Ultrasonic partial glossectomy.
BACKGROUND
Partial glossectomy is the main treatment for tongue carcinoma. The resection of the tongue, which is a very vascularised tissue, requires a good hemostasis. The advantage of the harmonic scalpel is in combining sectioning and hemostasis in one single instrument, allowing a bloodless dissection of soft tissue. The aim of this prospective study was to evaluate the benefits and risks when using a harmonic scalpel in partial glossectomy.


METHODS
In this prospective study conducted in a university hospital from march 2004 to December 2008, eighteen consecutive patients underwent a partial glossectomy with the use of harmonic scalpel. Results were compared with previous surgical procedures performed between September 2000 and February 2004 by monopolar hemostasis by our team (n = 12) when the harmonic scalpel was not available.


RESULTS
All 18 patients underwent partial glossectomy with the harmonic scalpel as the only instrument of section and hemostasis. The median blood loss was of 0 mL. The median operative time was 29 minutes (16 minutes less than partial glossectomies performed with conventional hemostasis. P < .001). No operative complications occurred. Two post-operative bleedings (5 days and 7 days after the glossectomy) occurred necessitating a new surgery to ligate the lingual artery. The margins of the resection were acceptable and no recurrence appeared.


CONCLUSIONS
The harmonic scalpel makes it fast and easy to perform a partial glossectomy with no bleeding. Ligation of the lingual artery (when it is visualized during the dissection) should be performed because of the frequency (more than 10% in our series) and because of the potential gravity of a lingual post-operative bleeding.
Pons
Yoann
Y
Head and Neck Surgery Department, Val of Grace's Academic Military Hospital, Paris, France. pons.yoann@gmail.com
Gauthier
Jérome
J
Clément
Philippe
P
Conessa
Claude
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005927:Glossectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013525:Surgical Instruments; D014062:Tongue Neoplasms / Q000601:surgery*; D014464:Ultrasonic Therapy / Q000295:instrumentation*