velocidade e ritmo para melhorar a sua inteligibilidade. Dessa forma, considerou-se os resultados da intervenção fonoaudiológica positivos e o paciente recebeu alta após um ano em tratamento. Conclui-se que as ressecções de língua apresentam sequelas significativas nas funções de deglutição e fala, assim sendo, é imprescindível a atuação fonoaudiológica para modificar e adaptar essas funções, além de proporcionar melhor qualidade de vida ao paciente.Curative surgery for tongue cancer results in sequelae that harm the good functioning of the stomatognathic system. The aim of the present study is to describe a case study, reporting the evaluation and evolution findings of the speech-language pathology rehabilitation of the swallowing and speech functions of a 58-year-old man submitted to total glossectomy in June 2009. After

  4. Glosectomía parcial en la trisomía 21: incidencia de las infecciones bucales y respiratorias, preoperatorias y posoperatorias Partial glossectomy in trisomy 21: incidence of oral and respiratory infections before and after surgery

    Zoila López Díaz


    Full Text Available Se estudió, durante un período de 10 años, la incidencia de infecciones bucales y respiratorias en 20 niños afectos de trisomía 21 o síndrome de Down, antes y después del tratamiento quirúrgico de la macroglosia característica de este síndrome. Todos los pacientes fueron valorados y tratados en los servicios de estomatología, pediatría, otorrinolaringología y alergia, antes de practicarles la glosectomía parcial, la cual se realizó con igual técnica quirúrgica y por la misma cirujana. Al comparar la incidencia de infecciones bucales y respiratorias, antes y después de la operación, se apreció una disminución significativa de éstas. Se demostró el valor del tratamiento quirúrgico de la macroglosia (glosectomía parcial en la mejora de la calidad de vida del niño trisómico.The incidence of oral and respiratory infections in children with trisomy 21 or Down syndrome, before and after surgical treatment of the characteristic macroglossia of this syndrome, was studied for 10 years. All the patients were assessed and treated by Dentistry, Pediatrics, Otorrhinolaryngology and Allergy services before they underwent partial glossectomy, which was performed by the same surgeon using the same surgical technique. When comparing oral and respiratory incidence before and after surgery, the reduction of both problems was significant. This paper proved the value of surgical treatment of macroglossia (partial glossectomy to improve the quality of life of trisomic children.

  5. Identificação das mudanças na mastigação e deglutição de indivíduos submetidos à glossectoma parcial Identification of chewing and swallowing changes in individuals submitted to partial glossectomy

    Laura Cristina Sales de Oliveira


    protocol demonstrated significant presence of oral stasis after swallowing, and compensatory head movements for swallowing solids. CONCLUSION: The patients submitted to partial glossectomy presented significant alterations in chewing and swallowing as a result from surgical cancer treatment.

  6. Spinal epidural abscess following glossectomy and neck dissection: A case report

    Esther Cheng; Eric Thorpe; Richard Borrowdale


    Introduction: Spinal epidural abscess is an uncommon but potentially life threatening entity that rarely occurs after otolaryngology procedures. Presentation of case: We report a case of a diabetic patient who presented with a lumbar spinal epidural abscess eight days after head and neck oncologic surgery. Magnetic resonance imaging revealed an L4 spinal epidural abscess. Cultures from the spinal epidural abscess, blood, urine, and the previous neck incision grew Klebsiella pneumoniae. The...

  7. Ablation of advanced tongue cancer and mobile tongue reconstruction by using a sensitive anterolateral thigh and vastus lateralis muscle free flap

    Tuhar; Zamfirescu, D; Gheorghiță, C; Slăvescu, D; Frunză, A; Lascăr, I


    .... The anterior lateral thigh flap sensitive myocutaneous (ALTF) with vastus lateralis muscle was used to reconstruct the oral defect in a patient undergoing total glossectomy with laryngeal preservation for T4 tongue cancer...

  8. Ablation of advanced tongue or base of tongue cancer and reconstruction with free flap: functional outcomes.

    Chien, C Y; Su, C Y; Hwang, C F; Chuang, H C; Jeng, S F; Chen, Y C


    To evaluate the functional outcomes of patients who underwent total or nearly total glossectomy for advanced tongue or base of tongue cancer. We used the radial forearm free flap (RFFF), anterior lateral thigh flap (ALTF) or fibular osteocutaneous flap (FOCF) to reconstruct the oral defect after radical resection in 39 patients undergoing total or nearly total glossectomy with laryngeal preservation. Good functional outcomes, measured by independent feeding, speech and swallowing were achieved in 35, 36 and 35 patients, respectively. The cumulative 4-year survival rates were 63.8% for tongue cancer and 42.9% for base of tongue cancer. Reconstruction with free flaps is a feasible method to restore the functional outcomes in speech and deglutition among patients who undergo total or nearly total glossectomy with laryngeal preservation.

  9. Long-term impact of tongue reduction on speech intelligibility, articulation and oromyofunctional behaviour in a child with Beckwith-Wiedemann syndrome.

    Van Lierde, K M; Mortier, G; Huysman, E; Vermeersch, H


    The purpose of the present case study was to determine the long-term impact of partial glossectomy (using the keyhole technique) on overall speech intelligibility and articulation in a Dutch-speaking child with Beckwith-Wiedemann syndrome (BWS). Furthermore the present study is meant as a contribution to the further delineation of the phonation, resonance, articulation and language characteristics and oral behaviour in a child with BWS. Detailed information on the speech and language characteristics of children with BWS may lead to better guidance of pediatric management programs. The child's speech was assessed 9 years after partial glossectomy with regard to ENT characteristics, overall intelligibility (perceptual consensus evaluation), articulation (phonetic and phonological errors), voice (videostroboscopy, vocal quality), resonance (perceptual, nasometric assessment), language (expressive and receptive) and oral behaviour. A class III malocclusion, an anterior open bite, diastema, overangulation of lower incisors and an enlarged but normal symmetric shaped tongue were present. The overall speech intelligibility improved from severely impaired (presurgical) to slightly impaired (5 months post-glossectomy) to normal (9 years postoperative). Comparative phonetic inventory showed a remarkable improvement of articulation. Nine years post-glossectomy three types of distortions seemed to predominate: a rhotacism and sigmatism and the substitution of the alveolar /z/. Oral behaviour, vocal characteristics and resonance were normal, but problems with expressive syntactic abilities were present. The long-term impact of partial glossectomy, using the keyhole technique (preserving the vascularity and the nervous input of the remaining intrinsic tongue muscles), on speech intelligibility, articulation, and oral behaviour in this Dutch-speaking child with congenital macroglossia can be regarded as successful. It is not clear how these expressive syntactical problems

  10. [A Case of Advanced Esophageal Cancer and Tongue Cancer Treated with Induction DCF Chemotherapy Followed by Radical Surgery].

    Tanaka, Motomu; Koyanagi, Kazuo; Sugiura, Hitoshi; Kakefuda, Toshihiro


    A man in his 60s was admitted for the treatment of advanced cervical esophageal cancer with metastasis to the lymph nodes and advanced tongue cancer with metastasis to the lymph nodes. Esophageal cancer was suspected to have invaded the trachea. The tongue cancer was located on the left side and had invaded beyond the median line of the tongue. Both cancers were pathologically diagnosed as squamous cell carcinomas. Therefore, it was determined that pharyngo-laryngo- esophagectomy and total glossectomy were required prior to the treatment. However, after 2 courses of docetaxel/cisplatin/ 5-FU combined induction chemotherapy, both cancers remarkably decreased; consequently, an esophagectomy to preserve laryngeal function and partial glossectomy could be performed simultaneously. The patient is well without recurrence 1 year post-surgery.

  11. Stimulating effect of tongue on craniofacial growth.

    Schumacher, G H; Becker, R; Hübner, A; Pommerenke, F


    The influence of the tongue on craniofacial growth was studied in 96 Mini-Lewe miniature pigs. The animals were partially glossectomized at different ages and slaughtered at various intervals after operation. The skulls were macerated for biometric analysis. Mandibular growth was significantly reduced lengthwise in animals glossectomized at age 12 weeks. The role played by the tongue in orofacial growth was also indicated by the reduced width of the lower jaw. In pigs partially glossectomized at age 12 weeks, lateral growth of the entire lower jaw was reduced after eight weeks. In animals glossectomized at age six weeks, lateral growth of the lower jaw was reduced in the region of the 1st deciduous molars and the canines after glossectomy. Partial glossectomy had no significant effects on vertical growth of the lower jaw, growth of the upper jaw or overall skull growth. Shortening of the tongue in miniature pigs six weeks old resulted in no measurable jaw changes 23 weeks after surgery.

  12. Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

    Dae-Sung Lee; Sun-Il Jung; Deok-Woo Kim; Eun-Sang Dhong


    We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topi...

  13. [Free radial forearm flap and myocutaneous flaps in oncological reconstructive surgery of the oral cavity, Comparison of functional results].

    Pompei, S; Caravelli, G; Vigili, M G; Ducci, M; Marzetti, F


    In modern multi-disciplinary cancer treatment, rehabilitation and functional results represent utmost intent in reconstructive surgery of the oral cavity. Even in cases where the stage of disease is advanced) and the perspective of survival is limited, it is possible to achieve an acceptable quality of life. The authors report, in this study, the morpho-functional results and the morbidity observed in glossectomies in which the reconstruction was performed using three different methods. In a total of 264 reconstructive flaps of the head and neck regions, the authors considered three groups of 15 patients that had had reconstruction after the demolitive procedure. Respectively these groups were divided by the followed methods: free forearm flap, pectoralis major myocutaneous flap and nasolabial flap. The morbidity showed an extremely low rate of flap loss in all the groups, but "minor" complications, such as fistulas and leakages, were significantly more frequent in the myocutaneous flaps group. Functional evaluation for speech and deglutition showed good results in most patients. Extremely severe postoperative conditions as a permanent NG tube or incomprehensible speech had been observed in less than 15% of the cases. Particularly, the pectoralis major flap, showed its best functional performances in the total or subtotal glossectomies with a sacrifice of the muscles of the oral floor. The free forearm flap is reliable and safe with its low thickness and pliability, especially for partial glossectomies. The nasolabial flap was confirmed to be the first reconstructive choice for selected limited resections of the tongue and of the antero-lateral floor. With this experience it is possible, even in more complex free flaps, to reduce the time consumption and the complication rate. Free flaps do not substitute routinely myocutaneous and conventional flaps, but they represent the "ideal" reconstructive alternatives for specific and selected indications.

  14. A systematic review on the sensory reinnervation of free flaps for tongue reconstruction: Does improved sensibility imply functional benefits?

    Baas, Martijn; Duraku, Liron S; Corten, Eveline M L; Mureau, Marc A M


    Tongue reconstruction after (hemi)glossectomy including sensory recovery is challenging. Although sensory recovery could improve functional outcome, no consensus on the need for reinnervation of the neo-tongue exists. Therefore, a systematic review was performed to determine if sensory reinnervation of free flaps in tongue reconstruction is better than no sensory reinnervation. The secondary study aim was to assess the effect of sensory reinnervation on overall functional outcome, such as speech and deglutition. Seven databases (Embase, Medline, Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar) were searched. Studies that reported the effect of sensory reinnervation on overall functional outcome were identified. Fourteen articles were included in the systematic review, concerning a total of 271 tongue reconstructions. Free flaps that were used were the radial forearm (RF) flap (n = 137), the anterolateral thigh (ALT) flap (n = 65), the rectus abdominis (RA) flap (n = 20), and the tensor fascia latae (TFL) flap (n = 5). Seven out of seven articles directly comparing sensory reinnervation with no sensory reinnervation revealed superior sensibility in the reinnervated group. Moreover, the innervated RF and ALT flaps showed superior recovery of sensibility compared to other flaps used for the reconstruction of hemiglossectomy as well as total glossectomy defects. There are indications that sensory reinnervation may have a beneficial effect on overall tongue function. Age, smoking, and sex did not affect sensory recovery. Four out of five articles showed that postoperative radiotherapy does not have a long-term adverse effect on sensory recovery. Sensory reinnervation of free flaps in the reconstruction of (hemi)glossectomy defects improves sensory recovery; however, evidence for beneficial effects on function is poor. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights

  15. Peroneal Flap for Tongue Reconstruction.

    Lin, Ying-Sheng; Liu, Wen-Chung; Lin, Yaoh-Shiang; Chen, Lee-Wei; Yang, Kuo-Chung


    Background For large tongue defects, reconstructive surgeons have devised a variety of feasible options, such as radial forearm free flap and anterolateral thigh (ALT) flap. In our institution, peroneal flap has been the workhorse flap for the soft tissue defect in head and neck reconstruction. We present our experience using peroneal flap in tongue reconstruction. Patients and Methods The study included 47 patients who had undergone tongue reconstructions with peroneal flaps after tumor resection. The size and location of the defect after tumor resection determined whether the peroneal flaps could be harvested as pure septocutaneous flaps to solely reconstruct the neotongue or to carry an additional muscle bulk to fill the adjacent defect. Retrospective chart review was used to look for postoperative complications and to perform functional assessments (which were also performed through telephone inquiry). Results Of the 47 patients, 3 (6%) had flap failure and 1 (2.1%) had partial flap necrosis. The hemiglossectomy group had better results than the total glossectomy group with respect to speech and diet, but neither of these results reached statistical significance (p = 1.0 for speech and p = 0.06 for diet). The results of the subtotal glossectomy group were better than those of the total glossectomy group with respect to diet (p = 0.03). No statistically significant differences were noted among the three groups with respect to cosmetic aspect (p = 0.64). Conclusions Considering its reasonable postoperative complication rates and functional results, peroneal flap can be considered a feasible option for tongue reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  16. Complications and Risk after Mandibular Reconstruction with Fibular Free Flaps in Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study.

    Lodders, J N; Schulten, E A J M; de Visscher, J G A M; Forouzanfar, T; Karagozoglu, K H


    Background We retrospectively analyzed the incidence and types of postoperative complications after mandibular continuity reconstructions with fibular free flaps (FFF) in patients with oral squamous cell carcinoma (OSCC) and identified potential risk factors for postoperative complications. Methods Data were retrieved from the medical records in the Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands from April 1995 to September 2013, and were statistically analyzed. Results In this study, 85 patients were included in whom 86 FFFs were used for mandibular reconstruction. Thirty-seven patients (43%) developed ≥ 1 surgical complication and 9 patients (10.5%) developed ≥ 1 systemic complication. Three patients (3.5%) developed total flap failure and six patients (7.0%) developed partial flap failure. Surgical complications were correlated with tobacco use, partial glossectomy, type of mandibular defect, and anatomic staging. Systemic complications were associated with age > 60 years and Charlson comorbidity index > 2. Hospitalization > 30 days was associated with type of mandibular defect. Conclusions The use of the FFF for reconstructing mandibular continuity defects in OSCC patients may be associated with postoperative complications. Patients with coexisting medical conditions and anterior mandibular defects have an increased risk for developing complications. Patients who undergo segmental mandibular resection including a partial glossectomy could have a reduced risk for complications.

  17. Pseudoepitheliomatous hyperplasia after diode laser oral surgery. An experimental study

    Seoane, Juan; González-Mosquera, Antonio; García-Martín, José-Manuel; García-Caballero, Lucía; Varela-Centelles, Pablo


    Background To examine the process of epithelial reparation in a surgical wound caused by diode laser. Material and Methods An experimental study with 27 Sprage-Dawley rats was undertaken. The animals were randomly allocated to two experimental groups, whose individuals underwent glossectomy by means of a diode laser at different wattages, and a control group treated using a number 15 scalpel blade. The animals were slaughtered at the 2nd, 7th, and 14th day after glossectomy. The specimens were independently studied by two pathologists (blinded for the specimens’ group). Results At the 7th day, re-epithelisation was slightly faster for the control group (conventional scalpel) (p=0.011). At the 14th day, complete re-epithelization was observed for all groups. The experimental groups displayed a pseudoepitheliomatous hyperplasia. Conclusions It is concluded that, considering the limitations of this kind of experimental studies, early re-epithelisation occurs slightly faster when a conventional scalpel is used for incision, although re-epithelisation is completed in two weeks no matter the instrument used. In addition, pseudoepitheliomatous hyperplasia is a potential event after oral mucosa surgery with diode laser. Knowledge about this phenomenon (not previously described) may prevent diagnostic mistakes and inadequate treatment approaches, particularly when dealing with potentially malignant oral lesions. Key words:Diode laser, animal model, oral biopsy, oral cancer, oral precancer, pseudoepitheliomatous hyperplasia. PMID:26116841

  18. Er,CR:YSGG lasers induce fewer dysplastic-like epithelial artefacts than CO2 lasers: an in vivo experimental study on oral mucosa.

    González-Mosquera, A; Seoane, J; García-Caballero, L; López-Jornet, P; García-Caballero, T; Varela-Centelles, P


    Our aim was to assess wounds made by lasers (CO(2) and Er,Cr:YSGG) for their epithelial architectural changes and width of damage. We allocated 60 Sprague-Dawley(®) rats into groups: glossectomy by CO(2) laser at 3 different wattages (n=10 in each); glossectomy by Er,Cr:YSGG laser at two different emissions (n=10 in each), and a control group (n=10). Histological examination assessed both prevalence and site of thermal artefacts for each group. Both lasers (CO(2) and Er,Cr:YSGG) caused the same type of cytological artefacts. The 3W Er,Cr:YSGG laser produced the fewest cytological artefacts/specimen, and was significantly different from the other experimental groups: 3W CO(2) laser (95% CI=0.8 to 1.0); the 6W CO(2) laser (95% CI=0.1 to 2.0) and the 10W CO(2) laser (95% CI=1.1 to 3.0). CO(2) lasers (3-10W) generate epithelial damage that can simulate dysplastic changes with cytological atypia that affects mainly the basal and suprabasal layers. Irradiation with Er,CR:YSGG laser (2-4W) produces significantly fewer cellular artefacts and less epithelial damage, which may be potentially useful for biopsy of oral mucosa.

  19. [Assessment of life quality of for patients after tongue reconstruction with radial forearm free flap, anterolateral thigh perforator flap or submental island flap].

    Zhao, Yang; Xiang, Jing-Zhou; Liu, Fa-Yu


    The aim of this study was to evaluate operation-related factors and quality of life (QOL) for patients after tongue reconstruction with radial forearm free flap (RFFF), anterolateral thigh perforator flap (ALT) or submental island flap (SIF). Totally 59 patients, diagnosed as tongue carcinoma, received glossectomy and simultaneous reconstruction with free flaps including RFFF, ALT or SIF in the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University from October 2004 to October 2014. All patients were followed up for 6 months and completed the University of Washington Quality of Life scale Version 4 questionnaires. The postoperative QOL was compared among the three groups. The data were analyzed using SPSS 21.0 software package. The operation duration of SIF group was significantly shorter than those of RFFF group or ALT group (Pspeech and postoperative pain among the 3 groups. In summary, there may be functional disability for patients after glossectomy and simultaneous reconstruction. The quality of life would be acceptable after tongue reconstruction with RFFF, ALT and SIF.

  20. Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

    Kwon, Soo-Ha; Tsai, Chia-Hsuan; Chang, Kai-Ping; Kao, Huang-Kai


    Introduction Oncological resection of the tongue can be reconstructed using a multitude of free flaps. The medial sural artery perforator (MSAP) flap has been well described in the literature in terms of its anatomy and harvest. However, functional outcome studies of post-reconstruction tongue defects using the MSAP flap have not been reported. This study represents the largest outcome study of patients with tongue reconstructions using MSAP flaps and a comprehensive review of its use. Materials and methods From December of 2010 to October of 2015, 579 patients with subtotal glossectomy and free flap reconstructions in Chang Gung Memorial Hospital were retrospectively reviewed. 27 patients were reconstructed with MSAP flap. The pre- and intra-operative factors, as well as flap-related factors were analyzed. Post-operative complications and functional outcomes were evaluated. Donor site assessment were also conducted. Results A 96.3% flap survival rate was found with an average total operating time of 6 hours and 18 minutes. 84.6% of patients had primary closure of the donor site with and the remaining either had skin grafts or delayed closure. Donor site closure can be achieved primarily with no functional deficit. Speech intelligibility remained for most patients. 100% of patients resumed normal oral feeding. Conclusion The MSAP flap is a small to medium sized flap most suited for subtotal glossectomy defects where optimal outcomes can be achieved in terms of speech clarity and restoration of oral intake. PMID:28182639

  1. Macroglosia asociada con deformidades dentofaciales: Alternativas terapéuticas y presentación de un caso Macroglossia associated with dentofacial deformities: Therapeutic alternatives and a case report

    José Manuel Díaz Fernández


    Full Text Available Se lleva a efecto una revisión bibliográfica de las alternativas de tratamiento en la corrección de la macroglosia asociada con deformidades dentofaciales. Se establecen las alternativas quirúrgicas ortodóncicas, así como las indicaciones y ventajas de cada variante operatoria. Se presenta un caso clínico donde ambas condiciones patológicas están presentes. Se emiten algunas consideraciones cuando se ejecuta una glosectomía de reducción en pacientes con anomalías dentofaciales.A bibliographic review of the treatment alternatives for the correction of macroglossia associated with dentofacial deformities is made. The surgical orthodontic alternatives are established, as well as the indications and advantages of every operative variant. A clinical case with both pathological conditions is reported. Some considerations are given when a reduction glossectomy is performed in patients with dentofacial abnormalities.

  2. Systemic lupus erythematosus, pregnancy and carcinoma of the tongue.

    Unsworth, Jeffrey David; Baldwin, Andrew; Byrd, Louise


    We present a case which describes a 29-year-old woman with systemic lupus erythematosus who was treated aggressively with cytotoxic immunosuppression. Five years later and approximately 12 weeks pregnant, she is confirmed as having carcinoma of the tongue. Not wishing to consider termination of her pregnancy, she underwent surgical resection, which included partial glossectomy with microvascular reconstruction. Good oral function (speech and swallowing) was restored within 2 weeks. The pregnancy proceeded relatively uneventfully to 37 weeks gestation when proteinuric hypertension necessitated induction of labour. She remains well with no evidence of recurrence. This case highlights the options available in the treatment of carcinoma of the tongue during pregnancy together with the ethical considerations required, balanced against optimising maternal outcomes.

  3. Free flap transfer reconstruction in managing tongue carcinoma during pregnancy.

    Miyazaki, Yuko; Fukuda, Kenji; Fujita, Kazutoshi; Nishimoto, Soh; Terada, Tomonori; Wada, Ryu; Sotsuka, Yohei; Kawai, Kenichiro; Kakibuchi, Masao


    Malignant oral cancers do not commonly occur in pregnant women. But when they do, the presence of a foetus and maternal physiological changes complicate and limit the treatment options. Risk benefit assessment and balancing of them are always important. A 33-year-old woman, who was 25 weeks pregnant, presented with a squamous cell carcinoma on her tongue. She was clinically staged II (T2, N0 and M0). Discussions between the patient, surgical teams and obstetricians agreed to continue her pregnancy while managing the tumour. Hemi-glossectomy and ipsilateral neck dissection was performed. Free antero-lateral thigh flap was transferred to reconstruct the tongue defect, successfully. The patient gave birth to a healthy baby afterward. She is tumour free for 6 years. Free flap reconstruction can be an option, even if the patient is pregnant.

  4. Application of lingual tonsillectomy to sleep apnea syndrome involving lingual tonsils.

    Suzuki, Kenji; Kawakatsu, Kenji; Hattori, Chikaya; Hattori, Hirokazu; Nishimura, Yoichi; Yonekura, Arata; Yagisawa, Mikio; Nishimura, Tadao


    In sleep apnea syndrome, surgical treatment is applied in obstructive-type cases and some mixed-type cases. If the obstructive part is in the root of the tongue, forward transfer of the tongue, lingual tonsillectomy and laser midline glossectomy are applied. In this study, we demonstrate the surgical technique of lingual tonsillectomy using an ultrasonic coagulating dissector (SonoSurg) with a blade tip shape developed in our department. We conclude that lingual tonsillectomy using SonoSurg, which we have frequently used, should be the first choice of treatment for snoring and sleep apnea caused by hypertrophy of the lingual tonsils from the viewpoints of effectiveness, prevention of hemorrhage, safety and handling.

  5. Defatting Vestibuloplasty for Functional and Esthetic Reconstruction of Tongue.

    Park, Si-Yeok; Kim, Min-Keun; Kim, Seong-Gon; Kwon, Kwang-Jun; Byun, Jin-Soo; Park, Chan-Jin; Park, Young-Wook


    The radial forearm free flap (RFFF) is a thin and pliable tissue with many advantages for tongue reconstruction. However, tongues reconstructed with RFFF occasionally need revision surgery because inadequate defect measurement at primary surgery can lead to bulkiness and limited movement of reconstructed tongue. In this case, the patient underwent partial glossectomy and RFFF reconstruction for treatment of tongue cancer five years prior. We could not make a lower denture for the patient, because the alveolo-lingual sulcus of tongue was almost lost. So we performed vestibuloplasty with a modified Kazanjian method on the lingual vestibule of the mandibular right posterior area, and defatting surgery to debulk the flap. After surgery, we observed that the color and texture of the revised tongue changed to become similar with adjacent tissue. The patient obtained a more functional and esthetic outcome. Accordingly, we present a case report with a review of relevant literature.

  6. Vibratory segment function after free flap reconstruction of the pharyngoesophagus.

    Haughey, B H; Fredrickson, J M; Sessions, D G; Fuller, D


    Reconstructive options following total laryngopharyngectomy include thin, pliable free tissue segments, approximating the natural thickness of the pharyngeal wall. The authors have investigated outcomes in the following clinical series, emphasizing speech and swallowing. Twelve cancer patients underwent laryngopharyngectomy with or without glossectomy. Eight jejunal, 1 radial forearm, and 3 innervated latissimus dorsi flaps were used for vibratory segment (VS) reconstruction, and all 12 patients underwent tracheoesophageal puncture (TEP). Eleven patients achieved intelligible speech, with a median intelligibility of 93%. The vibrating segments showed fluttering of the free flap tissue when studied by videopharyngography. Vocal quality was lower pitched and softer than "conventional" TEP speech. All patients achieved oral intake as their primary mode of nutrition. Free flaps are a successful option for VS reconstruction in patients undergoing laryngopharyngectomy or glossopharyngolaryngectomy, obviating the need for written or electrolarynx communication.

  7. Effects of tongue volume reduction on craniofacial growth: A longitudinal study on orofacial skeletons and dental arches.

    Liu, Zi-Jun; Shcherbatyy, Volodymyr; Gu, Gaoman; Perkins, Jonathan A


    The interaction between tongue size/volume and craniofacial skeletal growth is essential for understanding the mechanism of specific types of malocclusion and objectively measuring outcomes of various surgical and/or orthodontic treatments. Currently available information on this interaction is limited. This study was designed to examine how tongue body volume reduction affects craniofacial skeleton and dental arch formation during the rapid growth period in five 12-week-old Yucatan minipig sibling pairs. One of each pair received a standardized reduction glossectomy to reduce tongue volume by 15-17% (reduction group), and the other had the reduction glossectomy incisions without tissue removal (sham group). Before surgery, five stainless steel screws were implanted into standardized craniofacial skeletal locations. A series of cephalograms, lateral and axial, were obtained longitudinally at 1 week preoperative, and 2 and 4 weeks postoperative. These images were traced using superimposition, and linear and angular variables were measured digitally. Upon euthanasia, direct osteometric measurements were obtained from harvested skulls. Five en-bloc bone pieces were further cut for bone mineral examination by dual photon/energy X-ray absorptiometry (DEXA). The results indicate that: (1) while daily food consumption and weekly body weight were not significantly affected, tongue volume reduction showed an overall negative effect on the linear expansion of craniofacial skeletons; (2) premaxilla and mandibular symphysis lengths, and anterior dental arch width were significantly less in reduction than sham animals at 2 and/or 4 weeks after the surgery; (3) both premaxilla/maxilla and mandible bone mineral density and content were lower in reduction than sham animals, significantly lower in anterior mandible; (4) craniofacial skeletal and dental arch size were significantly smaller in reduction than sham animals, being most significant in the mandibular anterior length and

  8. Clinical evaluation of Lugol's iodine staining in the treatment of stage I-II squamous cell carcinoma of the tongue.

    Umeda, M; Shigeta, T; Takahashi, H; Minamikawa, T; Komatsubara, H; Oguni, A; Shibuya, Y; Komori, T


    Oral squamous cell carcinoma (OSCC) is often surrounded by epithelial dysplasia; leaving it unresected can result in local recurrence. Staining with Lugol's iodine solution detects epithelial dysplasia in oral mucosa, but whether it decreases local recurrence after OSCC surgery is unknown. This study investigated local recurrence rates in patients with early tongue cancer who underwent surgery using Lugol's staining. 93 patients with T1-2N0 tongue SCC underwent partial glossectomy using Lugol's staining during surgery. Resection was performed at least 5mm from the margin of the unstained area. Patients were investigated retrospectively for local recurrence status. Postoperative histology revealed negative surgical margins for SCC or epithelial dysplasia in 81 patients, close margins for SCC in 5, positive margins for mild epithelial dysplasia in 6, and a positive margin for SCC in one. Those with a positive or a close margin for SCC underwent additional resection 2-4 weeks after surgery; one was proved histologically to have residual SCC. No patients developed local recurrence, but 2 died of neck metastasis and 2 of distant metastasis. The 5-year disease specific survival rate was 93.8%. Lugol's staining during surgery can reduce local recurrence and improve survival in patients with early tongue SCC.

  9. A Rare Case of Malignant Transformation of Oral Lichen Planus of the Mandible

    Soo, Joanne; Kokosis, George; Ogilvie, Michael; “Sara” Jiang, Xiaoyin; Powers, David B.; Rocke, Daniel J.


    Summary: Oral lichen planus (OLP) is an immune-mediated mucocutaneous disease associated with an increased risk in oral squamous cell carcinoma (OSCC). Nearly all cases of malignant transformation have been reported in patients >40 years old. We report the case of a 37-year-old woman with a 5-year history of erosive OLP who presented with malignant transformation to OSCC. Delineating the margins of the disease was impossible at presentation given her OLP, and she was initially treated with concurrent chemoradiation therapy. She then developed a recurrence of the mandibular alveolar ridge. The patient was successfully treated with a composite resection including a segmental mandibulectomy, buccal mucosa resection, partial glossectomy, and ipsilateral neck dissection. This was reconstructed with a free fibula osteo-septo-cutaneous flap. Mandibular OSCC is a rare complication of OLP with few reports on effective reconstructive interventions. The case represents the youngest reported patient with mandibular OSCC arising in the context of OLP and highlights the utility of the free vascularized fibula graft in the treatment of these patients. PMID:28293492

  10. Recent advances and controversies in head and neck reconstructive surgery

    Kuriakose Moni


    Full Text Available Advances in head and neck reconstruction has made significant improvement in the quality of life and resectability of head and neck cancer. Refinements in microsurgical free tissue transfer leave made restoration of form and complex functions of head and region a reality. Standardized reconstructive algorithms for common head and neck defects have been developed with predictable results. Some of the major advances in the field include- sensate free tissue transfer, osseo integrated implant and dental rehabilitation, motorized tissue transfer and vascularized growth center transfer for pediatric mandible reconstruction. However there exist several controversies in head and neck reconstructive surgery. Some are old; resolved partially in the light of recent clinical evidences and others are new, developed as a result of newly introduced reconstructive techniques. These include, primary versus secondary reconstruction, pedicled versus free flaps, primary closure versus free tissue transfer for partial glossectomy defects, reconstruction of posterior mandible and reconstruction of orbital exenteration defects. Rapid advances in the field of tissue engineering and stem cell research is expected to make radical change in the field of reconstructive surgery. This manuscript review progress in head and neck reconstructive surgery during the last decade, current controversies and outline a road map for the future.

  11. Desmoid-type fibromatosis of the head and neck in children: a case report and review of the literature.

    Miyashita, Hidetaka; Asoda, Seiji; Soma, Tomoya; Munakata, Kanako; Yazawa, Masaki; Nakagawa, Taneaki; Kawana, Hiromasa


    Desmoid-type fibromatosis is defined as an intermediate tumor that rarely occurs in the head and neck of children. There is no doubt as to the value of complete surgical excision for desmoid-type fibromatosis. However, in pediatric patients, surgeons may often be concerned about making a wide excision because of the potential for functional morbidity. Some studies have reported a lack of correlation between margin status and recurrence. Therefore, we discussed our findings with a focus on the state of surgical margins. We report an unusual case of a 9-month-old Japanese girl who prior to presenting at our hospital underwent debulking surgery twice with chemotherapy for desmoid-type fibromatosis of the tongue at another hospital. We performed a partial glossectomy and simultaneous reconstruction with local flap and achieved microscopic complete resection. We also reviewed available literature of pediatric desmoid-type fibromatosis in the head and neck. We described successful treatment for the refractory case of pediatric desmoid-type fibromatosis. The review results showed that some microscopic incomplete resections of tumors in pediatric patients with desmoid-type fibromatosis tended to be acceptable with surgical treatment.

  12. Expression of hNav1.8 sodium channel protein in affected nerves of patients with trigeminal neuralgia

    ZHU Ling-lan; JIANG Xiao-zhong; ZHAO Yun-fu; LI Yu-li; HE Jin


    Objective: To explore the pathogenesis of trigeminal neuralgia (TN) and to provide a new target for the drug treatment of TN by studying the expression of tetrodotoxin-resistant hNavl. 8 sodium channel protein in affected nerves of patients with TN. Methods: Twelve affected inferior alveolar nerves were obtained from patients with idiopathic TN, to whom the drug therapy was not effective. As negative control, one normal inferior alveolar nerve was obtained from patients who accepted the combined radical neck dissection with glossectomy and mandibulectomy. One muscle sample was obtained as normal control. One dorsal root ganglion from rat was as positive control. These tissues and prepared hNav1.8 antibody were conducted immunohistochemistry response. Results: hNavl. 8 channel protein was expresses in all the 12 specimens of the affected nerves of patients with TN, but not in the muscle sample and the normal inferior alveolar nerve. Conclusion:The abnormal expression of hNavl. 8 channel protein in the affected nerves of patients with TN may play an impo~nt role in the pathogenesis of TN.

  13. Speech and swallowing function after reconstruction with a radial forearm free flap or a pectoralis major flap for tongue cancer.

    Su, Wan-Fu; Chen, Shyi-Gen; Sheng, Hwa


    The tongue plays a more significant role in English than in Mandarin, both in apical-palatal consonant production and tense-lax distinction. Theoretically, the same surgical intervention may produce a less significant impact on postoperative Mandarin production. The impact of tongue reconstruction on Mandarin articulation has not been reported. This study compared the tongue function outcome obtained using two methods of tongue reconstruction, radial forearm free flap transfer and pectoralis major flap transfer. Twenty-five patients with carcinoma of the tongue underwent tumor resection. The surgical defects were reconstructed using a pectoralis major flap in six patients and a radial forearm flap in 19 patients. Swallowing and speech function were evaluated 6 months to 5 years after the reconstruction. Speech intelligibility and a Mandarin articulation test were used to evaluate the articulation proficiency before and after surgery. Clinical evaluation of deglutition included a questionnaire on dietary habits and a swallowing rating of 1 to 7. Clinical evaluation showed that patients with free flap reconstruction had more intelligible speech (p = 0.014) even after total glossectomy. Assessment of data obtained by clinical questionnaire showed no significant difference between the two groups in swallowing function. Motility due to flap pliability increased speech intelligibility but had little effect on swallowing function. Our results suggest that radial forearm flap transfer is better than pectoralis major flap transfer in preserving speech function and that there is no significant difference between the two methods of reconstruction in their impact on swallowing function.

  14. Quality of life in patients after resection of pT3 lateral tongue carcinoma: Microvascular reconstruction versus primary closure.

    Canis, Martin; Weiss, Bernhard G; Ihler, Friedrich; Hummers-Pradier, Eva; Matthias, Christoph; Wolff, Hendrik A


    Controversy exists regarding the functional advantages of free flap reconstruction after partial glossectomy as compared to primary closure. Forty patients were included in this retrospective analysis after resection of pT3 lateral tongue carcinomas. Twenty patients received a free forearm flap and 20 patients had a primary closure. All patients had adjuvant chemoradiation, were free of disease at least 1 year after therapy, and completed the German versions of the European Organization for Research and Treatment of Cancer (EORTC) questionnaires Quality of Life Questionnaire-Core 30-questions (QLQ-C30) and Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (QLQ-H&N35). Mean time between surgery and quality of life (QOL) assessment was 16.2 ± 3.4 months. The average resection was 41.60% (reconstruction) of the oral tongue, and 39.1% (primary closure). After reconstruction, patients had significantly (p > .05) fewer problems with the swallowing, speech, and social eating subdomains of the EORTC QLQ-H&N35. All other items showed no significant differences. Our preliminary results suggest that free flaps might be useful when treating pT3 tongue cancer. © 2015 Wiley Periodicals, Inc.

  15. Methods and studies of tongue reconstruction

    Fahmi A. Numan; LIAO Gui-qing


    Total and even partial glossectomy could be a major event in the life of a patient. Tongue function is so complicated which makes maintaining normal functions of the tongue such as swallowing and speech and preserving larynx integrity after the surgery is a primary objective of the surgeon. This task is very difficult and the result is not predictable. Recent years, however, there has been interesting developments in microsurgical techniques, and these advancements enable oral and maxillofacial surgeons to achieve better results and improve the quality of their patient's life. The results even with use of the new technology are still far from perfect. Several reasons may cause variation in the result. Some of them have to do with the patient such as general health and other reasons are due to the method that is used and nature of the defect after the removal of the tumor. This article was undertaken to summarize the various methods and techniques used over the years to restore oral tongue functions after defects.

  16. Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

    Dae-Sung Lee


    Full Text Available We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

  17. Anterograde intra-arterial urokinase injection for salvaging fibular free flap.

    Lee, Dae-Sung; Jung, Sun-Il; Kim, Deok-Woo; Dhong, Eun-Sang


    We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

  18. Ultrasonography - A diagnostic modality for oral and maxillofacial diseases

    Priya Shirish Joshi


    Full Text Available Background: Many diseases present themselves in oral and maxillofacial regions and various modalities may be applied for their diagnosis, including intraoral and panoramic radiography, ultrasonography (USG, computer tomography, magnetic resonance imaging, and nuclear medicine methods such as positron emission tomography. Of these modalities, USG is easy to-use for the detection of non-invasive and soft tissue related diseases in oral and maxillofacial regions. USG plays an important role in analyzing normal and abnormal structures. In particular, in oral and maxillofacial regions, the USG may be clinically applied to evaluate lymph nodes, subcutaneous, and oral cavity-related diseases. Aims: The aim was to correlate the findings of USG and histopathology for the diagnosis of oral and maxillofacial pathology and to evaluate whether USG can be used as an adjunct in diagnosing oral and maxillofacial pathology. Materials and Methods: A total of 10 clinically diagnosed patients with intraoral cancerous growths, swellings in maxillary and neck region were included in this study. Incision biopsy was obtained for confirming provisional clinical diagnosis. The selected cases were advised USG. All patients were then posted either for hemi-glossectomy, hemi-mandibulectomy, and partial maxillectomy with or without radical neck dissection. Statistical Analysis: Student′s t-test and coefficient of correlation was used to statistically analyze significant relationship of both the methods. Result: In all 10 cases, USG correlated well with histopathology findings, it could also delineate tumor extent and measure tumor thickness. Conclusion: USG is an excellent method for the diagnosis of soft tissue lesions and can be used as an adjunct in diagnosing oral and maxillofacial pathology.

  19. A Bayesian approach to distinguishing interdigitated tongue muscles from limited diffusion magnetic resonance imaging.

    Ye, Chuyang; Murano, Emi; Stone, Maureen; Prince, Jerry L


    The tongue is a critical organ for a variety of functions, including swallowing, respiration, and speech. It contains intrinsic and extrinsic muscles that play an important role in changing its shape and position. Diffusion tensor imaging (DTI) has been used to reconstruct tongue muscle fiber tracts. However, previous studies have been unable to reconstruct the crossing fibers that occur where the tongue muscles interdigitate, which is a large percentage of the tongue volume. To resolve crossing fibers, multi-tensor models on DTI and more advanced imaging modalities, such as high angular resolution diffusion imaging (HARDI) and diffusion spectrum imaging (DSI), have been proposed. However, because of the involuntary nature of swallowing, there is insufficient time to acquire a sufficient number of diffusion gradient directions to resolve crossing fibers while the in vivo tongue is in a fixed position. In this work, we address the challenge of distinguishing interdigitated tongue muscles from limited diffusion magnetic resonance imaging by using a multi-tensor model with a fixed tensor basis and incorporating prior directional knowledge. The prior directional knowledge provides information on likely fiber directions at each voxel, and is computed with anatomical knowledge of tongue muscles. The fiber directions are estimated within a maximum a posteriori (MAP) framework, and the resulting objective function is solved using a noise-aware weighted ℓ1-norm minimization algorithm. Experiments were performed on a digital crossing phantom and in vivo tongue diffusion data including three control subjects and four patients with glossectomies. On the digital phantom, effects of parameters, noise, and prior direction accuracy were studied, and parameter settings for real data were determined. The results on the in vivo data demonstrate that the proposed method is able to resolve interdigitated tongue muscles with limited gradient directions. The distributions of the

  20. Neoplasias de língua em cinco cães Neoplasms of the tongue in five dogs

    Carlos Roberto Daleck


    Full Text Available Este trabalho tem como objetivo relatar a ocorrência de cinco casos de neoplasias de língua em cães. Os sinais clínicos mais observados foram ptialismo, halitose e hiporexia. Após biópsia excisional para exame histopatológico, os resultados revelaram dois casos de melanoma, um caso de histiocitoma, um caso de fibrossarcoma e um caso de mastocitoma grau II, sendo que neste o proprietário não autorizou qualquer forma de tratamento. O tratamento para os demais foi a glossectomia parcial e, no caso de fibrossarcoma, associou-se a quimioterapia. Dois animais apresentaram deiscência de sutura no pós-operatório, não havendo necessidade da realização de nova intervenção. Em relação ao prognóstico, os pacientes com histiocitoma, fibrossarcoma e um com melanoma não apresentaram recidiva, nem metástase da doença 12 meses após a cirurgia. No outro caso de melanoma, o paciente apresentou metástase na pele e nos pulmões 30 dias após a ressecção cirúrgica.This paper is aimed at reporting five cases of neoplasms of the tongue in dogs. The clinical signs most observed were ptyalism, halitosis and hyporexia. After excisional biopsy the histological findings revealed two cases of melanoma, one case of histiocytoma, one case of fibrosarcoma and one case of mast cell tumor grade II, but in this case the owner didn't authorize any form of treatment. The treatments for the others cases were the partial glossectomy, and in the fibrosarcoma's case the chemotherapy was associated. Two animals had suture deiscencia in the post operatory, but in these cases it wasn't necessary another surgery. About the prognostic, the patients with histiocytoma, fibrosarcoma and one with melanoma didn't present cancer recurrence either metastasis 12 months after the surgery. But in another melanoma case the patient presented skin and lungs metastasis 30 day after surgery.

  1. Cáncer de lengua en un paciente con Alzheimer Lingual cancer in an Alzheimer patient

    Daniel Antunes Freitas


    Full Text Available El cáncer bucal a nivel mundial se considera uno de los más incidentes en cabeza y cuello, y la lengua, la ubicación topográfica bucal más frecuente. Los principales factores de riesgo son: tabaquismo, alcoholismo, herencia y una higiene bucal inadecuada. Se reporta el caso de un hombre de 64 años de edad con hábitos tóxicos de tabaquismo y alcoholismo, y además deficiente higiene bucal. El paciente sufre enfermedad de Alzheimer y desarrolló en la lengua un carcinoma escamocelular con adenopatías cervicales metastásicas. El diagnóstico fue confirmado histopatológicamente. Se realizó glosectomía total y posterior radioterapia cervical. Se motivó a los familiares a mejorar la higiene bucal del paciente y actualmente se encuentra bajo control médico. Aunque no se puede asegurar que la aparición y desarrollo del cáncer bucal en este paciente fue debido al padecimiento de Alzheimer o a los demás factores de riesgo, si se contempló la posibilidad de convertirse este padecimiento neurológico en un factor predisponente para esta enfermedad.Oral cancer at world level is considered as one of the more incident in head and neck and the tongue is the more frequent topographical location. The main risk factors are the smoking, alcoholism, inheritance and a poor oral hygiene. The case of an Alzheimer male patient aged 64 with smoking, alcoholism and a poor oral hygiene and a lingual squamocellular carcinoma with metastatic cervical adenopathies. Diagnosis was confirmed by histology. A total glossectomy was carried out and later cervical radiotherapy was applied. Relate were instructed on a better oral hygiene of patient and nowadays is under medical control. Although it is impossible to assure that appearance and development of oral cancer in this patients were provoked by the Alzheimer' disease or to other risks factors if we take into account the possibility that this neurologic illness becomes a risk factor.

  2. 舌根部恶性肿瘤的手术治疗%Surgical treatment for malignant tumors of the root of tongue

    董震; 孟昭业; 张森林; 曹罡; 毛钊


    Objective Most malignant tumors of the root of tongue are found at the intermediate or late stage, and usually respond less desirably to treatment than those of the anterior tongue. The purpose of this study was to explore the effectiveness and prognosis of surgical treatment of malignant tumors of the root of tongue. Methods We retrospectively analyzed the clinical data of 12 cases of malignant tumor of the root of tongue treated by surgery. Results All the 12 patients underwent extended tumorectomy and cervical gland dissection. Four of them received local excision, the wound closed by suture or with the tongue flap, and the other 8 were treated by total glossectomy followed by tongue flap grafting. On postoperative follow-up, we found 1 case of inferior maxilla nonunion, 1 case of flap necrosis, 1 death fromlocal recurrence a year later, 1 death from lung cancer 2 years later, 1 death from sudden asphyxia, and 2 deaths from dystrophy a year later. The other 5 cases experienced no recurrence or metastasis. Conclusion Exairesis is an effective approach to the treatment of malignant tumors of the root of tongue. Appropriate surgical methods can improve the cure rate and the patient's quality of life, and postoperative nutritional support is important for prognosis.%目的 发生于舌根部的肿瘤由于位置较为隐匿,多数患者就诊时即处于中晚期,所以其疗效较舌前部的肿瘤差.探讨舌根部恶性肿瘤患者手术治疗的有效性及预后. 方法 对12例舌根部恶性肿瘤患者手术治疗的临床资料进行回顾性研究和分析. 结果 12例舌根部恶性肿瘤患者均行肿瘤扩大切除及颈淋巴结清扫术,其中4例予以局部切除后拉拢缝合,或转舌瓣关闭创面,8例行全舌切除+皮瓣转移修复.经术后随访,1例患者出现下颌骨骨不连,1例出现皮瓣坏死,1例术后1年因肿瘤局部复发死亡,1例因2年后并发肺癌死亡,1例因突然窒息死亡,2例术后1

  3. Immediate reconstruction following resection of oral cancer with free rectus abdominis myocutaneous flap


    目的:研究游离腹直肌肌皮瓣即刻修复口腔颌面部恶性肿瘤切除术后缺损的方法并评价其作用.方法:6例患者在进行广泛的口腔癌切除术后,应用游离腹直肌肌皮瓣进行缺损即刻修复,3例颊癌患者分别切除唇,颊,下颌骨及上颌骨后造成大面积洞穿性缺损,2例舌癌及1例下颌骨恶性肿瘤患者在进行舌切除及下颌骨切除后造成大面积及复杂的缺损,缺损修复的转移皮瓣最大面积达110mm×230mm.结果:游离腹直肌肌皮瓣及供区无严重的手术并发症,6例游离腹直肌肌皮瓣有5例愈合无并发症,1例皮瓣出现部分坏死,供皮区腹壁无组织感染及裂开.结论:游离腹直肌肌皮瓣使口腔颌面部缺损修复在功能和美观上达到满意的效果,提高了口腔颌面部恶性肿瘤患者广泛切除术后的生存质量.%Objective:To study the method of rectus abdominis myocutaneous free flap for immediate reconstruction of defects resulting from orofacial cancer resections and evaluate the effect of the flap. Methods:There were six patients with oral cancer following extensive surgery received the rectus abdominis myocutaneous free flaps for immediate reconstruction of defects.In three patients with buccle mucosa carcinoma,extensive perforating defects had resulted from resection of large areas of the lip,cheek,mandible,and maxilla.In two patients with tongue cancer and one patient with mandibular carcinoma,extensive and complex defects had resulted from glossectomy and mandibulectomy.The maximal size of the skin peddle of the transferred flap was 110mm×230mm. Results:There were no serious complications of the transferred rectus abdominis myocutaneous free flaps and donor sites.Five of six rectus abdominis myocutaneous free flaps healed without immediate complications and one flap had partial necrosis.There were no infections and dehiscences of the abdominal wall. Conclusions:The rectus abdominis myocutaneous free flap provide