Surgery for Posterior Tongue Mass Removal
The surgery to remove a lump on the posterior (base) of the tongue is called a glossectomy, specifically a partial glossectomy or base of tongue resection when limited to the posterior portion, or a total glossectomy when the entire tongue requires removal. 1, 2
Terminology and Surgical Approaches
The specific nomenclature depends on the extent of resection:
- Partial glossectomy or base of tongue resection: Removal of tissue limited to the posterior tongue/tongue base 1, 3, 4
- Total glossectomy: Complete removal of the entire tongue (both oral tongue and base of tongue), typically reserved for advanced cancers 2
- Lingual tonsillectomy: When the mass is specifically lingual tonsillar tissue 1
Modern Surgical Techniques
Transoral Robotic Surgery (TORS) has become the preferred minimally invasive approach for base of tongue masses, offering excellent visualization and access without external incisions. 4, 5, 6
TORS Advantages:
- Provides three-dimensional visualization and superior instrument maneuverability 4
- Allows successful resection of posterior one-third to one-half of the tongue 4
- Demonstrated safety in 285 patients with average operative time of 87 minutes and no life-threatening complications 3
- Achieves negative surgical margins in the majority of cases 5
Alternative Surgical Approaches:
Historical techniques that are no longer recommended include 1, 7:
- Glossopexia: Combined tongue resection with anterior suspension—abandoned due to severe complications including tongue immobility, decreased taste, and mediastinal infections 1
- Lingualplasty: Required tracheostomy and had 27% perioperative complication rate 1
Clinical Context Considerations
The specific procedure name and approach depends on the pathology being addressed:
- For benign masses: Lingual tonsillectomy or limited base of tongue resection via TORS 3
- For malignancy (T1-T2): TORS base of tongue resection with or without neck dissection 5, 6
- For advanced cancer (T4): Total glossectomy with free flap reconstruction, often as salvage therapy 2
Important Anatomic Considerations:
The posterior tongue contains critical neurovascular structures that must be identified during surgery 4:
- Glossopharyngeal nerve
- Hypoglossal nerve
- Lingual nerve
- Lingual artery
Base of tongue tumors have higher positive margin rates (28.1%) compared to tonsillar masses (7.5%), though recurrence rates are similar between locations. 6