Midline Tongue Splitting to Remove a Rare Acinic Cell Carcinoma of the Tongue Base: Surgical Technique and Case Report

Abstract

The aim of the present article is to describe a surgical technique to remove a rare type of oral carcinoma located at the base of the tongue. In this technical note, the authors describe how a tongue-based tumor can be achieved by a transoral approach through full-thickness tongue-splitting. In addition, the authors present a clinical case of remarkable rarity, both for the tumor histology and its unusual location, that permitted to apply the described technique. Pictures presented in the paper enrich the description of the surgical technique. A 77-year-old male was diagnosed with a neoplasm of considerable dimensions located at the level of the tongue base, very close to the median line. The patient was unaware of the neoplasm since no ulceration was present on the mucosal lining of the tongue, and only a negligible difficulty in swelling had appeared. In fact, he was diagnosed with the tongue tumor by chance: he fell over accidentally, broke his nose, and underwent a CT scan to verify whether facial bone fractures had occurred. Unexpectedly, CT imaging documented the presence of a mass measuring almost 7 cm in the axial plane and localized at the level of the tongue base. CT scan imaging suspected an adenocarcinoma of minor salivary glands. Nevertheless, a precise definition of the lesion couldn’t be determined, and the radiologist suggested performing an RMI. Magnetic Resonance concluded that the neoplasm was most likely an adenoid cystic lingual carcinoma. Considering the peculiar position of the neoplasm within the lingual body and considering that it appeared capsulated, the patient was offered to undergo surgical removal. The surgical technique applied in this case aimed at removing the tumor with the least invasive procedure to make the most of a natural route, the mouth, while avoiding far more challenging trans-cutaneous approaches. Full-thickness tongue splitting, with or without endoscopic magnification, is a suitable approach to achieve a well-defined, capsulated lesion of the tongue base; this technique allows complete neoplasm removal in a predictable and safe way.