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The surgery is performed under general anaesthesia. For most patients, removal of the tongue will be done through the transoral approach, and may be done concurrently with removal of other affected organs, for example the jaw (mandibulectomy), or voice box (laryngectomy), or the back of throat region (pharyngectomy). <links>
If the surgery is being done for tongue cancer, you may also require removal of the lymph nodes in your neck (neck dissection). The details of this procedure will be discussed separately. <link to neck dissection article >. In some cases, concomitant reconstructive surgery may also be required. <link to head and neck reconstruction article>
In experienced hands, surgery is usually very safe and complications are uncommon. Some of the more serious or common possible risks include: - Bleeding: this can happen after surgery and rarely can be life-threatening from swelling and blockage of the airway. - Changes in tongue appearance and function: the tongue is a very mobile and versatile organ which contributes to taste, sensation, speech, and swallowing. After surgery, there may be changes to the size, shape, or symmetry of the tongue, which can affect one or more of these functions. There may also be motor or sensory impairment leading to weakness or numbness of the tongue, or reduced taste sensitivity. We will work closely with the speech therapists and other members of the allied healthcare team to restore as much of these functions as possible.
The duration of surgery and length of hospitalization stay will depend of the extent of resection. For example, if a partial glossectomy is performed without any reconstruction, the duration of surgery usually spans 1-2hours, and the length of stay 2-4 days. However, if more extensive surgery is required, the operative time may be considerably longer (up to 12hours or more), and you may be hospitalized for around 2 weeks.
After your surgery is done you will usually be sent to a recovery area in the operating theatre. When your condition is stable and you are fully awake, you will be transferred to the ward or High Dependency Unit. You may not be allowed to eat or drink immediately after the surgery, until the next review by your primary surgeon.
Some mild post-operative pain at the operative site is expected. Your doctors will prescribe some medication for pain control. If you still experience significant pain, let the nursing staff know and they will contact your doctors to adjust your medication if necessary.
There may be a nasogastric tube inserted through your nostril to your stomach, so that feeding can be started after the surgery to maintain or boost your nutrition. This tube is usually temporary and will be removed once the surgical site has healed and is safe to resume eating via the oral route.
Avoid vigorous exercise or strenuous physical activities such as carrying heavy loads (>10kg) until further instructions from your doctor. You can continue with exercises taught by the physiotherapist and speech therapist. Adhere to your nasogastric tube feeding regime as advised by the dietician. If you are allowed to resume oral diet, avoid extremely hot or cold fluids, and start by taking food that is soft in consistency.
Maintain good oral hygiene to prevent infection and speed up the healing process. This may involve using antiseptic mouthwash regularly e.g. in the morning and after meals, or simply gargling with tap water.
Your doctor will usually prescribe you some medication to help with any pain you might have after the surgery.
Take your medication as advised. If you continue to have significant pain despite taking the medication, let your doctor or nurse know.
Seek immediate medical attention if you have any of the following: - Bleeding from the operated site - Noisy breathing, difficulty breathing or swallowing - Persistent fever (Temperature >38o CelciusCelsius) - Increased swelling or pain over your wound- Yellowish, foul smelling discharge from the wound.
Drain CareYour doctor may decide put one or morea surgical drains in your neck at the time of surgery. This is a tube placed to remove excess fluid to prevent it from collecting in your neck. The nurses will teach you how to care for the drain and how to measure the output of the drain.
Your doctor will remove the drain once the amount coming out every day is minimal.