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Therapy for Partial Glossectomy

Dennis Fuller, Ph.D

September 13, 2004

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Question

I evaluated a patient who recently had a partial glossectomy with a tongue flap replacement. The patient is currently unable to move his tongue. Do you have any suggestions for therapeutic techniques to restore lingual movement?

Answer

A partial glossectomy can mean a variety of dissections, i.e. a lateral wedge, unilateral complete, with or without the tonsile fossia involved. Has the remaining tongue been used to cover a floor of mouth excision? In any case, tongue movement for mastication and swallow and tongue movement for articulation need to be addressed. In addition, the patient should be taught self examination to insure that he/she is not damaging the remainder of the tongue while chewing. REMEMBER; the remaining Unilateral tongue portion will deviate to the affected side.

Treatment. non-movement in the initial weeks is to be expected. This may be due in part to the patient relearning volitional control. First session/week exercises. All exercises are five repetitions.

  1. Mandible opening; open mouth as far as possible. This is good exercise for stimulation of tongue base.

  2. With a tongue blade; push non-affected side of tongue against blade for count of three and relax.

  3. Attempt to lick alvelor ridge, left to right, then right to left.

  4. Attempt to lick lip, left to right , then right to lef.

  5. Attempt to push non-affected cheek out and hold for count of three.

  6. With teeth together and lips closed, attempt to push tongue forward and hold for count of three.

  7. Repeat #6 but push tongue to roof of mouth for count of three.

  8. For prevention of saliva pooling, pucker lips and do a strong suck-back and swallow.

  9. Any attempted articulation is good stimulation for tongue movement... I have a list of non-glossal sentences and then move into some that have glossal movement.

    i.e. "Why buy ham mom", "May I have more" and move to, "Head light" "small hotdog"

  10. If the patient is not a risk for aspiration, any swallowing activity is good stimulation for tongue movement. Start with a consistency that is easy to manage such as pudding or honey and move to a thinner consistency.
All of the above should be attempted even if the patient insists there is no movement. Re-access each week. Usually as the edema from surgery subsides, glossal movement increases.

Dennis Fuller, Ph.D., is an Associate Professor in the Departments of Communication Sciences and Disorders and Otolaryngology, Saint Louis University. He publishes in the areas of Post Surgical Communication and Swallowing disorders. He is a current Legislative Council representative from Missouri to ASHA.


Dennis Fuller, Ph.D


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