Cancer of the mobile part of the tongue

Cancer of the mobile part of the tongue is the most common pathology among all tumors of the oral cavity. In 2019, 3,471 cases of tongue cancer were detected in Russia, which is 19.3% of all head and neck tumors. The number of cases detected per year has increased by 22% over 10 years.

Despite the easily accessible location of the organ, tongue tumors are often detected at stage III-IV. This is due to the inattentive attitude of patients to their health, the delay in contacting a doctor and the lack of early diagnosis. All this leads to the need to perform extended surgical interventions and significantly worsens the prognosis.

The main risk factors for developing tongue cancer are:

• genetic predisposition;
• alcohol use, tobacco smoking and their combination;
• chronic trauma of the tongue due to improperly made dentures or malocclusion.

The first symptoms of tongue cancer are long-term non-healing ulcers that do not respond to local treatment and steadily increase in size. With the growth of the tumor, pain is added, which can "give" to the ear, the tongue is deformed and becomes asymmetric. If you or your relative have the above-described symptoms that can not be managed within two weeks, you should immediately consult an oncologist at the department of head and neck tumors, because it is early diagnosis that allows you to achieve maximum oncological results and in 80-90% of cases cure the disease.

According to Russian and international recommendations, the treatment of tongue cancer begins with surgical intervention, which, with a significant prevalence of the tumor, can be supplemented with radiation therapy or chemoradiotherapy. The depth of the tumor spread is crucial in determining the treatment strategy.

In stage I tumors, it is possible to perform organ-preserving interventions using a CO2 laser. Patients after such interventions are quickly rehabilitated, and the function of the tongue practically does not suffer.

In the case of more common processes, you have to perform extended interventions in the language:

• half resection of the tongue;
• removal of the movable part of the tongue when the tumor spreads beyond its midline.

The operation on the tongue is supplemented with the removal of the lymph nodes of the neck on the side of the tumor, since with a depth of the tumor spread of more than 4 mm, the risks of metastasis significantly increase.

Performing a resection of more than a quarter of the tongue leads to functional disorders, such as blurred diction, difficulties in pronouncing sibilant sounds and the “P” sound, less often to difficulty swallowing. In such situations, the most modern method of treatment is to perform a single-stage reconstruction. It is possible to perform the reconstruction of the tongue using a skin-fascial graft, which is taken from the inside of the forearm (free radial flap). Next, the graft is modeled in a special way, moved to the oral cavity with the replacement of the removed part of the tongue, and receives nutrition at the expense of vessels that are sewn to the vessels on the neck under a microscope.

This technique, despite its complexity, allows patients to restore speech and swallowing, which significantly affects the quality of life. In the department of head and neck tumors of the MCSC, such interventions have been performed since 2017, and based on the experience accumulated to date, we can conclude that it is necessary to perform tongue reconstruction.