Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Glossectomy is standard-of-care treatment for resectable tumors in the oral tongue. Surgical resection can reduce soft-tissue bulk from the native tongue, hindering swallow. Tongue tethering due to scarring after surgery can further inhibit swallow and speech. This study aims to evaluate how the extent of tongue resection impacts functional outcomes of speech, swallow, and quality-of-life.
Methods: Patients with oral tongue squamous cell carcinoma (SCC) who underwent surgical resection at a tertiary-care, academic institution between 1/2000-1/2024 were queried. Patients were included if they underwent glossectomy with or without free flap, had a postoperative evaluation with a speech-language pathologist (SLP), and had least one month of follow-up. Patients were grouped by tongue resection extent: hemiglossectomy or partial glossectomies (PG) were compared to subtotal or total glossectomies (TG). Functional outcomes including swallow as measured by Functional Oral Intake Scale (FOIS), penetration-aspiration scale (PAS), Understandability of Speech (UOS), MD Anderson Dysphagia Inventory (MDADI), tongue range of motion (ROM), and tongue pressure were extracted.
Results: In total, 274 patients were included: 240 (87.6%) underwent PG, and 34 (12.4%) underwent TG. Median age was 62.4 years (IQR, 52.9-71.4), 139 (50.7%) were male, 117 (42.7%) were current/former smokers, and 23 (8.4%) had heavy alcohol consumption. Compared to PG, patients undergoing TG had more advanced tumors (T3-4: 94.2% vs 11.2%, p<0.001), free flap (97.1% vs 24.1%, p<0.001), mean resected specimen volume (182.1 vs. 11.3 cm3, p<0.001), and adjuvant radiation (82.4% vs. 38.3%, p<0.001). Postoperatively, tongue strength (21.0 vs. 47.0 kPa, p=0.003), tongue ROM (12.5 vs. 100.0, p<0.001), mean FOIS (2.0 vs. 6.0, p<0.001), PAS (4.0 vs. 1.0, p<0.001), MDADI (64.5 vs. 79.0, p=0.026), and G-tube reliance (76.5% vs. 6.7%, p<0.001) were worse for TG than PG, respectively, at a median time of 4.9 months (IQR 1.3-20.8) after surgery. 44% of PG patients were satisfied (MDADI >80), compared to only 13% of TG (p<0.001). Tongue resection volume was significantly correlated with poorer food intake (r2=-0.48, p<0.001), aspiration (r2=0.52, p<0.001), speech (r2=0.52, p<0.001), tongue strength (r2=-0.43, p=0.014), and MDADI (r2=-0.33, p<0.001). Tongue resection volume was not significantly associated with worse FOIS when free flaps were used (r2 =-0.028, p=0.88), in contrast to the significant correlation between resection volume and FOIS when no free flaps were used (r2=-0.46, p<0.001), suggesting that free flap usage to rebuild lost tongue bulk demonstrates a clinically relevant rescue phenotype.
Conclusion: Among patients undergoing glossectomy, the degree of tongue resection volume is significantly correlated with worse outcomes for speech, swallow, and quality-of-life as measured by validated instruments even at a median of 5 months postoperatively. Nearly all patients who underwent TG required a feeding tube for nutrition, and only 16% were able to be rely entirely on oral intake. Interestingly, free flap usage demonstrated a rescue phenotype in which resection volume was no longer significantly associated with worse functional score, highlighting that restoration of tongue bulk yields much-needed benefit. Future research should investigate how reducing tongue resection extent with neoadjuvant therapy may contribute to better functional outcomes.