Glossectomy refers to the surgical removal (–ectomy) of part or all of the tongue (gloss). It is most commonly performed to treat malignant tumors, particularly squamous cell carcinoma of the tongue. In some cases, it may also be indicated for severe macroglossia (enlargement of the tongue), especially when it obstructs the airway or impairs speech and swallowing. Tongue cancers can be locally aggressive and may spread to nearby oral structures or regional lymph nodes, making early diagnosis and intervention crucial. Depending on the extent of disease or tissue involvement, the procedure may be limited to a portion of the tongue (partial glossectomy) or involve complete removal (total glossectomy). Total glossectomy often requires reconstructive surgery to restore oral function, including swallowing and speech.

Indications For Glossectomy

A glossectomy is indicated in the following cases:

Cancer:

Glossectomy is most commonly indicated for tongue squamous cell carcinoma (SCC), a serious and potentially aggressive malignancy of the oral cavity. It is considered an effective surgical approach for managing localized and advanced tongue cancers. In particular, oral tongue squamous cell carcinoma, which affects the anterior, mobile portion of the tongue, is one of the most common indications for partial or total glossectomy. For large tumors that cross the midline or are located near critical anatomical boundaries, precise surgical techniques such as anatomical unit resection have been proposed to improve oncologic outcomes.¹

Macroglossia:

Multiple pathologies and disorders contribute to the enlargement of the tongue. Syndromic disorders like Beckwith-Wiedemann and Down syndrome are known to cause macroglossia. Mild-to-moderate tongue enlargement does not need any treatment. However, excessive growth of the tongue muscles tends to block the airway passages and consequently contributes to obstructive sleep apnea. Other issues associated with a large tongue include difficulty in eating/drinking, i.e., dysphagia, and speech difficulties. Therefore, doctors treat it with surgical resection of the tongue. Studies show that tongue reduction surgery is a feasible option in patients with Beckwith-Wiedemann syndrome-induced macroglossia.²

Glossectomy Types

Based on the extent of tongue removal, doctors classify the glossectomy procedure into different types. The glossectomy classification is as follows:

Partial Glossectomy: In partial glossectomy, the surgeon removes less than half of your tongue.
Hemiglossectomy: As the name indicates, half of the tongue is removed in a hemiglossectomy.
Subtotal Glossectomy: In subtotal glossectomy, more than half but less than the entire tongue is removed surgically.
Total Glossectomy: Patients undergo complete excision of the tongue. This is mostly done for aggressive, malignant cancers of the tongue.

Glossectomy Procedure

Before starting the procedure, your doctor will order multiple radiographic imaging tests, like MRI and CT scans, to evaluate the overgrowth of the tongue. Sometimes, doctors perform a biopsy (by taking a small sample from the tongue) before performing complete excision.

Anesthesia:

Doctors perform glossectomies under general anesthesia. This step ensures a pain-free and comfortable procedure. After anesthesia is effective, the surgeon performs any of the glossectomy types (partial, subtotal, etc.).

Glossectomy Surgical Approaches/Techniques:

Your surgeon can choose from any of the following techniques:

Transoral Glossectomy

Through-the-mouth (transoral) approach is used when dealing with the anterior part of the tongue. Surgeon’s assistants use mouth gags and cheek retractors to keep the mouth open. Your doctor makes incisions on the tongue with a laser (carbon dioxide laser) or cautery (monopolar cautery) to minimize bleeding and post-operative complications.³ After incising, the affected part of the tongue is removed.

Lip-Split Madibulotomy Glossectomy

This approach combines the transoral method with a sagittal mandibular osteotomy, allowing excellent access to deeper areas like the base of the tongue and sublingual space. It is especially useful for large or posterior tumors. A neck dissection is commonly performed along with this approach. The incision begins on the inner lip mucosa, extends through the midline of the mandible (sagittal plane), and exits at the cutaneous lip, passing through the vermilion border (the red portion of the lips).

Transcervical Pull-Through Glossectomy

This is the preferred technique for resecting tumors located at the posterior tongue or base of the tongue. It provides good access to the posterior tongue, floor of the mouth, and sublingual compartments through the submental and submandibular neck spaces. Depending on the extent of disease, the surgeon may perform a partial, hemi, subtotal, or total glossectomy as part of the treatment plan.

Stitching Up:

After removal, the surgeon closes the incision with sutures. Doctors may use resorbable or non-resorbable sutures or a combination of both. In case of non-resorbable sutures, you have to get the stitches removed after 10-12 days.

Procedures Associated With Glossectomy

Patients undergoing hemiglossectomy may also need a tracheostomy, i.e., a surgical procedure to create an opening in the trachea (windpipe). This bypasses the oral/nasal pathways of breathing, which may be necessary for hemiglossectomy or complete tongue removal.

After complete removal of the tongue muscle, doctors reconstruct the tongue by taking flaps from different parts of the body. In the majority of total glossectomy cases, free flaps are taken from the chest, legs (fibula and anterolateral thigh), and the abdomen (rectus abdominus).⁴ In some cases, oncologists advise patients to undergo radiation therapy to ensure the complete elimination of cancerous cells. This minimizes the chances of cancer recurrence.

Glossectomy Recovery

The recovery after a glossectomy is slow and difficult. As the tongue is crucial for multiple functions, including chewing, swallowing, tasting, and speaking, resection of a part or the whole tongue interferes with numerous daily activities. The recovery time varies for different glossectomy types.

Recovery Time:

Patients undergoing partial glossectomy can go back home the next day. The average partial glossectomy recovery time is a few weeks. For hemiglossectomy, the hospital stay is usually for 7 to 10 days, and recovery takes several weeks to months. Hospital stay (7-10 days) and recovery period are the same for subtotal and total glossectomy patients (up to months).

What Happens After Glossectomy?

You might experience some discomfort (pain and swelling) following the surgery, but that generally lasts for a couple of days and subsides as the wounds heal. Loss of a part or the whole tongue is linked to alterations in multiple functions, for which you will need medical help and rehabilitation. Several issues that arise after a glossectomy include:

Speech:

Health providers check your speech quality via speech intelligibility. A study by Riva and colleagues reveals that partial glossectomy contributes to impairment in tongue mobility, which reduces the speech intelligibility of the patient.⁵ So, you will need to take speech therapy sessions and do swallowing exercises for rehabilitation. Before and after analyses reveal that speech therapy evidently improves life quality and reduces the severity of speech difficulty and dysphagia/deglutition (swallowing difficulty).⁶

Swallowing:

Your tongue plays a crucial role in food swallowing. Therefore, dysphagia is pretty common following a tongue resection surgery. Modern healthcare service providers focus on swallowing exercises to improve function in patients. Research shows that accuracy tasks and swallowing exercises significantly improve post-operative swallowing in patients.⁷

Dysgeusia (Loss of Taste):

Dysgeusia is also a common issue arising after tongue removal. You can still have taste sensations if the tongue is removed partially. Astonishingly, you might even have some taste sensations after a total glossectomy, thanks to the taste receptors on your palate.⁸ However, there is no definitive way to retrieve the lost taste sensations.

Glossectomy Post-Op Care

You should strictly follow the doctor’s instructions, especially regarding pain-killer medications, etc.
Take a softer diet (yogurt, cheese, etc.) during the recovery period to minimize surgical complications.
Maintain good oral hygiene to keep surgical site infections at bay.
Avoid strenuous exercises for a few days after the surgery, as it may cause gaping of wounds and excessive bleeding.
Get swallowing guidance and speech therapy from professionals.
Get emotional support by joining groups and connecting with individuals who have undergone glossectomy.

Glossectomy Complications

There are possible surgical complications of glossectomy. Bleeding and site infection are seen in most surgeries. However, with glossectomy, you can experience nerve injury, airway blockage (due to severe post-operative swelling of the floor of the mouth), or rejection of the transplanted graft. Recurrence of cancer is a serious complication of glossectomy done for aggressive tumors.

Wrapping Up

Glossectomy is the surgical procedure of removing the tongue muscle. Cancer patients and individuals with macroglossia (due to genetic syndromes) undergo glossectomies to improve speech, swallowing, and breathing. An oral surgeon removes part of the tongue (partial), half of the tongue (hemiglossectomy), subtotal (more than half), or total glossectomy (complete removal of the tongue), depending on the severity of your disease. Reconstruction of the tongue can be done with flaps from the arm, chest, legs, and abdomen.

The procedure is done under general anesthesia, and you will need to stay in the hospital for 2-7 days, and complete recovery usually takes a few weeks to months. Patients experience swallowing and speech difficulties following the procedure. Clinical studies show that swallowing exercises and speech therapy offer great help in improving your quality of life.

Refrences

1
K., Zhang, S., & Wu, H. J. (2023). A precise glossectomy for tongue cancer adjacent to or crossing the midline: a novel anatomical unit resection surgery. International Journal of Oral and Maxillofacial Surgery, 52(7), 725-734.
2
Geisler, E. L., Jeffers, J., Salhi, S., & Perlyn, C. A. (2022). Reduction Glossectomy for Macroglossia in Beckwith-Wiedemann Syndrome: Is Post-Op Intubation Necessary?. The Cleft Palate-Craniofacial Journal, 59(1), 126-131.
3
Kimoto A, Suzuki H, Yamashita J, Takeuchi J, Matsumoto K, Enomoto Y, Komori T. A Retrospective Evaluation of Partial Glossectomy for Early Tongue Cancer Using a Carbon Dioxide Laser. Photomed Laser Surg. 2017 Sep;35(9):479-483.
4
Han, A. Y., Kuan, E. C., Mallen‐St. Clair, J., Badran, K. W., Palma Diaz, M. F., Blackwell, K. E., & St. John, M. A. (2019). Total glossectomy with free flap reconstruction: Twenty‐year experience at a tertiary medical center. The Laryngoscope, 129(5), 1087-1092.
5
Riva, G., Sapino, S., Ravera, M., Elia, G., & Pecorari, G. (2022). Long-term functional outcomes and quality of life after partial glossectomy for T2 squamous cell carcinomas. Brazilian Journal of Otorhinolaryngology, 88(Suppl 4), S33-S43.
6
Balbinot, J., Real, C. S., Melo, C. C. D., Dornelles, S., & Costa, S. S. D. (2022). Quality of life in tongue cancer treated patients before and after speech therapy: a randomized clinical trial. Brazilian Journal of Otorhinolaryngology, 88(4), 491-496.
7
Pavlidou, E., Kyrgidis, A., Vachtsevanos, K., Constantinidis, J., Triaridis, S., & Printza, A. (2023). Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy. Journal of Clinical Medicine, 12(17), 5613.
8
Grasl S, Janik S, Wiederstein S, Haymerle G, Renner B, Mueller CA. Chemosensory Functions After Glossectomy-A Cross-Sectional Pilot Study. Laryngoscope. 2023 Feb;133(2):375-382. doi: 10.1002/lary.30454. Epub 2022 Oct 18. PMID: 36254878; PMCID: PMC10092492.

Glossectomy: Understanding the Procedure and Recovery

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