Side Effects After Glossectomy
Glossectomy causes profound and permanent impairments in speech and swallowing function, with 80-88% of total glossectomy patients experiencing moderate to severe speech intelligibility problems and 84% requiring special food preparation long-term, though patients paradoxically report favorable quality of life outcomes. 1, 2
Speech and Communication Impairments
The most devastating functional consequence of glossectomy is speech dysfunction:
- Total glossectomy results in moderate to severe speech intelligibility impairment in 80-88% of patients, with patient-reported Speech Handicap Index scores averaging 47.2 ± 42 1, 3
- Specific voice issues include weak, breathy vocal quality, problems with pitch variation, and severely compromised articulation 4
- In subtotal glossectomy, approximately 87% achieve good or acceptable speech, demonstrating the critical importance of tongue preservation when oncologically feasible 2
- Partial glossectomy patients typically return to baseline speech function by 1 year post-operation, though this varies with extent of resection 5
The tongue's role in articulation is irreplaceable—even with microsurgical reconstruction, the flap lacks the intricate muscular control necessary for normal speech production 1, 2.
Swallowing Dysfunction and Nutritional Impact
Dysphagia represents the second major morbidity:
- 84% of total glossectomy survivors require special food preparation indefinitely, with 24% exhibiting aspiration and 72% having pharyngeal residue on objective testing 1
- Despite these objective findings, 85% of total glossectomy patients resume oral feeding, and no patients in one series required permanent tube feeding 2, 3
- The oral phase of swallowing is primarily impaired after glossectomy, as the tongue's role in bolus formation and propulsion is compromised 6
- Videofluoroscopic examination of swallowing provides critical information for rehabilitation planning and should be performed routinely 6
Partial glossectomy patients show no significant differences in swallowing function between baseline and 6 months post-surgery, indicating good functional recovery with limited resections 5.
Airway Management Considerations
Respiratory complications are significant, particularly with extensive resections:
- Total glossectomy combined with total laryngectomy (performed in approximately 33% of total glossectomy cases) eliminates aspiration risk but requires permanent tracheostomy 2
- In larynx-preserving total glossectomy, 90% achieve decannulation, though this requires intensive rehabilitation 2
- Patients with severe pretreatment dysfunction, extensive cartilage destruction, or baseline aspiration are poor candidates for larynx preservation and should undergo total laryngectomy 7
Quality of Life Paradox
A striking finding in the literature reveals an important clinical reality:
- Despite moderate to severe objective impairments, total glossectomy survivors report favorable long-term quality of life, with EORTC QLQ-30 global health status scores of 80 ± 20 and functional scale scores ranging from 87-91 1
- This paradox underscores that patient-perceived quality of life should guide treatment decisions, not just objective functional measures 1
- All but one patient (88%) reported pain relief following surgical excision, which significantly contributes to improved quality of life despite functional deficits 3
Adjuvant Treatment Effects
When radiotherapy or chemoradiation is added:
- Xerostomia (dry mouth) and sticky saliva persist as long-term problems, with a clear time trend showing adjuvant radiation negatively affecting dry mouth scores 4, 5
- Chemoradiation independently worsens swallowing outcomes, eating ability, and mouth opening compared to surgery alone 5
- Alterations in swallowing function can occur long after radiation-based treatment and require lifetime monitoring 7
- Up to 50% of survivors of advanced head and neck cancer experience dysphagia after radiation or chemoradiation 4
Wound Complications and Surgical Morbidity
Immediate postoperative complications include:
- Wound complications occur in approximately 44% of cases, including orocutaneous fistula (21%) and suture dehiscence (23%) 2
- These complications typically resolve with conservative management and do not preclude eventual oral feeding 2
Oncologic Context
The functional sacrifices must be weighed against survival benefits:
- 5-year survival after total or subtotal glossectomy ranges from 25-47%, with better outcomes in motivated patients receiving postoperative radiotherapy 2, 3
- Total glossectomy offers superior cure rates compared to primary radiotherapy for advanced disease, particularly in resource-limited settings 3
Rehabilitation Strategies
Critical interventions to optimize outcomes:
- Palatal augmentation prostheses can improve swallowing rehabilitation in glossectomy patients 6
- Appropriate swallowing exercises and compensatory strategies should be determined based on videofluoroscopic findings 6
- Nutritional evaluation before and after treatment is essential, with close monitoring to prevent weight loss >10% of ideal body weight 7
- Speech-language pathology evaluation should occur preoperatively and continue throughout recovery 7
Clinical Decision Algorithm
For advanced tongue cancer requiring glossectomy:
Assess baseline function: Patients with severe pretreatment aspiration, extensive cartilage destruction, or nonfunctional airway should undergo total laryngectomy with glossectomy 7
Extent of resection: Preserve maximum tongue tissue oncologically safe—subtotal glossectomy yields 87% good/acceptable speech versus 12-20% with total glossectomy 2, 3
Reconstruction: Microsurgical free flaps (deep inferior epigastric or anterolateral thigh) provide optimal functional outcomes 2
Counsel realistically: Inform patients that 80-88% will have moderate-severe speech impairment and 84% will require modified diet, but 85% will eat orally and most report good quality of life 1, 2