Total glossectomy sans laryngectomy--are we justified?

Eighty-five cases of cancer of the tongue treated with total glossectomy are presented; 82 had a squamous carcinoma. The majority had a large primary with no disease in the neck. Thus only 6 patients required concurrent therapeutic radical neck dissection. A laryngectomy was done in 9 cases for gross extension of disease and in 1, as prophylaxis against aspiration. In 75 cases the larynx was preserved. Mortality from aspiration pneumonitis was 4%. Local recurrence rate was 42% for predominantly posterior lesions and 27% for anterior lesions. The speech, though not quite articulate, was fairly understandable. Thus, in cases of total glossectomy preservation of larynx is worthwhile and justifiable except when involved with disease, when the risk of even minor degrees of aspiration is high (elderly, frail individuals) and with associated extensive pharyngeal resection hampering the swallowing machanism.