Malignant lesions involving tongue are very difficult to treat. This is partly due to the fact that tongue is richly endowed with lymphatics. Even small lesions can involve regional lymph nodes. The proximity of this organ to mandible makes irradiation a difficult task. Mandible responds to irradiation rather poorly causing osteo radionecrosis leading on to troublesome fistula formation after irradiation. Irradiation of these patients need to be planned carefully and is fraught with irritable side effects like dryness of mouth, halitosis etc.
Clinical details of the patient who was treated with hemiglossectomy:
65 years old female patient - C/O ulcerating mass in the left lateral border of tongue anteriorly - 6 months duration.
H/O Tobacco chewing ++
On examination:
Tongue protrusion and mouth opening were normal.
Slough covered ulcero proliferative mass measuring 3 cms in its largest dimension, could be seen occupying the lateral portion of anterior 1/3 of tongue. On palpation mass was found to be indurated. Clinically there was no evidence of Nodal metastasis. CT scan of neck also showed no evidence of nodal metastasis.
Biopsy was reported as well differentiated squamous cell carcinoma.
Since the mass was involving the anterior portion of the left side of tongue the patient was taken up for surgical resection of the mass - Hemiglossectomy.
This patient underwent hemiglossectomy via intra oral route - without splitting the mandible as there was no ankyloglossia / trismus. Due to full mouth opening surgical exposure was good and the posterior border of the mass was clearly found not involving the posterior 1/3 of tongue.
Clinical photograph of the patient
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