CPT® Code 41153

A glossectomy is a surgical procedure that involves the removal of part or all of the tongue. In the context of CPT® Code 41153, this procedure is performed as a composite operation that includes the resection of the floor of the mouth and a suprahyoid neck dissection. This type of surgery is primarily indicated for patients diagnosed with cancer affecting the tongue and oropharynx, particularly when there is involvement of the mandible, which is the lower jawbone. The procedure begins with the resection of the mandible, which is crucial for accessing the affected areas. A visor flap technique is utilized to facilitate this access, requiring an incision along the lower gingival buccal sulcus adjacent to the mandible. Following the elevation of the skin over the chin and lower lip, the involved mandible is excised. The surgical approach continues with an incision of the mucosa in the floor of the mouth, allowing for the removal of diseased tissue along with a margin of healthy tissue to ensure complete excision of cancerous cells. This resection typically includes the soft tissue beneath the sublingual glands and may involve transection of the Wharton duct, which drains saliva from the submandibular gland. Additionally, the affected portion of the tongue is excised, again with a margin of healthy tissue. After the completion of the glossectomy and floor of mouth resection, the resulting defects are often repaired through separate reconstructive surgeries, which may involve skin grafts, free flap grafts, or mandibular reconstruction. The distinction between CPT® Code 41153 and other related codes, such as 41150 and 41155, lies in the inclusion of the suprahyoid neck dissection, which specifically entails the excision of the submandibular salivary gland and lymph nodes within the submandibular triangle, as opposed to a more extensive radical neck dissection that encompasses multiple lymph node levels and additional structures.