Advanced Carcinoma of the Tongue: Management by Total Glossectomy Without Laryngectomy

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Abstract
A major goal of any surgical program for patients with tumors is to cure their cancer. Patients requiring total glossectomy usually are seen initially with far-advanced disease, often after failure of other treatment modalities. As a result, they may be suffering from constant pain as well impairment of speech and deglutition. The prognosis is poor, and palliative surgery with good rehabilitation of the speaking and swallowing mechanisms becomes a reasonable, albeit limited, objective. Our series does show that properly selected patients can be successfully rehabilitated after total glossectomy with out laryngectomy. This successful rehabilitation begins with good patient selection and preoperative preparation. Postoperative rehabilitation requires the interplay of a highly motivated patient and a well-coordinated health care team. The physician, nurse, speech pathologist, dietitian, and social worker all have important roles in ensuring the patient's return to a good quality of life. The surgeon will direct the efforts of the team. To the nurse and the speech pathologist falls much of the bedside job of instructing and motivating the patient. Because such effective rehabilitation has been demonstrated by the success of our patients, we advocate preserving the larynx whenever possible in the patient who must undergo total glossectomy.

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