Total glossectomy without laryngectomy - A review of functional outcomes and reconstructive principles

Purpose of review: To provide an overview of functional outcomes and reconstructive principles of total glossectomy without laryngectomy reported in recent series, and the evidence regarding which patients are at risk for poor functional outcomes. Recent findings: After total glossectomy with laryngeal preservation gastric tube dependency ranges from 30 to 44% for primary treatment. Between 85 and 95% of patients are able to have their tracheostomy tube removed. Many patients can also regain meaningfully intelligible speech. In the setting of prior radiation or chemoradiation therapy, achieving oral diet and tracheostomy decannulation is less likely. Reconstructions must have sufficient bulk to allow for contact with the palate, and achievement of this vertical height has been shown to be associated with improved speech and swallowing outcomes. Laryngeal suspension is an important adjunct to prevent both laryngeal prolapse and minimize aspiration risk. The role of either sensory or motor reinnervation is unclear, although there is currently more evidence for the benefit of sensory reinnervation. Summary: With meticulous reconstructive technique and appropriate patient selection, total glossectomy with laryngeal preservation can be performed as a primary or salvage procedure with acceptable functional outcomes.