TOTAL GLOSSECTOMY WITH LARYNGEAL PRESERVATION

Objective: To evaluate the results of a planned combined therapy with surgery and postoperative radiotherapy in the management of large (T3 to T4) squamous cell carcinomas of the tongue-tongue base in properly selected patients. Patients and Methods: Twenty-one patients underwent this procedure in a 4-year period. The selection criteria were direct ed to identify those patients in whom laryngeal preservation was feasi ble and who were motivated. Five categories of patients were included: those with (1) large primary tumors of the tongue-tongue base; (2) re currence after initial radiotherapy, brachytherapy, chemotherapy, or a combination of these modalities; (3) recurrence after initial surgery and radiotherapy; (4) double primary tumors; and (5) second or third primary tumors arising in the tongue or base of the tongue. Preoperati ve investigation included examination under anesthetic and magnetic re sonance imaging. Depending on the proximity of the primary tumor to th e mandible, a mandibular split, a marginal resection, or a segmental r esection was carried out. Soft-tissue replacement was achieved by a my ocutaneous or a muscle flap of the pectoralis muscle with split skin. Whenever possible tissues of the contralateral floor of the mouth were also used. Laryngeal suspension was performed in all cases. Postopera tive radiotherapy consisted of megavolt therapy, 66 Gy in 6 weeks to t he primary site and both sides of the neck. Results: Resumption of swa llowing and speech was achieved in all patients. External deformity wa s slight. Patients were able to return to their families. Conclusions: Total glossectomy with laryngeal preservation in properly selected pa tients provides local and regional control and preserves quality of li fe.