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The Pharynx and Oral Cavity
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Most children with macroglossia will be under the care of a paediatrician, who will supervise the necessary investigations, but the ORL team may be asked to help if treatment is needed. The child may need airway support with a Guedel airway or, in severe cases, a tracheostomy. Surgical reduction of the tongue (partial glossectomy) is usually undertaken in a specialist centre by an experienced team with appropriate back-up facilities including a PICU.
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Total glossectomy is mainly reserved for T3/T4 tumours.Post-radiotherapy recurrence.Where >50% of the tongue is involved (high risk of perineural and perivascular spread) – in such cases, the contralateral lingual vessels and the lingual and hypoglossal nerve may be involved precluding hemiglossectomy.
Chronic Aspiration
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Guri S. Sandhu, Khalid Ghufoor
The problems with these two approaches are that they run a high risk of breakdown and, as the larynx is closed, the patient is tracheostomy dependent and has no voice. Also these procedures are not easily reversible. In 1975 Biller et al.27 described a two-layer, vertical supraglottic closure, with a small opening at the tip of the epiglottis (Figure 56.7). The procedure was designed to prevent aspiration in total glossectomy patients. Some retained the ability to speak and others could commence oral intake but retained a tracheostomy tube.28
Psychometric properties of the Italian version of the Speech Handicap Index
Published in Disability and Rehabilitation, 2021
Francesco Mozzanica, Letizia Scarponi, Martina Rota, Giovanni Succo, Erika Crosetti, Marco Guzzo, Paolo Bossi, Cesare Piazza, Francesco Ottaviani, Antonio Schindler
The present study has some drawbacks. First of all, the number of recruited patients is relatively small, even if it appears in line with previous reports. In addition, the large majority of the enrolled patients was affected by tongue cancer and underwent total or partial glossectomy. A more heterogeneous group of subjects would have been preferable, thus allowing comparisons of the I-SHI results among patients who underwent different type of surgery. However, the patient population was well represented in terms of kind of therapeutic approaches, as half of them received a mainly surgical approach, while another half received also postoperative radiation treatment. In addition, even if the accrual of mostly tongue carcinoma patients is a limit, it should be considered that they represent the population of patients at highest risk of showing long term disabilities in speech, due to complex surgical and reconstructive interventions. A second limitation lies in the fact that information regarding the criterion validity of the I-SHI were gathered only by comparing the scores obtained in the I-SHI and EORTC QLQ-H&N35 questionnaires. The comparison with additional speech assessment results (such as those obtained using the Frenchay Dysarthria Assessment [29]) would have increase the criterion validity of the I-SHI. Third, a small ceiling effect for the I-SHI total score obtained in asymptomatic subjects was found. However, it must be noted that the SHI was developed for head and neck cancer patients and is consequently not surprising that people without cancer would have scored near ceiling.
An interactive surgical simulation tool to assess the consequences of a partial glossectomy on a biomechanical model of the tongue
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
K.D.R. Kappert, M.J.A. van Alphen, S. van Dijk, L.E. Smeele, A.J.M. Balm, F. van der Heijden
In literature, there is still a debate on how to simulate the functional muscular subdivision. Some FE models described in literature divide the genioglossus in the anterior, middle and posterior part (Harandi et al. 2014; Wu et al. 2014; Dabbaghchian et al. 2016; Hermant et al. 2017), while other literature shows that there are also arguments to separate the genioglossus into a horizontal and oblique subdivision (Mu and Sanders 2010; Honda et al. 2013; Sanders and Mu 2013). There are also arguments to subdivide the intrinsic muscles into multiple functional regions. For validating our new way of generating an FE model, to enable virtual surgery, it was necessary to use the same muscle divisions as in Buchaillard et al. (2009). In addition, Van Alphen et al. (2017) showed that the tongue muscle innervation patterns can differ greatly among subjects, which makes it difficult to ascertain that specific muscles are denervated by surgical procedures. However, from our longstanding clinical experience and other clinical research, we can conclude that gross tongue movements after a partial glossectomy are usually affected by fibrosis rather than by denervation (Speksnijder et al. 2011). Moreover, denervation at a local site seems effectively compensated at a central cerebral level (Mosier et al. 2005).
Macroglossia secondary to lisinopril-induced acute angioedema
Published in Baylor University Medical Center Proceedings, 2019
Colten Ducote, Matthew J. Kesterke, Ritesh Bhattacharjee, Andrew Read-Fuller, Likith V. Reddy
Angioedema usually resolves within several days of onset with medical therapy; however, some patients experience persistent macroglossia that can last weeks to months. In the encephalopathic patient, the cause of prolonged tongue edema is usually related to bite trauma. Biting trauma results in venous congestion and impaired lymphatic drainage, which can cause edema for prolonged periods. Bite blocks placed between the teeth can stop patients from biting but are rarely effective long term. Unless the patient’s mental status improves, the only effective long-term option is partial glossectomy. Multiple techniques are described in the literature for partial glossectomy. Postoperatively, patients should have regular follow up with a speech therapist, because issues with glossal function, speech deficiency, and deglutition are common.