Difference between revisions of "Glossectomy"
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|Cardiovascular | |Cardiovascular | ||
|Consider CAD | |Consider CAD if smoking history | ||
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|Respiratory | |Respiratory | ||
|Mouth opening, mass obstruction of the airway, presence of trismus, tongue fixation, consider smoking history | |Mouth opening, mass obstruction of the airway, presence of trismus, tongue fixation, consider pulmonary pathology related to smoking history | ||
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|Gastrointestinal | |Gastrointestinal | ||
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* Maintain FiO2 <0.3 if lasers are used | * Maintain FiO2 <0.3 if lasers are used | ||
* Prophylactic steroids for airway edema | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
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=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | === Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | ||
* Encourage early nutrition, foley removal, mobilization | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
Revision as of 07:13, 17 February 2022
| Anesthesia type |
General |
|---|---|
| Airway |
Nasal ETT, Oral ETT |
| Lines and access |
PIV |
| Monitors |
Standard, 5-lead ECG |
| Primary anesthetic considerations | |
| Preoperative |
History of head and neck radiation, airway history |
| Intraoperative |
Adequate muscle relaxation, electrocautery and risk of airway fire, tracheostomy may be indicated |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 1 |
Glossectomy refers to surgical removal of part or all the tongue. It is primarily performed for excision of malignant lesions in addition to benign neoplasms of the tongue, obstructive sleep apnea, and macroglossia. Excisional or incisional biopsies of tongue lesions of undetermined etiology are also performed.[1]
There are several approaches to performing a glossectomy, most commonly transorally (through the mouth) for smaller and shallower tumors. Larger tumors or those with significant depth may require resection of the lower lip and mandible ("lip-split mandibulotomy"), or opening the sublingual or submental compartments for improved visualization of the inferior tongue ("transcervical pull-through"). Neck dissection and reconstruction can be performed for all glossectomy procedures.[1]
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | Consider CAD if smoking history |
| Respiratory | Mouth opening, mass obstruction of the airway, presence of trismus, tongue fixation, consider pulmonary pathology related to smoking history |
| Gastrointestinal | Assess for dysphagia |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
- CT/MRI
Operating room setup
Patient preparation and premedication
- Consider preoperative flexible laryngoscopy to assess tumor extension
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
- Standard monitors, PIV
- Mouth gags per surgeon
Induction and airway management
- Nasal intubation may or may not be required depending on tumor location (for example, side versus base of tongue) and surgeon's preference
Positioning
- Supine, arms tucked
- Arm positioning may differ if radial free flap
- If neck dissection, avoid neck over-rotation and brachial plexus stretch injuries
- Table often 180°
Maintenance and surgical considerations
- Maintain FiO2 <0.3 if lasers are used
- Prophylactic steroids for airway edema
Emergence
Postoperative management
Disposition
- Encourage early nutrition, foley removal, mobilization
Pain management
- Multimodal including nonopioid and bolus/PCA opioid analgesics with peripheral local anesthetic
Potential complications
- Airway obstruction second to airway edema
- Bleeding
- Infection
- Aspiration
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ 1.0 1.1 Bigcas, Jo-Lawrence M.; Okuyemi, Oluwafunmilola T. (2022), "Glossectomy", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32809471, retrieved 2022-02-17
Top contributors: Helen Heymann, Olivia Sutton and Chris Rishel