Difference between revisions of "Glossectomy"
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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. | 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.<ref name=":0">{{Citation|last=Bigcas|first=Jo-Lawrence M.|title=Glossectomy|date=2022|url=http://www.ncbi.nlm.nih.gov/books/NBK560636/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=32809471|access-date=2022-02-17|last2=Okuyemi|first2=Oluwafunmilola T.}}</ref> | ||
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 | 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.<ref name=":0" /> | ||
== Preoperative management == | == Preoperative management == | ||
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|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | |Consider CAD from smoking history | ||
|- | |- | ||
|Respiratory | |Respiratory | ||
|Mouth opening, mass obstruction of the airway, presence of trismus, tongue fixation | |Mouth opening, mass obstruction of the airway, presence of trismus, tongue fixation, consider smoking history | ||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| | |Assess for dysphagia | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| Line 43: | Line 43: | ||
|- | |- | ||
|Other | |Other | ||
| | | | ||
|} | |} | ||
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ||
* CT/MRI | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
* Consider preoperative flexible laryngoscopy to assess tumor extension | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
| Line 57: | Line 61: | ||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
* Standard monitors, PIV | |||
* Mouth gags per surgeon | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
* Nasal intubation may or may not be required depending on tumor location (for example, side versus base of tongue) and surgeon's preference | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
* 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<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
* Maintain FiO2 <0.3 if lasers are used | |||
=== 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. --> === | ||
| Line 71: | Line 87: | ||
=== 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. --> === | ||
* Multimodal including nonopioid and bolus/PCA opioid analgesics with peripheral local anesthetic | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
* Airway obstruction second to airway edema | |||
* Bleeding | |||
* Infection | |||
* Aspiration | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
Revision as of 08:10, 17 February 2022
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 | |
| 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 from smoking history |
| Respiratory | Mouth opening, mass obstruction of the airway, presence of trismus, tongue fixation, consider 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
Emergence
Postoperative management
Disposition
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