Triumphant Rehab Follows Tongue Removal

After lifesaving cancer surgery, patient can speak, swallow and breathe again.

Shortly after graduating from the University of Notre Dame in Indiana, Henry* established a successful, 35-year career as an architect in Florida. But his passion has always been gourmet cooking. He loves creating masterpieces with food.

“When I was a kid, I helped my mother prepare the family’s meals,” recalls Henry, 59. “She was always adding flairs to her recipes to make the food taste better. Her efforts instigated my infatuation with cooking. It also encouraged me to experiment with flavors as an adult. For years, I routinely cooked decadent meals for my family and friends.

A year ago, Henry suddenly lost his fondness for food. At the same time, he began to experience numbness in his mouth, bleeding from his tongue, and difficulty when chewing or swallowing. Concerned, he visited his primary care physician for an evaluation.

“By the time I noticed those symptoms, my doctor discovered I had tongue cancer that had already progressed beyond my tongue,” Henry shares. “The cancer had spread to the lymph nodes in my neck as well.”

For treatment, Henry was referred to the head and neck surgical oncology department at the Cleveland Clinic Indian River Hospital Scully-Welsh Cancer Center. There, Ashley C. Mays, MD, FACS, a head and neck surgical oncologist and reconstructive microsurgeon, worked as a part of a team to remove the cancer and reconstruct the defect.

“Henry presented to me with an advanced stage tongue cancer, also called oral cavity cancer,” Dr. Mays remembers. “He had the most common type of cancer in the mucosal head and neck called squamous cell carcinoma. The standard treatment for oral tongue cancer is surgery.

“The surgery I performed on Henry involved the complete removal of his visible tongue as well as the base of his tongue located in his throat. The procedure is called a total glossectomy. I also removed the lymph nodes on both sides of his neck to clear out any disease that had already spread.”

The problem with glossectomy is that the tongue is a critical organ for speaking, swallowing and protecting the airway. Without a tongue, speech resonance and normal speech are challenging. The person also cannot propel food in the mouth to swallow normally.

“Without a way to reconstruct these very complicated defects, patients are not able to undergo this standard surgical treatment for tongue cancer,” Dr. Mays asserts. “In Henry’s case, I performed a transplant surgery that involved taking skin, fat and muscle from his thigh and using it to reconstruct a new tongue in his mouth.

“Some cancer surgery patients leave the hospital and go straight home with home health services. But others, including Henry, are left with complex functional disparities. These patients require extensive speech, language and swallowing rehabilitation to regain some degree of normal function.

“I’ve found that those patients typically do best in an acute rehabilitation setting because they get close monitoring and rehabilitation while they’re healing. Fortunately, we have just such a facility in the region with Encompass Health, which is where Henry went.”

Encompass Health Rehabilitation Hospital of Treasure Coast in Vero Beach is an acute rehab hospital that is well-equipped to treat patients recovering from cancer surgery. It offers a higher level of care than a skilled nursing facility and is the only acute rehab hospital on the Treasure Coast.

Multifaceted Rehab

“Encompass Health is fortunate to be working in collaboration with the Scully-Welsh Cancer Center and with Dr. Mays,” states Dawn Bucaj, RN, BSN, the rehab facility’s business development director.

“Dr. Mays’ presence has been an integral part of patient care on the Treasure Coast. She provides care that patients previously had to travel outside of the area to receive, and we’ve established a great partnership with her.”

Cancer surgery can affect a patient’s physical, mental and functional abilities, Dawn says. To better care for patients after cancer surgery, Encompass Health provides advanced technologies and treatments targeting all affected areas for an improved quality of life

“Our team of experts gets to know each patient’s prognosis,” Dawn explains. “They discuss expectations and short- and long-term goals with patients. The team then creates a personalized plan of care, addressing specific needs for a comprehensive approach to rehabilitative care.

“Once admitted into our hospital, cancer patients are evaluated in several areas, including their diagnosis, complications of immobility and inactivity, and issues resulting from medical treatment such as surgery. We care for many patients who experience deficits due to the cancer treatment they’ve received.”

Henry’s rehabilitation at Encompass Health was multifaceted. First, he needed to recover from the wound to his thigh where the skin, fat and muscle were removed for transplant. That’s the easy part. Thigh wounds typically heal quickly, and patients can walk, run and jump as they did before surgery.

Other aspects of rehabilitation after reconstructive surgery take more time and effort to be successful.

“With the help of the folks at Encompass Health, Henry was able to achieve an almost miraculous recovery.” – Dr. Mays

All patients undergoing tongue reconstruction receive a tracheostomy, a surgically created hole in the front of the neck into the trachea (windpipe). A tracheostomy tube, or “trach” tube, is inserted through which the patient breathes without using the nose or mouth.

“This is done for airway protection after surgery,” Dr. Mays states. “To have the trach removed, patients must have very intensive speech and language pathology involvement.

“In addition, people working on airway rehabilitation must learn to move a piece of tissue that’s not native to their mouth to control oral secretions. They must retrain their minds and bodies to use the transplant in the same way they used their tongue. It is a very complex, dynamic surgery, so rehab is not as simple as keeping tabs on the site postoperatively.”

“I Feel Fortunate”

At Encompass Health, Henry received intensive speech, swallowing and airway rehab. Through a herculean effort by Henry and the Encompass Health staff, an extraordinary recovery was achieved.

“I’ve performed this surgery many times, and a high percentage of patients are never able to have the trach removed because they are unable to control their secretions so they won’t aspirate their saliva,” Dr. Mays relates. “But we were able to remove Henry’s trach.

“Further, Henry developed very good, intelligible speech. I cannot stress enough how difficult that is to accomplish when the patient doesn’t have a mobile tongue any longer.

“He was a very motivated patient. He was invested in his rehabilitation, and with the help of the folks at Encompass Health, Henry was able to achieve an almost miraculous recovery considering the extensive disease he began with.”

Following rigorous rehabilitation, Henry’s reconstructed tongue is serving him well.

“I cannot discern tastes like I could with my natural tongue, which affects how I season my cooking, but I can speak, swallow and breathe on my own,” he enthuses. “I feel fortunate to have found Dr. Mays. Thanks to her surgical skill, I’m functional — and alive.”

Dr. Mays can be reached at the Scully-Welsh Cancer Center in Vero Beach at (772) 770-6830.
© FHCN article by Patti DiPanfilo. mkb
* Patient’s name changed at his request.
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