Tongue Reconstruction: A soldier's post-cancer battle

Imagine losing your tongue to a disease. Every year about 30,000 people develop cancers of the mouth and it most often affects the tongue.

Now, doctors are using new surgical techniques that help turn another body part into a replacement tongue.

Captain Greg Page decided to enlist in the National Guard after September 11, but the battle of his life would begin with a painful sore under his tongue.

"I find out it's squamous cell carcinoma," said Greg Page who fought oral cancer.

About half the people with this deadly type of cancer will die in five years.

Greg Page
"It's almost like I felt like I'm marching in to a battle, because here I am coming to fight this thing," said Page.

So big, Doctor Derrick Lin would have to remove about half of Greg's tongue.

Greg Page
"In the past we'd just leave that alone and what would happen was this edge would seal down to the bottom of the mouth, so it becomes tongue tied like this," said Page.

Making it hard to swallow or even speak. Something this Military Intelligence Officer couldn't imagine.

"Definitely a lot of that job is briefing,” says Page. “A lot of it is public speaking and to think that I'm going to lose a big part of my tongue and not be able to do that is pretty scary."

Instead, Doctor Lin used a new reconstruction approach. After the cancer was removed, he took tissue from Greg's forearm.

"It's connected to a vein from the arm,” explains Dr. Derrick T. Lin, MD, FACS, Associate Professor at Harvard Medical School, Department of Otolaryngology Massachusetts Eye and Ear Infirmary. “It's brought up to the tongue, recreating the tongue and the aortic veins are reconnected in the neck."

The new technique cuts surgery time from 24 hours to six hours. And hospital stays go from 21 days to 7 days. The surgery helps Greg talk and swallow normally.

But something unusual reminds him how unique his tongue reconstruction really is.

"You can see the hair there,” says Dr. Lin. “That's his forearm."

A strange side-effect this soldier who knows things could have been much worse can definitely live with.

Hair on a patient's reconstructed tongue can be removed but Greg has chosen not to do it at this point. The majority of people coming to see Doctor Lin for oral cancer are over age 70.

Now that surgery times have been so dramatically reduced, tongue reconstruction can be offered to patients up into their 90's.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC: TONGUE RECONSTRUCTION: A SOLDIER'S POST-CANCER BATTLE
REPORT: MB # 3503

BACKGROUND: Squamous cell carcinoma is a type of skin cancer. Skin cancer falls into two groups: non-melanoma and melanoma. Squamous cell is a type of non-melanoma skin cancer. Tongue cancer is a subgroup of head and neck cancer. Cancer develops from the squamous cells of the tongue. This leads to a local tumor growth, and it later spreads. Tongue cancer is often grouped with other mouth cancers, such as cancer of the lips, hard palate, cheek lining, floor of the mouth (portion of the mouth underneath the front of the tongue), or gums. These cancers are collectively known as oral cavity cancer.

SYMPTOMS: Squamous cell skin cancer usually occurs on the face, ears, neck, hands, or arm. It may occur on other areas. The main symptom is a growing bump that may have a rough, scaly surface and flat reddish patches. The earliest form appears as a scaly, crusted, and large reddish patch (often larger than 1 inch). A sore that does not heal can be a sign of squamous cell cancer. Any change in an existing wart, mole, or other skin lesion could be a sign of skin cancer. (Source: http://www.ncbi.nlm.nih.gov/)

TREATMENT: Most very small cancers of the oral tongue can be quickly and successfully treated by surgical removal leaving behind little cosmetic or functional change. This is not always true, however, as there can be many variables and factors that can seriously impact speech and swallowing. Larger cancers may indeed have some effect on speech and on swallowing, but one must remember that not treating this problem would cause far more significant problems, up to, and including death. (Source: http://www.tonguecancer.com)

NEW TECHNOLOGY: The new tongue reconstruction surgery includes removing a portion of the tongue and reconstructing the new tongue, is long and complex, lasting about 10 hours. It requires surgeons to dissect and reattach the blood vessels, just like with a typical organ transplant. The blood vessels are sewn together with tiny sutures, some smaller than a single strand of hair. When patients wake up, their reconstructed tongue is in place. (Source: http://www.news-medical.net)

FOR MORE INFORMATION, PLEASE CONTACT:

Mary Leach
Director of Public Affairs
Mass. Eye and Ear
(617) 573-4170
Mary_Leach@meei.harvard.edu


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