Seven cases of total laryngo-glossectomy combined with mandibulectomy: A retrospective case series from a single institution

Objective

In cases of tongue, gingival, or base of tongue cancer with mandibular tumor invasion, total laryngo-glossectomy and mandibulectomy may be necessary. However, since such cases are limited in number, very few cases have been reported. This study aimed to investigate the treatment strategy involving total laryngo-glossectomy combined with mandibulectomy.

Methods

This study included patients with head and neck cancer who underwent radical surgery involving total laryngo-glossectomy combined with partial mandibulectomy between January 2014 and December 2023. We investigated the sex, age, primary lesion location, tumor-node-metastasis classification, history of radiation exposure, preoperative/postoperative treatments, surgical methods for resection and reconstruction, extent of neck dissection, surgical duration, blood loss volume, perioperative complications, time to resume oral intake post-surgery, length of hospital stay, duration of follow-up observation, and outcomes.

Results

Seven patients who underwent total laryngo-glossectomy combined with partial mandibulectomy were included in this study. The median age at the time of surgery was 57 years (six males and one female). Four patients had floor of the mouth cancer, two had gingival cancer, and one had dual primary cancer involving the tongue and hypopharynx. Two patients had a history of radiation therapy for other head and neck cancers. Five patients received induction chemotherapy with docetaxel, cisplatin, and fluorouracil, and four patients received postoperative chemoradiotherapy with cisplatin. Four patients had direct tumor invasion necessitating concurrent resection of the facial skin. Among the patients without prior radiation therapy to the head and neck region, five underwent bilateral neck dissection (I–IV), whereas the remaining patients underwent neck dissection on the affected side only. Reconstruction in all patients involved the free rectus abdominis musculocutaneous flap and a titanium mandibular reconstruction plate. Two patients experienced major leakage owing to suture rupture, and both recovered following negative pressure wound therapy. The median time to resumption of oral intake after surgery was 12.5 days, and the median hospital stay was 38 days. The median follow-up period was 26 months, with four patients remaining disease-free, one experiencing recurrence, and two succumbing to their primary disease.

Conclusion

Long-term survival can be anticipated with appropriate treatment, even in cases of total laryngo-glossectomy combined with partial mandibulectomy. In addition, to facilitate post-treatment oral intake, it is crucial to thoroughly evaluate the reconstruction methods, materials, and forms in a larger number of cases.