REBUILDING THE TONGUE
Each year, about 30,000 people in the United States are diagnosed with oral cancer. Cancers of the tongue can be helped by surgery, but that involves actually removing part of the tongue. Now, improving function for patients in need.
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Steve Merkle is thankful for how his life has turned out. At 23, he got some unexpected news.
Steve Merkle
Had tongue cancer
"I had a little spot on my tongue, kind of a canker sore type of thing. That's when I got the bad news."
That bad news was tongue cancer. Surgery removed the cancer and a piece of his tongue.
Steve Merkle
"I was doing pretty good for 13 years, and then it came back, basically in the same spot."
This time, more than half of his tongue was removed. Doctor Bruce Haughey says the tongue is clearly vital for speech.
Bruce Haughey, M.D.
Head and Neck Surgeon
Washington University in St. Louis
St. Louis, MO
"You can have a sound coming out of your voice box, but without a tongue, it's totally unintelligible."
But it's also critical for survival.
Bruce Haughey, M.D.
"It stops food and liquids going down into the lungs."
Doctor Haughey reconstructs the tongue using tissue from the forearm or thigh.
Bruce Haughey, M.D.
"We set about sort of a series of origami-like folding techniques using two dimensions of tissue to make three dimensions of shape for a tongue-like organ."
The folding technique provides better function.
Bruce Haughey, M.D.
"We aim for producing something that's just like the real thing."
After reconstruction, 84 percent of patients eat normally and no longer need a feeding tube. Speech also improves significantly.
Steve Merkle
"Dr. Haughey did such a great job that, really, I'm kind of back to normal. I can eat everything and do everything I did before."
Now, after beating cancer twice, Steve says he doesn't take anything for granted.
Doctor Haughey points out that it's speech intelligibility that improves, which means patients are much easier to understand with this technique than with standard techniques. He says the next step is successful tongue transplantation. The first tongue transplant in the world was done in July of 2003.
BACKGROUND: Each year, In the United States, about 30,000 people are diagnosed with oral cavity cancer, and the majority of those affect the tongue. If it's caught early enough, the prognosis is excellent, usually with just one type of treatment. However, if it's caught in stage III or stage IV, the prognosis is much more guarded as that means it is an aggressive, advanced tumor. Cancer of the tongue begins as a small lump, a firm white patch, or an ulcer. If untreated, the tumor may spread throughout the mouth and to the rest of the body. As a tumor grows, it becomes more life-threatening. Although the exact cause is unknown, it most often occurs among pipe, cigar, and cigarette smokers and people who use smokeless tobacco. It also occurs in people who consume large amounts of alcohol or those who wear dentures. It is rare in people under age 40, particularly women and is most common in men over age 60.
THE TONGUE'S IMPORTANCE: Bruce Haughey, M.D., from Washington University in St. Louis, says: "The tongue is a very critical organ. It has life-sustaining function in the sense that it is protecting the airway inlet to the lungs. It stops food and liquids going down into the lungs." It is also vital for speech. Dr. Haughey says, "You can have a sound coming out of your voice box, but without a tongue, it's totally unintelligible. It's just a sound."
TREATMENT: Treatment for tongue cancer is based on the stage of the disease when it is diagnosed. Your doctor may recommend that you have one or more of the following treatments:
- Radiation
- Anticancer drugs (chemotherapy)
- Surgery to remove the tumor
Plastic surgery and speech therapy are often part of therapy, particularly if it is necessary to remove any portion of the tongue, lymph glands, or jaw to remove all of the cancer. Plastic surgery is often necessary to restore function and appearance.
NEW FOLDS FIX THE TONGUE: Dr. Haughey and colleagues from Washington University, are using a new series of folding techniques to create a "new" tongue for patients who have to have much of their tongue removed due to cancer. They take tissue from the forearm or thigh and then use origami-like folding techniques to create a tongue-like organ in the mouth. How they do it depends on how much of the tongue is missing. Dr. Haughey says: "The folding techniques are possible because the tissue, fortunately, is a very pliable and has a good blood supply. We take that folded tissue that's made into the shape of the tongue and then join up the blood vessels to blood vessels in the neck to revascularize the tissue." Results of Dr. Haughey's study show all patients in the study were able to have their tracheotomy removed and 84 percent of patients were able to eat by mouth again without a feeding tube. Patients who received tongue-base replacement had an overall intelligibility score of 98 percent - which means their speech significantly improved. Those who received forward (anterior) -tongue replacement had an overall score of 76 percent. Other studies show intelligibility for tongue replacement patients at 40 percent and 50 percent respectively. Dr. Haughey says, "The main thing that is different about this technique is that it involves a series of maneuvers with the tissue that results in a tongue-like appearance for the reconstructive tissue. It was satisfying to see not only the invention and development of the techniques we use to make a new tongue, but then also to see, well, what would that really mean in terms of the functional recovery?"
Teresa Bieg, R.N., Nurse to Dr. Bruce Haughey
Washington University in St. Louis
St. Louis, MO
(314) 362-7514
Copyright © 2003 Ivanhoe Broadcast News, Inc.
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