CPT® Code 41145

A complete or total glossectomy is a surgical procedure that involves the removal of a significant portion of the tongue, specifically more than one-half or one side of the tongue. This procedure is primarily indicated for the treatment of tongue cancer. In some cases, a tracheostomy may be performed in conjunction with the glossectomy, which involves creating an opening in the neck to facilitate breathing. The tracheostomy is typically executed through a vertical or horizontal incision made over the cricoid cartilage, allowing for access to the airway. The procedure requires careful dissection through the layers of the neck, including the removal of subcutaneous fat and separation of the strap muscles to expose the pretracheal fascia and thyroid isthmus. The thyroid isthmus is then divided to access the trachea, where an incision is made to insert a tracheostomy tube. Following the establishment of the tracheostomy, an incision is made under the mandible to gain access to the floor of the mouth, where the glossectomy is performed. The surgical team removes the affected portion of the tongue along with a margin of healthy tissue to ensure complete excision of cancerous cells. The defect created by the removal of the tongue may be closed with primary sutures, or alternatively, a skin graft or free flap graft may be utilized for reconstruction. In the case of CPT® Code 41145, the procedure is further complicated by the inclusion of a unilateral radical neck dissection, which involves the excision of lymph node groups and surrounding tissues on one side of the neck, including the removal of the sternocleidomastoid muscle, internal jugular vein, and submandibular gland, among other structures. This comprehensive approach is essential for addressing the spread of cancer and ensuring thorough treatment of the affected area.