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  • Title
  • 1. Introduction
  • 2. Resection of Lesion
  • 3. Specimen Margins
  • 4. Hemostasis
  • 5. Closure
  • 6. Long-acting Local Anesthetic

Partial Glossectomy

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Liana Puscas, MD, MHS1; C. Scott Brown, MD1; Vahagn G. Hambardzumyan, MD2
1Duke University Medical Center
2Yerevan State Medical University, Heratsi Hospital Complex

Main Text

Jaw and oral cavity involvement by metastatic disease is very rare, occurring in less than 1% of all oral malignancies. Unfortunately, oral metastasis is usually a manifestation of an advanced stage of primary cancer and indicates widespread disease and poor prognosis.1

In this clinical case, a patient presented with a left breast lump and a well-circumscribed lesion on her tongue, causing interference with eating as it grew. Despite its benign appearance, an initial in-office biopsy was performed. Further investigations included a mammography that revealed an irregular mass in the upper outer quadrant of the breast, along with enlarged ipsilateral lymph nodes. Contrast-enhanced CT scans further showed a lesion on the right side of the tongue, a left breast lump, and spinal metastasis. Osteoscintigraphy confirmed multiple bone metastases. Subsequent breast core biopsy results indicated invasive ductal carcinoma, and the tongue biopsy revealed an unexpected diagnosis of metastatic lesion secondary to breast cancer. Hormone therapy was initiated, and the patient underwent a palliative partial glossectomy.

Only a few similar cases were reported in the literature.2 To alleviate the patient's symptoms, a decision was made to proceed with a palliative partial glossectomy.

Before initiating the resection, the dimensions of the lesion were measured. The perfectly round lesion was found to be well-encapsulated and not ulcerated. Nevertheless, a decision was made to include a 1-cm margin to ensure complete removal of the lesion. The surgical procedure involved meticulous resection while addressing the specific dimensions and contours of the lesion. During the resection, attention was given to specimen orientation, ensuring accurate identification and documentation of different margins for further analysis. Additional margin specimens were collected and evaluated for cancerous tissue by frozen section pathology for anterior-dorsal, posterior-dorsal, left lateral-posterior, ventral-anterior, and ventral-posterior.

Throughout the procedure, significant attention was given to achieving hemostasis by electrocauterization resulting in little bleeding and a clear operative field.

The surgical site was closed using Vicryl sutures considering their ability to provide better tensile strength in a dynamic structure like the tongue. The closure was done with horizontal mattress sutures to minimize potential complications.3 Postoperative pain management was addressed with topical administration of bupivacaine, providing long-acting analgesia. The patient received preoperative dexamethasone to mitigate potential swelling. The reduction of postoperative edema is crucial for the optimal surgical outcome and the patient’s recovery.

This video demonstrates the removal of the metastatic breast cancer lesion on the patient's tongue while ensuring comprehensive margin assessment through frozen sections. The choice of sutures and postoperative analgesia reflect a patient-centered approach, emphasizing optimal recovery and symptom relief.

The patient referred to in this video article has given their informed consent to be filmed and is aware that information and images will be published online.

Citations

  1. Lee YH, Lee J Il. Metastatic carcinoma of the oral region: an analysis of 21 cases. Med Oral Patol Oral Cir Bucal. 2017;22(3). doi:10.4317/medoral.21566.
  2. Zegarelli DJ, Tsukada Y, Pickren JW, Greene GW. Metastatic tumor to the tongue. Report of twelve cases. Oral Surg Oral Med Oral Pathol. 1973;35(2). doi:10.1016/0030-4220(73)90286-7.
  3. Bouchard C, Troulis MJ, Kaban LB. Pediatric Dentoalveolar Surgery. In: Peterson’s Principles of Oral and Maxillofacial Surgery, Fourth Edition. 2022. doi:10.1007/978-3-030-91920-7_7.
  4. Kumar GS, Manjunatha BS. Metastatic tumors of the jaw and oral cavity. J Oral Maxillofac Path. 2013 Jan-Apr; 17(1):71-75. doi:10.4103/0973-029X.110737.
  5. Hirshberg A, Shnaiderman-Shapiro A, Kaplan I, Berger R. Metastatic tumours to the oral cavity - pathogenesis and analysis of 673 cases. Oral Oncol. 2008 Aug;44(8):743-52. Epub 2007 Dec 3. doi:10.1016/j.oraloncology.2007.09.012

Cite this article

Puscas L, Brown CS, Hambardzumyan VG. Partial glossectomy. J Med Insight. 2024;2024(209). doi:10.24296/jomi/209.

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Filmed At:

Duke University Medical Center

Article Information

Publication Date
Article ID209
Production ID0209
Volume2024
Issue209
DOI
https://doi.org/10.24296/jomi/209