Own experience of surgical treatment for advanced cancer of the tongue and the mouth floor

Purpose of the study. Improvement of surgical treatment outcomes in patients with advanced cancer of the tongue and the mouth floor providing radical surgery with preservation of the organ functions.

Materials and methods. Two patients with advanced cancer of the tongue and the mouth floor with metastases to lymph nodes in the neck (St.4 (IVA, рT4a N2b M0), clinical group 2, were operated on according to our special technique. The surgery was performed under endotracheal anesthesia. After cervical lymph node dissection, the tongue and the mouth floor tissues were resected intraorally. The incisions were made through their entire thickness along healthy tissues. Smears were taken from the dissected tissues for intraoperative pathology consultation control for the presence of cancer cells. The tissues of the mouth floor affected by the tumor were completely removed without going beyond the hyoglossus muscle, since the lingual and hypoglossal nerves go along its outer surface. This allowed radical tumor removal with preservation of the tongue functions.

Results. Patients operated on according to our special technique have been observed for more than 9 months without continued tumor growth and recurrences tumor with preservation of the tongue and the mouth floor functions.

Conclusion. In such patients, ablastics principles are combined with the preservation of the tongue functions. This can be achieved because after removal of the tongue tumor, resection of the mouth floor is performed without going beyond the hyoglossus muscle not affected by the tumor, since the lingual and hypoglossal nerves go along its outer surface. Complying with ablastics, it preserves the tongue functions: chewing, swallowing, articulate speech, taste perception.

1. Malignant neoplasms in Russia in 2020 (morbidity and mortality). Ed. by A. D. Kaprin, V. V. Starinsky, A. O. Shakhzadova. Moscow: P. A. Herzen Moscow State Medical Research Institute – Branch of the National Medical Research Radiological Center, 2021, 252 p. (In Russ). Available at: https://oncology-association.ru/wp-content/uploads/2021/11/zis-2020-elektronnaya-versiya.pdf, Accessed: 29.10.2022.

2. Sanginov DR, Mudunov AM, Yuldoshev RZ, Bazarov NI, Niyazov IK, Safarzoda NA. Reconstructive surgery and quality of live in patients with locally-advanced head and neck cancer. Avicenna Bulletin. 2019;21(1):168–170. (In Russ). https://doi.org/10.25005/2074-0581-2019-21-1-165-172

3. Krasavina EA, Balatskaya LN, Choynzonov EL, Kulbakin DE. Voice rehabilitation after surgery for oral and oropharyngeal cancer. Siberian Scientific Medical Journal. 2019;39(6):65–69. (In Russ). https://doi.org/10.15372/ssmj20190608

4. Zaderenko IA, Mudunov AM, Alieva SB, Ahundov AA. Choosing options of surgical treatment for reccurent oropharyngeal cancer. Head and Neck Tumors (HNT). 2017;7(2):25–29. (In Russ). https://doi.org/10.17650/2222-1468-2017-7-2-25-29

5. Paches AI. Head and neck tumors. 4th edition. Moscow: "Meditsina" Publ., 2000. (In Russ.).

6. Aedinova IV, Volkova VL, Svetitskiy PV, Bauzhadze MV, Islamova EF. Surgical treatment of posterior regions of the mouth and oropharynx cancer using mandibulotomii. Modern Problems of Science and Education. 2016;(3). (In Russ). Available at: https://science-education.ru/ru/article/view?id=24857, Accessed: 27.09.2022.

7. Paches AI, Olshanskiy VO, Lyubaev VL, Tuok TKh. Malignant tumors of the oral cavity, pharynx and larynx. Moscow: "Meditsina" Publ., 1988. (In Russ).

8. Loyt AA, Kayukov AV. Surgical anatomy of the head and neck. St. Petersburg: "Piter" Publ., 2002. (In Russ).