CPT® Code 41140

Complete or total glossectomy is a surgical procedure primarily performed to treat cancer of the tongue. This procedure involves the extensive removal of the tongue, specifically more than one-half or an entire side of it, which is critical in managing malignancies that affect this area. In cases where a tracheostomy is deemed necessary, the surgeon makes a vertical or horizontal incision in the neck, typically over the cricoid cartilage, to facilitate airway access. The procedure requires careful dissection through the platysma muscle to reach the midline raphe between the strap muscles, which are then separated to expose the pretracheal fascia and the thyroid isthmus. The thyroid isthmus is subsequently divided to allow for further access. If a tracheostomy is performed, the trachea is incised, and a tracheostomy tube is inserted and secured to ensure the patient’s airway remains open during and after the procedure. Following this, an incision is made under the mandible to access the floor of the mouth, where the mandible may be split to facilitate the removal of the tongue along with a margin of healthy tissue to ensure complete excision of cancerous cells. The surgical site is then closed using primary sutures, although alternative methods such as skin grafts or free flap grafts may be employed for reconstruction. The mandible is wired together to stabilize the area, and the incision is closed with drains placed to manage any postoperative fluid accumulation. This procedure is distinct from other related surgeries, such as the one described in CPT® Code 41145, which includes a unilateral radical neck dissection in addition to the glossectomy.