Glossectomy

Glossectomy

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
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Editor rating	Comprehensive
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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.

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.

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

Patient preparation and premedication

• Consider preoperative flexible laryngoscopy to assess tumor extension

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

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